COVID-19: Riding the Pandemic Waves

© Peter Hyde 2020, peter at
Disclaimer: I'm an interested engineer, not a doctor or epidemiologist
"You can’t control the random bits of misfortune which may strike you. You can only control your responses."     (Peter Adeney)



April 8 - "Zero Day" - one possible future (fiction)

New Zealand shut the stable door after the Covid-19 horse had bolted, then set about reining it in. On March 26 the entire nation began a full-on, four-week lockdown. The country had 102 confirmed and probable cases, exactly one month after Italy had reached its own 100 mark and a mere three weeks after the USA did. In a world already inured to fast food, fast jets, fast computers and instant messaging, exponential virus time seemed to top them all.

In the early days the lockdown was a bit chaotic. The government got the basic messages out - "Stay home! Be kind! Don't pop your bubble! And also be kind!" - but then scrambled to iron out rules for a host of businesses who reckoned they were essential and churches, iwi, interest groups and individuals who thought they were special.

Kiwis grumped loud and long about their inability to surf, boat, hunt and tramp the lockdown away - walks confined to the local neighbourhood got old real fast. Or they fretted about the businesses and staff who were losing their livelihoods - at least for a time, but in some cases for good. Even so, they complied - Google's mobility website showed them going out less and staying home more than anyone else in the developed world. The government's declared aim was to eliminate the virus altogether, and the people would settle for nothing less.

At the end of week two, a media storm arose because the Minister of Health, early on, had driven his family 20km to walk along a beach. The reaction reflected the national determination to defeat the virus - with no holds barred and no quarter given to anyone who'd let the side down. The daily Covid-19 press conference at 1pm became compulsive viewing - checking the score, obsessing over the numbers in hospital and intensive care, or whether the nearest cluster was still growing.

Slowly, but surely - 89 new cases, 67, 54, 50 - the curve began to bend, even as testing was escalating to new heights. As the third week began, the confidence was palpable - we not only could beat this thing, we bloody well were beating it.

Some folk began lobbying for a rapid re-opening to save the economy, but wiser heads prevailed. "Four weeks means four weeks" - the remaining days were spent completing and then explaining plans for how the lockdown would end. And on April 23, end it did.

New border controls meant a mandatory two-week quarantine for all arrivals, extended as required for someone who tested positive. International air crew stayed in designated hotels they couldn't leave, except to fly again. New regulations mandated strict social distancing and enhanced cleaning and air filtration in all commercial premises, even as they were allowed to reopen. Gatherings of more than 50 people were banned for the duration. Protection for hospital and care workers was heavily beefed up, since experience had shown that their workplaces - outside of airports - were far and away the biggest sources of new infections.

For most people, some much-missed privileges returned - they could enjoy the outdoors again. They could attend funerals and weddings. They could gather in small, widely-spaced groups to spend time together. But some old ways didn't quickly return. Nightclubs and cinemas stayed closed. There were no concerts. Pubs, restaurants and cafes were tightly constrained by spacing rules - outdoor seating was really popular at first, but winter soon put paid to that.

As case numbers dwindled, testing shifted to surveillance mode. By now, only one test in 1,000 was positive - and vastly less when districts were randomly sampled to try and spot hidden community spread. To preserve testing supplies in a world still madly chasing them, samples were batched together 50 at a time for tests. It was far quicker and used way less supplies to test a whole batch at once. Only if it tested positive did they need to go back and do 50 individual tests.

Along with border quarantine and surveillance testing came electronic tracking, to speed up contact tracing. A simple phone app logged whenever someone's phone came within bluetooth range of another. This needed no mobile data, no location tracking, no central registry. If someone tested positive for Covid-19, their encrypted log was uploaded to a government server and within ten minutes all contactees got a message inviting them to get tested. The whole system was completely voluntary - but heavily spruiked by the "Opt in and win!" campaign, with its intentional double meaning. Sure, people wanted to beat the virus - but they also liked the idea of the weekly $20,000 draw for those who kept the app loaded and bluetooth on.

The Prime Minister took pains to explain all the protective measures: "we've got layers - like an onion". Arguments raged back and forth about extra layers, such as masks and other protective gear for the general public. In the end, no law was made but most people made and wore masks in public anyway - until Zero Day.

