The Present and Future of the Coronavirus

This post describes the potential future of the Coronavirus and what we can expect to happen in the next couple of weeks and months. It was originally published in Israel, where it became instantly viral. I translated it and sent it to one of the largest global media corporations, only to be told that they can’t publish it because of “public sensitivity”. I see no other way to bring this information to the public, except by the new digital media. Please read it carefully and to the end, to see both the reasons for optimism and pessimism.

(Also, if it matters any, I’m a futures studies researcher (also known as a futurist), have a PhD in Nano-technology, and have consulted for some of the largest pharma companies out there for years about the future of medicine and healthcare.)

In the past three months, the world has experienced a jolt of a truly global magnitude. China imposed a curfew on hundreds of millions of citizens and prevented them from leaving their homes for many weeks. Some are still in quarantine. Two months later, when the Coronavirus (its scientific name is SARS-CoV-2, and the disease it causes is called COVID-19, but I will call it “the Coronavirus” for short) made it to Italy, we witnessed a similar response from the authorities. That seemed pretty radical at the time, but today the Italian government decided to impose a total quarantine in all of Italy, in a move that could bury what’s left of the country’s economy.

Oh, and some countries, like Israel, decided that any person who comes from abroad — will have to be quarantined for two weeks. That’s right. Total closure of borders.

So — why? Why is everyone so anxious about a virus that some — like U.S. President Donald Trump — say is no more severe than the seasonal flu?

In this post, I would like to explain the reason for all these dramatic steps. I warn in advance that it can be a pretty scary article, but I believe the public should also understand the implications of the spread of the virus, and why governments are taking extreme precautionary measures to contain it — all while hesitating to explain their reasoning to the general public.

If we do not understand how serious the situation can be, we will not follow the instructions and recommendations of the World Health Organization (WHO) and other official bodies that care for our health. My real concern, therefore, is not about people panicking. Rather, it is that the people who do not follow best health practices — the ones recommended by the WHO, the CDC and your Department of Health, wherever you may live — are the ones who will precipitate the worst-case scenario.

So please: read this post carefully to understand how the future might unfurl in the most negative scenarios — but keep reading to the end to discover the silver lining, and why there is definitely hope for a better future.

When a new virus appears

Sometime mid-December, laboratories in the city of Wuhan, China began receiving saliva samples taken from pneumonia patients in the city. It took them about a week to sequence the genetic code of the virus in the samples, and recognize that there is an eighty percent similarity between it and the infamous SARS … but that other than that, it’s a new virus that hadn’t revealed itself to humanity up until that time.

It took some time for the Chinese government to fully figure out the severity of the situation, but soon it became clear that Wuhan was in serious trouble. Residents flocked to the local hospitals complaining of fever, pneumonia and struggling to breath. Fortunately, although the new virus was indeed similar to SARS, the associated mortality rate was much lower. While in the case of SARS ten percent of those infected die, the estimated mortality rate for the new Coronavirus in Wuhan was only 2 percent (and this is probably an overestimation as we do not know the exact number of people who got infected with mild symptoms — and never went to see a doctor).

Here we should pause for a moment and explain what we have learned so far about the disease. Out of every 100 people infected with the virus, about eighty will develop only mild symptoms, or even remain asymptomatic; fourteen or so will develop a more severe illness, including shortness of breath and pneumonia, which will require hospitalization; approximately five will need emergency treatment due to infectious shock, respiratory failure and collapse of the body’s systems; and somewhere between two and four people will die [2].

These data are surely inaccurate since a large proportion of those infected by the virus do not develop a significant disease. In these cases, the patients may not get tested, and are therefore not included in the statistics. Because of this, the number of infections is probably much larger — maybe twice, three times, or ten times or more — than we know. If we rely on data from South Korea, where more than 100,000 people have been tested — including those who are not suspected of being infected — the mortality rate there seems to be “only” at 0.6 percent. While this might sound encouraging, bear in mind that at 0.6 percent, the virus is still six times more deadly than seasonal Influenza (which kills 0.1 percent of the infected) [3]. Moreover, only 1.3 percent of all U.S. Influenza patients in the past year needed hospitalization, compared with around twenty percent of Coronavirus patients[4].

