A reflection

When I wrote the first blog about COVID-19 in Jan 2020, I had no idea it would turn out to be THE event of our LIFETIME.  Not 2008, not 911, not 1987, but 1929.   So the earlier blogs (Jan 26-Mar 5, 2020) require re-visiting.  

First the total death, which I predicted to be fewer than that in 2003 SARS on Jan 26, is way off.  That number was based on the assumption that COVID-19 would be at the same scale as SARS, but with a lower fatality rate.  That first premise is wrong, for a number of reasons.  Some will be dissected next, but an important factor is that many people with COVID-19 show mild symptoms but are still infectious, making disease identification and containment difficult.  This feature was well appreciated by late Jan 2020.

Second is the fatality rate, predicted to be 1% or lower.  Data now indicate that the rates at different places vary.  Wuhan, China is 4%.  China outside of the Hubei Province is 0.9%.  Different countries have different numbers as well.  I believe the 1% number is still valid.  Wuhan has a higher rate because of the lockdown measure, ensuing panicking, cross infection, and overwhelmed medical system.   Besides, we all know confirmed cases are always undercounted more.  On the other hand, the overall fatality rate doesn’t tell the whole story, because some people are clearly more susceptible than others. 

Third is how well COVID-19 is transmitted.  This question can’t be answered in an absolute term.  For one thing, it needs to be compared to other diseases.  For another, R0 is not simply a quality of the virus, but also depends on the environment and people’s behaviors.  Media reports are filled with cases of transmission, but, obviously, instances of contact-but-no-infections are not reported or receive little attention.  According to the Chinese media, you would think everybody coming out of Wuhan was a carrier.  But simple calculation will tell you only one in several hundred was.  At the moment it is better to think it is preventable, but the hard part is to know who is really infected around you.  

Fourth is the prediction that lockdown hurt.  This was validated by the vast differences in mortality rates in Wuhan, Hubei, and the rest of China.  Lockdown in other provinces help stem the infection, but in Hubei, especially in Wuhan, it is a big sacrifice.  Nevertheless, around Feb 15-20 one could clearly see the tide turning everywhere in China.  Lockdown in China, however one views it, achieves its principal goal.  We could have talked about the benefits and costs by now, except that we are having a bigger problem on hand.  

Since Feb 20, COVID-19 has run loose over the globe.  Many countries recorded their first cases in mid-late Jan, but the numbers then stayed low for almost a month.  The exception was Japan, with several hundred cases, many from a cruise ship.  But suddenly South Korea, Iran, Italy.  Now all the major countries in Europe, the US, and others.  It is important to evaluate how it has come to this, and how different countries cope with the situation.

In South Korea, it was mostly due to a single person interacting within a religious sect.  For about two weeks South Korea was the number 2 infected country in the world.  But by March 10-15 COVID-19 appears to be largely contained, similar to the stage China was in around Feb 15-20.  A few things were in Korea’s favor.  The government acted quickly, able to limit the damages mostly to the religious sect.  Once you identified all the sect members, your work was 70% done.   They also tested a lot of people and got them and many other people off the streets.  Korean people stay at home, or wear masks when outside.  Now hopefully in 2 weeks it will be essentially over.  This is actually what I wish Wuhan could have done, although the situations were admittedly different.  When the outbreak first appeared in Wuhan, nobody knew what it was, let alone testing and identifying.  And the rest of China is simply too big for the same Korean measure.  

Before South Korea it was Japan, being No 2 for a month.  Japan has remained an odd case.  The extent of infection is never clearcut.  Maybe higher than the official counts, but maybe not much worse.  But the citizens act similarly as in South Korea, and we don’t see reports of large community transmission lately.  So it is safe to say COVID-19 is contained there, more or less.

Outside East Asia, unfortunately, look bleak.  Especially the major European counties: Italy, Spain, France, Germany, UK, etc.  Italy already has over 20000 confirmed cases, many of these countries will have 10000 soon.  Lockdowns have been officially implemented in many countries.  These lockdowns are not the same as in China in terms of severity.  If in Wuhan, the lockdown is 100%, then the rest of China in Feb was 70%, in Italy, it is 50%.  Even at this level of lockdown, though, many Italian people still go out socializing, eroding the effects.  It has become so bad that Sweden and UK are abandoning reporting, testing, or treating cases, especially the mild ones.  This will create huge problems down the line, not the least for other countries.   

In the US, many businesses and schools are shut, and panic buying widespread, just like in Europe.  But the real problem is that nobody knows what the extent of COVID-19 is.  What is the next step: need to catch up and test everybody who calls, or just give up, testing only those at the hospitals?  What will you find, and then what will you do?  This creates a huge amount of uncertainty.  The stock market has crashed.  Won’t see clarity any time soon: how much a problem COVID-19 is now?  How long will it last?  How many countries will be affected by how much?  What will individual countries do?  This has 1929 written all over it.

If history is a guide, it takes about a month to contain COVID-19 with their efforts in China and South Korea.  US has scientific and medical advantages on its side, and people drive often and live further apart in the US.  If it can get over the initial shortcomings, COVID-19 could be suppressed by mid April.   But like in China, even when the disease is contained, not everything will get back to normal right away.  Especially considering how the Europeans are doing.  Even if Italy recovers, how well will its neighbors do?  If there is only one weak spot, the whole world will not be back up.   

  

When I wrote the first blog in Jan, I didn’t imagine COVID-19 would become such a global issue.  For SARS in 2003, other countries handled their cases well, and when it was over in China, it was over everywhere.  For COVID-19, China’s response was much faster and drastic than in 2003.  The first cases were recognized in late Dec 2019, the virus was sequenced in early Jan 2020, essentially all we know about the virus and disease now had been published in scientific journals by mid Jan to early Feb 2020, as well as in countless media reports.  Wuhan lockdown started on Jan 23, 2020.  There is no other disease in history humans have known or acted so quickly, so much, and so openly.  But who could think that 2-3 months later, the outlook gets even worse?  COVID-19 is probably harder than SARS, but politics plays a bigger part.  The US has been fighting a moral combat against China for more than three years now, and Western Europe and Australia have been happily playing along.   So when China was suffering in Jan and Feb, Western politicians and media couldn’t help but enjoying their time, as if they were watching a movie from Mars.  For at least one month, maybe even longer, they didn’t prepare.  Then it hit.  And when it hit, they still bashed China.  For so many it is just knee-jerk reaction: China is not open, China is hiding something.  Well, everybody knew about the viral sequence in early Jan, why didn’t you have a testing kit ready and mass produced just in case?  In biology this is so easy!  Everybody knows all the symptoms by mid Jan, why didn’t you do your CTs?  Everybody knows mild cases still transmit, the elderly are vulnerable, etc, by late Jan, why didn’t you look closer and prepare in Seattle and many other places, until March?   Some people believe their superiority over China so much that they forget the virus can’t care less. 

Panicking hurt Wuhan, China, but willful unpreparedness hurt many other countries.  I predicted the new COVID-19 will become just another disease in the winter.  I can’t predict how the new 1929 will end.