On Zero Day, June 14, it rained up and down New Zealand, with driving snow in the high country. But nobody minded. Outside of border quarantine, nobody at all had Covid-19 - not even in hospital. Surveillance testing now covered more than 50,000 people a day, spread right across the country - yet no new cases had turned up for a week. At 6pm, everybody watched the news then went outside. They blasted their neighbourhoods with horns and hooters, played their favourite music Really Loud, performed hakas and let off every firework they'd stashed in the back cupboard three Guy Fawkes' ago. In the rain.

The next day, the national Covid-19 Alert level dropped for the last time - from 2 to 1 - and stayed there for fifteen straight months until the vaccine arrived. There were several scares and five limited outbreaks, all picked up and contained within days.

The economy made a gang-busters recovery. Food and other exports soared, international students returned in droves and a surprising number of tourists - once they could get here - were willing to go through quarantine to visit a virus-free country for months at a time. Australian tourists dominated at first, especially after they also reached Zero and were exempted from quarantine. Supply lines, torn and stretched for so long, gradually recovered, and exporters soon started complaining about the high dollar. Just like old times.

Kiwis sat in their island nation, looking at the outside world with a ton of empathy, a lot of a relief, and more than a little smugness. They'd knocked the bugger off.


April 3 - Data! And More Data!

On this day:

Slowly, the Covid-19 elephant is starting to take shape. Where once we thought it had three trunks, one of them possibly rainbow-coloured, we now realise that one of the trunks, at least, was actually a tail. And those big flappy things causing all that breeze? They're ears.

One rainbow which is slowly disappearing is this one: "lots of people already had Covid-19, it's mostly mild or asymptomatic, and herd immunity is only a month or two away". This widespread-but-mild theory is getting less and less tenable as more population test results finally start showing up. For example, in the Netherlands, testing of sewer samples taken in February showed no virus. In March, plenty of virus. Conclusion? It hadn't been spreading at high levels prior to March, so lots of people in the Netherlands haven't already had the disease.

More telling still are the results of antibody-testing of San Miguel County, a small but well-connected Colorado community. The tests were funded by wealthy locals who happen to run a life sciences company. They tested over 600 first responders and their families last week, and none of them had Covid-19 antibodies.

In the past week, they carried out more than 3000 extra tests in the wider community, with a couple of thousand more to come. Thus far they've found, at most, under 1% who were definitely positive - people who have had the virus at some point, even if they are better now. Furthermore, some fraction of that "under 1%" may be false positives, because antibody tests typically suffer from a false-positive problem in a way that swab/PCR tests looking for exact RNA sequences don't. So maybe 30 people there have had it, maybe 15 - though certainly not zero (extensive PCR tests have found seven who have it right now).

These results are consistent with large-scale PCR testing in Iceland and even early on in one of the worst-hit towns in Italy - both show small percentages testing positive for the virus at any given moment. And although every result is open to interpretation and challenge - and to be sure everyone wants to see more antibody testing from badly-hit areas like Wuhan, northern Italy and New York - the evidence is steadily accumulating that this thing is still in the early stages of its potential spread through human populations.

Sadly, it's not just about to reach its natural peak and subside of its own accord and, even more sadly, the many hospitalisations and deaths we're seeing really are from a relatively small number of infections - not from tens or even hundreds of millions of widespread "hidden" cases.

Which brings us back to other measures to fight it. The news that the virus hasn't spread all that widely does have an upside: suppression and elimination may be possible, if done right. Lockdowns can achieve a lot initially - slowing the spread to the point that aggressive testing, case isolation and contact-tracking might keep it under control, or even wipe it out in a given region - provided we can also prevent new sources of infection from outside.

But aggressive testing requires resources - not just labs but trained staff, not just staff but equipment, and not just equipment but also very mundane things like the swabs and chemical reagents which are needed to run each test. Right now, there's a worldwide shortage of those reagents - so much so that Israel has sent Mossad agents out to secure more supplies on more than one occasion. Most countries want to ramp up testing, not every country is going to be able to do so - that's why most places will impose firm limits on who can get tested for quite a while to come.