The Great Disruptor

China was not ready to disrupt the economy of the entire city of Wuhan without a very good reason. Wuhan is one of China’s most advanced industrial cities, with 11 million inhabitants and a thriving economy. Or at least it was. However, within a month of the first diagnoses, the Chinese authorities saw that a large number of people in Wihan required hospitalization for breathing difficulties and pneumonia. The Coronavirus, it turns out, is highly contagious. Each person infected with the virus infects an average of 2.2 other people. In this respect, the Coronavirus is almost twice as contagious as seasonal Influenza [8]. It is no wonder that in Wuhan city, the number of infected people quickly increased.

Remember the World Health Organization statistics? Out of every 100 virus carriers, approximately twenty will need emergency treatment. Let’s assume for a moment that indeed, most infected people are not diagnosed because the severity of their symptoms is minimal. Let’s also assume that there are only twenty serious patients out of every 500 carriers, and not twenty-something of every 100. That’s a big “discount”, but fine, we’ll do it still.

Suppose, too, that the virus — which, as mentioned, is more contagious than influenza — reaches the levels of the Influenza Pandemic of 1889, which is believed to have infected up to sixty percent of the world’s population (the virus behind that epidemic had the same infection rate as the Coronavirus, where every person infects, on average, about two people). This is also what German Chancellor Angela Merkel recently said: up to 70% of Germans could contract the Coronavirus. But we’ll stick with sixty percent for now. Because we’re being optimistic, remember?

We’ll do some quick math calculation now. If sixty percent of the 11 million residents of Wuhan were to be infected, the city’s hospitals would have had to treat 264,000 people who were likely to die without urgent medical care.

There is not one city in the world whose hospitals would have been able to handle such a load. In comparison, an average hospital in the United States contains only 190 beds, and a large portion of those are reserved for non-emergency patients [9]. I don’t know how many beds there are in Chinese hospitals, but one thing is certain: they too would have had no chance at coping with the emergency that the Coronavirus presented them with. The Chinese government realized the magnitude of the problem, closed off all of Wuhan, and set up two new hospitals within a fortnight, in an operation only China could dream of pulling off successfully. At the same time, China imposed a curfew on all residents, preventing them from leaving their homes for weeks (except possibly for a small emergence once a week to purchase food). All that, just to curtail the spread of the virus.

At this point, you may wonder why China was willing to essentially dump the entire economy of Wuhan down the drain. You may ask — wouldn’t it be better if only the hospitals collapsed, instead of the entire economy? Is the option of stopping all life in the city really so much better than simply allowing hospitals to be overwhelmed by patients?

The streets of Wuhan during the quarantine. Link to Wikimedia Commons.

The Importance of Hospitals

The answer is that hospitals are far more essential to the economy and society than they may seem at first glance.

Here are some of the things that will happen in a situation where hospitals are at full capacity — or beyond. I apologize in advance for the apocalyptic picture, but it is not far from the situation in which the hospitals in Wuhan found themselves, and were eventually saved from by the “excessive” actions of the Chinese government.

Ready? Here’s a short list -

Medical staff will work around the clock, becoming exhausted, and make mistakes. They will also contract the Coronavirus sooner or later, and then they will infect anyone who comes to the hospital.

The stock of medications for reducing fever, preventing and stopping seizures (arising from fever), anaesthetizing patients (needed in case of intubation), etc. will be depleted within days, so that patients would not receive the quality medical services they expect and deserve.

The small number of respirators will not be sufficient for all patients in critical condition. The supply of oxygen tanks will also run out fairly quickly.

Corona patients in critical condition will lie dying in their beds without receiving adequate treatment from the medical staff — some of whom will themselves be sick with fever, chills and other symptoms. And remember the missing respirators, drugs and oxygen? There just won’t be enough to help everyone. Indeed, there is already evidence coming from Italy — where there is a severe shortage of respiratory machines — that hospitals are transferring respirators from older patients to younger Coronavirus victims.

Chronic patients will not be able to go to the hospital to receive medication. Think about cancer patients, heart disease patients, people with neurological or metabolic diseases of any kind and many others. The hospitals will be clogged with Coronavirus patients, and in any case — there will not be enough medical personnel to treat the chronically ill. And if any clinicians are reassigned from the Corona patients to treat those chronic patients — they will likely infect them too.

