We Are At War

In December 2019, the first instance of a new disease (Covid-19) related to previous coronaviruses (SARS, MERS) and causing severe acute respiratory syndrome emerged in Wuhan China, Hubei province. In less than four months, the disease has spread rapidly and infected more than 170,000 people across the globe without an end in sight.

On 11th March, 2020, the WHO declared COVID-19 a pandemic. We are now seeing exponential growth across the globe, with cases confirmed in more than 160 countries.

Experts are able to draw conclusions from the outbreak in China or ongoing outbreaks in South Korea, Italy, or Iran. We can also learn by cross-referencing prior coronavirus outbreaks (SARS 02/03, MERS 2012) which share a similar atomic structure.

Currently Italy has the highest number of cases outside of China, Other countries are lagging behind the same trajectory, and a few weeks behind.

The effects of readily testing and enacting strict containment measures can be observed in Japan, Singapore, and Hong Kong where increase is slower.

Hospital capacity

COVID-19 patients in critical condition require labour intensive medical attention and respiratory devices. They also tend to be hospitalized for multiple weeks, pushing available medical resources to limits.

We need to flatten the curve to maintain an active case count below hospital capacity. This creates even distribution to hospital resources to keep mortality rates low with the same number of people affected.

Source © CDC

The curve can be flattened through non pharmaceutical interventions such as social distancing and proactive testing which slow the outbreak to manageable levels.

Number of cases

Although we know the number of confirmed cases, we do not know the number of true cases. Due to a lack of available testing kits in many countries, GP's are discouraged from testing people exhibiting symptoms unless they also meet a specific set of criteria, thereby the current true number of people infected remains uncertain.

South Korea is testing thousands of people at a time, this could be the reason for their low fatality rate at 0.6%, they are confirming cases where people have mild symptoms, or are yet to exhibit any. In contrast to this, the US has a fatality rate of about 3.6%, where negligible testing is taking place, and perhaps only the serious cases are confirmed. The fatality rate can also be low as testing is conducted in drive-throughs, and not solely focused on patients who have been admitted to hospital.

Many countries have adopted non-pharmaceutical measures to decrease this count through means of social isolation. New Zealand and Australia have enforced for a mandatory 14 day self-isolation policy for all international arrivals. Other countries such as Singapore, Japan, and the USA have called for more lenient policies restricting travel from specific countries.

Testing is imperative to identify cases and hot zones before they develop out of control. In Seattle, where the first confirmed case was found in the US, the virus had been spreading for up to six weeks due to a lack of testing. Without testing we are blind to what we are facing, leading to suboptimal reactions.

By refusing to test as many people as possible, the number of cases can be kept artificially low, but the death rate is likely to be higher than reality.

Effect on the economy

As coronavirus blazes through nations forcing businesses shut, and shopping precincts to close doors, financial markets are taking massive losses. Global economies have hit their biggest downturn since the 2008 financial crisis.

Governments must select either less cases, less deaths, and a worse economy; or more cases, more deaths, and a better economy. There is a delicate balance to be met between these two variables.

We don't know how the choices made today will play out in the long run. Judging from how virulent COVID-19 is, and with existing measures of containment falling short, perhaps it's better to experience short term repercussions today without enforcing social isolation (As the UK has chosen), rather than experiencing negative effects to the economy for a longer duration. China has found a resurgence of cases with citizens returning to work, suggesting that efforts to flatten the curve are an ongoing problem.

At least the planet can breathe a sigh of relief.

China is seeing blue skies as industrial CO2, and NOX emissions are slashed, possibly the clearest since the 2008 Beijing Olympics.

What We Know About The Enemy (COVID-19)

Asymptomatic Transmission

COVID-19 can be undetected in a person for 2 to 14 days (0 to 27 days in rare cases) without exhibiting any symptoms. This makes it much harder to detect and more transmissible as people continue normal interactions, thus undermining the effectiveness of containment measures.

Spread via Droplets & Aerosols

After an infected person coughs, droplets can travel 1.5 meters away. The droplets can then persist on a surface for up to nine days, varying with temperature & humidity. This type of contagion can be especially prevalent in healthcare settings

Due to the risk of aerosol transmission, China & South Korea have been actively spraying disinfectant in streets and subways shared by the public at large. In the cruise ship harbored off the coast of Japan, Diamond Princess, the case count continued to increase despite stringent social isolation measures and a quarantine lockdown. This suggested that COVID-19 had possibly passed through air ducts into separate cabins.

High Complication Rate

80% of people experience mild symptoms without requiring medical attention, 15% develop serious symptoms. 5% require intensive care with specialist equipment such as ventilators. and ECMO machines.

Source: © Wikipedia

We are facing global shortages of equipment in face masks and HAZMAT suits crucial in protecting health workers. As the outbreak amplifies the number of cases, this will only become more critical.

The US has roughly 160,000 ventilators and 264 ECMO machines With a population of 327 million, if 5% of patients require intensive care, this means 16.35 million people will require ventilators.