Contact tracing has its own demands, though fortunately more manageable. It's often disciplined legwork to interview positive cases and follow up - something that requires trained people, but these should be possible to scale up fairly quickly. It may also be semi-automated systems, such as phone company logs or individual phone apps that track and log who you come close to, which then automatically notify those contacts if you later test positive. Variations on the app approach are being tried in several countries - with South Korea again to the fore.

Expect more in this space. And, as lockdowns are gradually eased with the virus still in the wild, expect your government to be urging you to install something that keeps track of your movements and physical contacts. The idea sounds so 1984ish that we wouldn't have considered it for a moment in 2019. But this is 2020, and in the new normal it's likely we'll find ways to make it work with a minimal - and hopefully widely-acceptable - level of Big Brotherliness.

Lockdowns must eventually ease - virus or no virus - because no government can print money indefinitely and people still need a functioning economy for food, health and shelter - even if almost everything else is parked for the duration. In that scenario, our toolbox for virus suppression will include the above, along with all else we're currently learning - whether habits like physical distancing and effective use of protective gear, the the wide range of potential treatments now in testing, or the simple fact that some demographics are far more at risk than others.

As the shape of our opponent finally starts to crystallise, the likely shape of our various responses also comes into view. It's still very early days and there will inevitably be vast differences in how the pandemic is handled in different jurisdictions. But the base requirements are now pretty clear:

Easy, right? No government would ever volunteer for this kind of problem and the choices it presents. But because of other choices made long ago - followed by way too much tip-toeing earlier this year - all governments, and all of us, are going to deal with these issues for the rest of 2020, right on into 2021. Until there is a vaccine.

Keep safe!


March 31 - Green Shoots

On this day, worldwide confirmed cases passed three quarters of a million people and total recorded fatalities reached 38,000, including over 12,000 in Italy, and one in New Zealand. Donald Trump said "New York is really in trouble, but I think it’s going to end up being fine. We’re loading it up, we’re stocking it up."

When the worldwide curves of Covid-19 cases and fatalities are so steep, and even leaders like Modi and Trump are finally talking about how serious this pandemic is, it may seem perverse to talk about the good news that's finally starting to come through. But my aim throughout has been to try and look a little bit ahead of the daily news cycle, to try and be ready for what's coming next in this titanic, fast-moving tussle with a mindless strand of RNA.


Right now, what does all this news mean? For any one thing, not much. But never forget that we're playing a probabilities game with this virus, which means that every little gain counts. The less it spreads, and the less deadly it is when someone is infected, the more lives we'll save. And the more likely we can find a way to deal with it - or even live with it - short of lockdowns.

The biggest gains to be had right now are still those we control ourselves - good habits, widely adopted. Stay away from other people unless you can't avoid it. Use masks when you go out, gloves and glasses too. Learn how to use them to the most effect, and how to handle them safely. If you can't buy masks just yet learn how to make them, and how to safely sterilise and re-use them.

Keep helping others to be as informed as possible, and to act on that knowledge.


March 29 - "Isols" - one possible future (fiction)

Partway through the second cycle, the lockdown abruptly unravelled. There were harbingers to be sure - it turns out that essential workers such as nurses, truckies and supermarket staff need mechanics to keep their wheels turning. Mechanics need parts suppliers, parts suppliers need import agents and freight companies, and all of them need takeaways, security guards and contract cleaners. Who knew?

Scare stories on social media didn't help - one or two widely-shared tales of looting mushroomed into a new epidemic of concern, so managers of small businesses took to sending one of their staff in each day just to mind their premises.

But the real tipping point came when the government, with its tax base and currency slumping and international finance drying up, halved their wage support for affected businesses. Faced with a stark choice between re-opening and going under, managers and staff alike chose to defy the lockdown. And customers came.

They'd all had a taste in the three-week gap between the first and second lockdowns and decided they could cope with the ongoing personal risk. In the face of financial ruin, they were ready to discount the risk to others. It helped that supplies of protective gear had gone through the roof, so everyone had become accustomed to the correct "hand-wash, mask, eye-protection, gloves" routine - and the reverse for removal. On top of the 2-metre rule, religious hand-washing and some novel treatments, it all seemed to help - just enough.

But there was a stark division between the willing workers and the "isols", who continued to stay home and rely on the steady increase in food delivery and other services designed around them in the new economy. They were the chronically ill, the immune-compromised and older folk - mainly over 65s, who at least had their pensions to live off. They knew that Covid-19 presented vastly more risk to them than to a 30-year old, and also knew that the die had been cast - the disease was now inexorably spreading, and they were only safe if they stayed in their bubbles.