Pregnant women will not be able to give birth in hospitals; there will not be enough staff to care for them and ensure their health, and anyway, they would likely contract the virus during or immediately after delivery. Many will choose to give birth in their homes — a risky and potentially dangerous choice, especially when those with specialized medical training must be present in the hospitals and would be unable to assist in childbirth.

Traffic accident victims will find themselves being quickly treated and released to their homes. A patient that is admitted to the ER with a complex fracture might have it set in the quickest, most basic way, and would then be sent home with some pain medication. So yeah — the fracture will likely heal sub-optimally, leaving the victim with some disability and pain for the rest of his life. But there is simply no other way to treat people when the hospitals are full to the brim with more critical patients.

Anyone coming to the hospital with a health problem that requires immediate treatment — an elderly man with a heart attack, a child who has swallowed a marble — will find that they have to wait days for appropriate medical treatment, if they can get it at all

Now think for a moment about all these cancer patients, heart patients, the victims of traffic accidents, the women who delivered hastily at best and so on. The hospitals cannot help them, and they will be sent to their homes, where they will need constant care and constant assistance. Who will provide them with this care? Their families, of course. But their relatives are the same people who should’ve been out working at the very same time, to provide for the family and keep the economy going. What happens when they are stuck in their homes, caring for their relatives, instead of working?

Oh, and this is assuming of course that those relatives were among the lucky ones who were spared from getting the virus or have already recovered from it. Remember — it can cause flu-like symptoms, with high fever and weakness. Have you ever tried to work while you had the flu? Not a pleasant experience, to say the least.

Finally, think what it means for every family of five to have one of their relatives being unable to breathe — but not being admitted into the hospital because of the collapse of the medical system. This kind of experience makes people really rethink whether their government deserves their trust — and from there, the road to citizen uprising is short. Which is what China almost experienced.

In other words, if the Chinese government had allowed the virus to spread among the population just like that, there is a real chance that the economy there would have collapsed anyway — and the national solidarity and cohesion might have gone down the drain with it.

Sounds apocalyptic? well yeah. But that’s how events like that always sound. Whenever major disasters strike — like a severe earthquake or a large scale war — the hospitals are the weak link. There is always a lack of resources in hospitals, and a particularly large number of people rushing in to get care can bring them to the verge of collapse or force them to make difficult decisions: prioritizing patients, sending patients home even when hospitalization would normally be required, and even turning new patients away and denying them medical care.

And all this could happen in your nation or state.

Let’s apply the statistics I mentioned above to New York City for a moment. NYC’s population stands at 8.6 million people. We’ll deduct some 1.6 million children from that number, since kids and teenagers develop very weak symptoms, if at all. The final tally of people with the potential to get seriously sick will be 7 million.

Suppose now that only sixty percent of the above 7 million get infected, and that only one in 25 (i.e. 20 out of 500) will require hospitalization. That would mean that if all those people get infected at approximately the same time — let’s say, within a month or two — then hospitals in the area will need to have 168,000 beds to treat them all, not to mention numerous respirators.

The largest hospital in NYC is the New York-Presbyterian Hospital.

It has 2,381 beds.

See the problem?

Now, apply the same basic calculation for whatever city you’re living in. It might be Los Angeles, Boston, Mumbai or Sao Paulo. It doesn’t matter. If the virus gets to your city and is not stopped, then you’re going to be in the same situation within a few weeks, or maybe a few months, tops.

Of course, we made two extreme assumptions here: the first is that a large number of people will become sick, and the second is that they will all get sick in a relatively short period of time. Both these assumptions may come true, but they don’t have to.

A snapshot from a hospital in Italy, almost one month ago. Today it’s worse. Source: Emergenza coronavirus Author: Dipartimento Protezione Civile from Italia

Reasons for optimism

Are you scared yet?

Good! It’s fine to be scared when there’s evidence of an incoming disaster. But it’s also important to understand that we can make things better, and avert the worst-case scenario if we just do things right.

At the moment, departments and ministries of health around the world are trying to enforce quarantines and enclosures on individuals and even entire cities. This may seem like an overkill for some, but quarantines can slow the spread of the virus among the population, thus preventing a situation where… oh, I don’t know… 168,000 people need urgent medical care all at the same time. Quarantines can make sure that the virus will spread slowly through the population, instead of burning through it like wildfire, leaping from one person to the other with wild abandon. If that plan works out, it will mean that the hospital visits will be spread out, scattered over many months, and maybe even several years. It would still put a huge strain on the hospitals, but it would be tolerable.