If we account for only 75% of the population becoming infected, 12.26 million people will require ventilators. In reality not everyone will be hospitalized at the same time, if the outbreak continues over 6 months and each patient requires ventilating for 2 days, we can calculate this as follows

If 12.26 million critical patients were to be infected over a period of 183 (Six months) days, and each case required 2 days of ventilation, the result is 133.9 thousand ventilators required. In reality not every ventilator will be available as many will already be occupied by patients with diseases other than COVID-19.

In order for the US to have enough ventilators, we may need to flatten the curve to span one year, in which case 67 thousand ventilators will be required per two day period

By ensuring equipment is readily available and hospital capacity is met, the mortality rate of COVID-19 can be kept as low as 1%, whereas without the necessary facilities, fatalities may swell as high as 4 or 5%

COVID-19 is NOT the flu

Many similarities have been made between COVID-19 and the common flu (influenza). They are both contagious viruses causing respiratory illness. The flu's mortality rate to date is 0.1%, whereas current observations set COVID-19's at 3.8%. COVID-19 manifests similar symptoms to the flu, but appears with a slower onset (2 to 14 days) and typically lasts longer with serious cases affecting the lower respiratory tract. It is also more contagious than the flu. These facts make it far more transmissible and harder to isolate.

Disproportionately affects the demographic

People who are 60+ are most at risk, with the most fatalities occurring in those 80+. Gender differences do not appear to be significant.

Looking into data from South Korea, in total there were more confirmed cases in females, but fatalities are almost twice as high in men. The larger number of female cases can be attributed to healthcare roles traditionally housing more women, and higher fatalities in men to more smoking tendencies. However, the sample size is too small to draw conclusive results. Kids seem to be spared from the virus.

The immune system naturally weakens with age, COVID-19 can be fatal when combined with pre-existing medical conditions. We need to protect the elderly around us by setting up systems to let them live in isolated areas where they are able to support themselves.

Novelty

Because the virus has never before been seen in the population, everyone is equally susceptible. There is no herd immunity and no fire breaks which would contain the virus. For herd immunity to develop, approximately 80% of the population would need to be immune, then the virus would not spread very far from the infected person.

Despite being similar to past coronaviruses, there is no prior vaccine to work from. Biomedical companies are racing to create one, but in the meantime we may have to wait up to a year before a vaccination is finally approved for human consumption.

Unreliable Testing

Testing kits have a high chance of false negatives , some manufactured test kits were reporting up to a 50% chance of false negatives.

Some cases have been reported where early testing reported negative, with subsequent testing reporting a positive. This makes it particularly difficult to pin down where the virus currently is

Active duration

Despite testing positive for COVID-19, patients are no longer infectious 10 days after experiencing first symptoms. Scientists took virus samples of patients 9 days after symptoms arose and were unable to get the virus to reproduce

The most effective way of destroying the virus is through use of soap. This is more effective than alcohol, as soap will destroy the lipid bilayer that contains the virus.

We need to act now

Wuhan China, where COVID-19 originated and hit the hardest in China, went into lockdown on January 22nd, 2020. Following this, the number of confirmed cases continued to increase until February 4th, almost two weeks later when the number of new cases finally dropped.

Source © Wikipedia

Any action taken today is felt about two weeks later, and patients may only be discharged from hospitals up to a month later. When Wuhan went into Lockdown they had 15,000 cases, yet they peaked two weeks later at after cases reached 80,000. Italy went into lockdown on March 9th, when they had 9000 cases, today their count continues to increase. When the response to our actions is delayed it makes it hard to measure how much effect they have had.

We can only estimate the number of true cases. Although a country reports a certain number of cases, in reality there may be ten times more due to the slow onset of COVID-19. From looking at countries that went into lockdown, China, South Korea, and Italy, the number of confirmed cases continues to increase for two weeks before progression is abated.

The number of true cases are likely to be an order of magnitude higher than the real case count.

The virus transmission grows exponentially, humans generally understand linear change, but have a hard time understanding exponential change. Although only a small number of the population are infected, the current doubling time is around 3 to 4 days. Cases double every 3 to 4 days. Within three weeks of the virus infecting 1% of the population, it can double 6 times to infect 64% of the population.

Sensational

Media outlets are pouncing on COVID-19, as a new source of sensationalism. Justified or not, COVID-19 is a gripping topic as an Unknown, Invisible, Fatal enemy that can affect You regardless of your wealth, ,nationality, or belief system. As such, it is important that we identify sources of real information and not turn to the many sources of noise prompted by authorities with an agenda that is not in your best interests.

We're witnessing COVID-19 become one of the largest trends in Google search history

Psychological effects

As a consequence of social distancing, we may be facing a loneliness epidemic after parks and mall are emptied and devoid of people. As direct social interactions dwindle and move online, our familiar social systems will be discarded. The demographics most prone to social isolation need to be considered and catered to. Those people for who loneliness is piercingly real.