A different way to look at the pandemic

Back in the paleolithic era (circa 1995), I worked long-range analysis for the Chief of Staff, US Army. I wrote a think piece about the internet. The prevailing view was there would be a “digital divide” based on access. A second, less widely-held opinion was that internet access would become a public utility (like water): so essential, it would be ubiquitous. I held to the second view, and postulated that there would still be a “digital divide,” only that this divide would be between the people who could understand and act on the digital information firehose (call them digitals), and those that couldn’t (that is, digitally disabled). It might be too early to tell, but I think I got it right (even a blind squirrel finds a nut on occasion).

Fast forward to today and our coronavirus quarantine in a fully digital world. We’re bombarded with info about the pandemic: on TV, from social media, in online news feeds. What do we believe? What should we act on? How to process all this . . . stuff? In the next two posts, I’ll try to give you a frame of reference. Today, I will focus on figuring out what we know, don’t know, and can assume. Next post, I’ll pull out the crystal ball (I took it with me in retirement) and suggest what might happen after we’re all done with the coronavirus (whenever that is).

The digitally disabled are the ones sharing stories from friends of friends on social media, often with impressive credentials (CoVid Task Force Director, or Senior CDC researcher) full of “do this, don’t do that advice.” If you search, you can never find these original sources. If you fact-check the advice, you’ll find it is a mix of common sense and outright fabrication. What you can find are the authoritative websites of the CDC, WHO et al and what they really say. I find the Johns Hopkins site and the Financial Times graphs very helpful. Be a digital, and track the sources.

The same advice applies to the news. News reports, like early reports from the battlefield or eyewitness accounts of a crime, are invariably not quite right. Maybe not totally wrong, but still not right. I have run across several verifiable accounts from emergency room doctors that are very interesting, but I don’t share them widely, because although they are real, they are fragmentary: something perhaps true at a point in time, but not the whole story. And nobody has the whole story, yet. Even the data we have are very suspect: in some cases because the sources are bad, in others because we don’t know what to count.

What do I mean? Are mortality rates good data? Suppose someone with advanced Alzheimer’s disease catches CoVid19 and dies: from which did they die? If someone is not tested for CoVid19 and dies with flu-like symptoms, does it count as a seasonal flu or coronavirus fatality? What about data concerning confirmed cases of coronavirus? China just admitted it hasn’t been reporting asymptomatic cases. Imagine a hypothetical country which refuses to do any CoVid19 testing (like North Korea): they will have zero confirmed cases, just a very bad flu season! So we have to very, very careful about the data. And have a little sympathy for doctors and political leaders trying to make life-or-death policy decisions in a period of very sketchy data!

Here’s an example from the Financial Times website (a good source, just to show you how little even good sources can know):

This chart shows death rates as of Sunday, March 29th. You might infer that the US is doing worse, since our rate is accelerating (based on the slope). France and Spain were doing still worse, although their slopes indicate things are improving. China and Iran are doing ok; Japan is doing great. Except China is lying, Iran is clueless, and Japan has been accused of deflating its numbers (their numbers jumped immediately after they postponed the Olympics). Yes, all these data are provided by the national governments. The real story to this graph: most everybody is bunched between reported deaths doubling every two and three days. Those are the margins we’re working with, and much of the variability can be explained by demography, culture, health care resources, and population density, which are all long-term givens, as opposed to crisis policies.

Here’s another one from FT, this time with cumulative cases:

Here the US trend is better (see the curve bending?) although we have the most cases (look out, here comes Turkey!). But again, notice that the entire world is bunched between doubling-every-two-to four days.

The outlier in all this is South Korea, where the data are probably pretty good and the results outstanding. Many cite the early testing they did as key, but forget South Korea (1) is a compact country the size of Indiana with a density twenty times the US (2) has a population that is younger, healthier, and more compliant, and (3) instituted draconian control measures like mandatory locator services (using cell phones) with fines and jail time. Imagine that working in New York!

You probably have seen the R0 (called “R nought”, around two) for coronavirus mentioned: it is the rate of infectability, or how many people on average does an infected person infect. R0 is based on all kinds of solid assumptions, but as one medical researched commented, it is a variable: an infected person in a room all alone who never comes in contact with anyone has an R0 of zero. How does an R0 of two work out? Quarantine measures can slow the infection, and assuming those recovered are immune (not proven), eventually the pandemic subsides, but not before almost all of the planet has been exposed. See, it’s not about not getting CoVid19: many if not most will. It’s all about making sure not everybody gets sick at the same time in the same place, overwhelming emergency medical resources (which drives up the fatality rate). Oh, and if/when we get a vaccine, of course, the lucky few can be protected.

We need ventilators, right now. They are not difficult to build, but every machine has to be tested, so of course we also need to ramp up testing devices and people to run the tests. Unless we want to use untested machines, in which case we might want to change our liability laws (in the notably litigious States), because some device is going to malfunction, and there will be a class action lawsuit. Wonder why some firms are not so excited to be building a device in such high demand?

But then there is the little problem of the outcomes for ventilator patients. If you need a ventilator and can’t get one, you are probably going to die. However, data on ventilator use for ARDS (Acute Respiratory Distress Syndrome, which results from CoVid19 among other things) are that about forty-to-sixty percent of all patients on ventilators still die. Total numbers of ventilators is a meaningless statistic: what matter is the number available at a given hospital at a specific time. Over time, we can move the ventilators from place to place.

So be very careful about drawing conclusions from any of the data, especially national data. Countries are not uniform in size, density, government honesty or culture norms, nor in when their epidemic started. Let alone the various policy options they choose. When all is said and done, there should be enough good data to make comparisons. Those who try to do so now will look foolish, for a good reason.

Enough of the complications: what do we know, and can we assume? The following data points and conclusions have been consistent over time:

• Social distancing can flatten the curve and delay the number of cases in a given location at a given time, which is all important.
• Eighty percent of people infected with CoVid19 are either asymptomatic (perhaps twenty-five percent!) or have flu-like symptoms. This is why the CDC is considering having everybody wear masks: there may be a sizable group of infected people walking around without symptoms. Some of us may have already recovered from CoVid19 and not know it! Most people who are infected will feel sick; a much smaller group will feel really, really sick. Only about five percent require hospitalization.
• The issue of intensive care and ventilators is primarily for those with pre-existing conditions such as diabetes, obesity, high blood pressure. From another direction, seventy-eight percent of those infected who ended up in intensive care had a pre-existing condition. Even the preliminary data on deaths among the young point to pre-existing conditions (especially obesity).
• Widespread viral testing (whether you have the virus) is necessary but not sufficient; we also need antibody or serum testing to confirm who already has had the virus (assuming it provides immunity, which is likely). The combination of these two types of tests provides a path back to normal life. As my son-in-law surmised, we might soon (and for a year or two) be walking around with disease passports which certify why we’re allowed out and about.

That would be quite a change, but who would rather stay in quarantine while the economy grinds to a complete halt? Would such a change be permanent? I’ll explore that with my next post!