Similar measures, such as border closures, serve the same purpose. But it can’t be the only protective measure. The U.S. initially closed its borders to Chinese people because it feared they would carry the disease into the country. Unfortunately, the U.S. government did not invest as well as it should into testing kits, and as a result, we know only now that the virus had actually made its way into the States some seven weeks ago, with nobody knowing about it. So abundant testing — and quarantining the infected — is also a must.

Finally, we must not forget about personal responsibility. Frequent use of disinfectants such as hand sanitizers, and maintaining basic hygiene rules will help reduce infection and improve society’s chance to “live out the virus”. As recent evidence shows that the virus can survive and maintain infectivity for three days on plastic and stainless steel surfaces, you should also sanitize such surfaces often if they’re exposed to many people.

We have witnessed in Italy just what can happen when such measures are not invoked in a timely manner. But there is a demonstrated reason for optimism: China has already proved to the world that the virus can be stopped by acting out on these steps.

And so, here’s the bright side: countries that have taken all the above measures effectively have been able to stop the spread of the Coronavirus. South Korea conducts more than 10,000 tests a day, some at roadside stations, and utilizes various technological means to monitor all those in quarantine to ensure they do not breach it. Government officials check twice a day on those in quarantine, and anyone who enters the country needs to download an app to their smartphones and report about their health condition every day [12]. As a result of these measures, the number of new infections in South Korea has been declining(!) in recent days. Singapore and Taiwan are taking similar steps, with similar levels of success. The population in these countries is generally well-disciplined, and their health systems are in good condition in the first place. Their economies benefit from this “breathing room” in dealing with the virus. Where is the U.S. in regards to these factors? Switzerland? Germany? I guess we’ll soon find out.

Even if we are unable to completely eradicate the virus with these steps — and unfortunately, that seems highly probable — the extra time that they give us, should provide your nation’s health system with the time to accomplish one critical task: preparing for and equipping itself for the virus.

I can assure you that every hospital in every well-functioning nation these days is trying to purchase every respirator that is still on the market, refresh equipment that has languished unused in dank basements, and order plenty of medicine and masks for what is to come. Thanks to this equipment, they will, hopefully, be able to treat patients even during extreme capacity.

And while preparing for the worst, they are all also hoping for a ‘miracle’ — that is, an unexpected and unpredictable event.

The Joker Up Earth’s Sleeve

There is still a joker — a card that can be drawn out of the pack and may change the entire picture in the upcoming months. But we need to be pretty darn lucky for that to happen.

The ‘miracle’ I’m talking about is that the Coronavirus will dissolve and disappear as summer comes and temperatures rise. A recent study (which has not been peer-reviewed yet) shows that the virus was most contagious in China at precisely 8.7° C (about 47° F). That means that as summer returns to some parts of the world, the virus will find it more difficult to spread there. That said, the researchers themselves acknowledge that the study does not take into account many other factors that could be affecting the virus’ spread. [10]

As is often the case in science, there are dissenting opinions. Experts say there is no evidence that the deadlier relatives of the new Coronavirus — SARS and MERS — had been rendered less contagious or less lethal by summer. And anyway, when summer comes to visit on one side of the planet, the other side experiences winter. Even if summer can rid us of the virus for half a year or so, it will simply spread in that time to other countries that haven’t been exposed up to this point because it was summer there. Then, half a year later, it would come visit New York City, San Francisco, and all the other places it has become acquainted within the last couple of weeks.

Mike Ryan, one of the WHO’s top officials, has already warned against the hope that warm weather will stop the spread of the virus. As he said — “We have to assume that the virus will continue to have the capacity to spread… It’s a false hope to say, yes, that it will disappear like the flu.” [11]

But we can still hope, right?

It’ll Be Okay

Seriously, it will.

But only if we act wisely.

Futurist Stewart Brand once said he was “pessimistic about the short term and optimistic about the long run.” He is pessimistic about the short term because he sees everything that can go wrong and all the horrible things that can come to pass. He is optimistic about the long run because we humans are good at finding solutions for all these problems.

In some countries we’ll see the worst scenario becoming a reality: hospitals will be overloaded and utterly collapse, with all the collateral damage I previously described.

But it doesn’t have to happen in your country.

If the Ministry of Health in your country is requiring you to take some extreme steps — maybe self-quarantine, or refraining from going out to the pub, or maybe just sanitizing your hands every few hours — do it. Just do it.

Don’t say — “it’s just like the flu”.

Don’t say — “people die all the time”.

Just do as the Ministry or Department of Health is telling you to, because they’re trying to prevent the worst-case scenario. But for them to succeed at it, we need to take heed of their advice!

I’m not saying it won’t be hard. It is unpleasant and uncomfortable to sit in quarantine. Sterilizing your hands every few hours, or pressing the elevator button with your elbow instead of your finger, also gets old very quickly. It’s not much fun to walk around with a street mask when you only have a small tingle in your nose. But these instructions are meant to prevent the scenario in which hospitals will collapse — and will take many grandmas and grandpas with them. Oh, and the economy will take a hit too.

If you adhere to these instructions, you should know that you are a hero. I kid you not. You are. You’re saving lives, and the people around you should know and appreciate that. So share this post with them, won’t you?

And then, in the long term, we can all be optimists.

The Long-Term View

In the long term, the first vaccines will probably appear by the end of this year or a little later. There is a good chance that they will mitigate and restrain the next attacks. If this happens, the virus may even disappear completely (though that is not very likely), or become another type of a winter seasonal sickness that will burden our health system.

But the Coronavirus’ time is near.

Medical science and technology are expected to make huge steps forward in the next decade or two, owing to the incredible advancements in technologies like artificial intelligence, sensors, nano-technology and others. We will find a solution for this virus in the next two decades, however clever it may be.

In the long-term view, we’re doing good, and our situation will only keep improving as the years go by.

The novel Coronavirus — one of humanity’s new enemies — is making our lives difficult in the short term, but on the way it is already accelerating the development of medical and remote-diagnostic technologies. We are witnessing the opening of hospitals with advanced robotic services that can help deal with the virus. And health systems, which have always been reserved about adopting new technologies, will be highly motivated to adopt any new technology that can help deal with this virus. We can expect to see rapid adoption of advanced systems and innovative technologies that can improve our lives and health.

We just have to be smart about this virus, and it’ll be okay.

Be pessimistic, be optimistic, but most of all — be smart.

— — — — — — — — —

I would like to thank Dr. Erez Garty, Roy Kedar and Gilad Greenbaum for reviewing this post and making sure (as much as possible) that it’s scientifically accurate. I would also like to thank David Yavin and Avi Geldman, who helped me translate this post to English.

About me: Dr. Roey Tzezana is a futures studies researcher at the Blavatnik Interdisciplinary Cyber Research Center at Tel Aviv University. He’s acting as a lead analyst in XPRIZE , where he has led the research about human longevity. He’s acting as a scientific consultant to several firms and international organizations, and is the author of several best-selling books about the future of technology and society, one of which has been described by the Israeli Secretary of Treasury as “a book that every politician should read”.

[1] https://www.scmp.com/news/china/society/article/3052966/chinese-laboratory-first-shared-Corona virus-genome-world-ordered

[2] https://www.medicalnewstoday.com/articles/256521#sars

[3] https://www.forbes.com/sites/kenrapoza/2020/03/06/Corona virus-impact-lessons-from-china-and-south-korea-for-the-us/#d53b6ec64751

[4] https://www.cdc.gov/flu/about/burden/2018-2019.html

[5] https://science.sciencemag.org/content/358/6365/933.abstract

[6] https://www.cnn.com/2020/03/07/health/Corona virus-mutations-analysis/index.html

[7] https://www.newscientist.com/article/2236544-Corona virus-are-there-two-strains-and-is-one-more-deadly/

[8] https://www.livescience.com/Corona virus-myths.html

[9] https://www.ahd.com/state_statistics.html

[10] https://www.scmp.com/news/china/science/article/3074131/Corona virus-highly-sensitive-high-temperatures-dont-bank-summer

[11] https://www.nytimes.com/reuters/2020/03/06/world/asia/06reuters-health-Corona virus-who-priority.html

[12] https://www.ynet.co.il/articles/0,7340,L-5691621,00.html#autoplay