For a couple of days the government had gone all-out to try and restore the lockdown, re-emphasising concerns for health-workers and at-risk groups, and sending police in protective gear to arrest prominent defiers. They'd already tried to shore up the economy with measures which everyone had forgotten existed - nationalisation, foreign exchange controls, devaluation and price freezes. But the tide was running against them and, in the end, they capitulated.

They declared that schools and public offices should re-open, with all staff over 55 or with existing health conditions working remotely. They used stadiums and field hospitals to provide separate housing and treatment of mild and suspected Covid-19 cases to help slow the spread, but not stop it. They created special rules for retirement village, rest home and home-care staff, who were obliged to remain inside their client bubbles for weeks at a time, rotating out for a break and then back in via a two-week quarantine - skipped if an antibody test showed they were immune.

Other arrangements had to be made for multi-generation households, especially in poorer demographics where this was much more common. New subsidies and regulations saw families split up - but also plentiful accomodation provided where it had never been on offer before the epidemic. Accomodation businesses, suffering grievously from the lack of tourists, got a new lease on life.

Such measures were generally effective at limiting spread among the most vulnerable, although each time they failed it became a national scandal. Even so, there was a massive bump in hospital cases six weeks after the Reopening, one that persisted far longer than anyone had feared. Younger folk might be less vulnerable to Covid-19, but lots of them were infected in short order, and each critical case required weeks of hospital care. During the second half of the year there were many, many deaths, spread across all age groups except children.

Even though health staff were eventually well supported by newly-immune temps and volunteers, they remained under the pump for months. Some bailed, some coped, but most continued to work while suffering varying degrees of physical and mental burnout, with far too many falling to the disease itself. Luckily, some of the new stop-gap treatments - immunity-boosting BCG vaccinations, anti-virals and other drugs - did help to lower their risk, and improve their chances if infected, as for everyone else. But stressed-out workers are more vulnerable than most.

The finger-prick antibody tests were a godsend - finally there was a way both to measure how widely the disease had spread and also to tell if a specific person was now immune - and it took only five minutes. For a time, the "Immune" cards issued when you tested positive were like gold - though the first version had to be abandoned once it was realised that would-be forgers had an unreasonable amount of time and tools at their disposal. The second, contactless version was good enough; most phones could read them and Immigration even started mandating them for tourists, who had to present a card before boarding their flight in - they were then exempt from any quarantine period.

In the end though, the cards only mattered for travellers, and even then they had to be reinforced by confirmatory tests at the border - not every issuing government was careful enough for their cards to be trusted.

By early 2021, the base assumption was that most people out in the community had already had Covid-19 - whether they knew it or not - and everyone in isolation had not. Aggressive antibody testing continued until the last cases left the hospitals, by which time the immune count exceeded 70%. Then sentinel swab-testing resumed, to spot any flare-ups or, worse, a mutated form which might bypass the herd immunity that had been purchased at such an immense price.

One by one at first, and then in droves, the isols came out to play.


March 27 - Conflicting Theories

On this day New Zealand went into a full lockdown, the US case count surpassed China's and the UK's recorded fatalties passed 500. Travellers worldwide were left stranded as lockdowns began, borders closed and commercial flights disappeared.

As lockdowns tighten around the world, we're at a moment of maximum uncertainty. We all want to know how bad this will be, how long will it last, and - above all - how do we best get out the other side? The answers to all of those depend hugely on which of two main competing theories about the disease is more correct (remember these are theories):

As I mentioned in my March 23 post, there's persistent tension between these two theories because, no matter how much the issue is debated (and by god it's being debated!), there aren't yet enough solid unassailable facts to allow us to tell for sure which theory is more correct. WHO definitely inclines to the latter theory and has done from the start. Some scientists and policy-makers - particularly in the US, UK, Sweden and perhaps the Netherlands - seem to favour the former, at least some of the time. And if you're a government, which theory you lean towards makes a huge difference to when and how you go about coming out of a full lockdown, which in turn has immense economic consequences. Not to mention health consequences if you get it wrong.

The good news is that early answers to this question are probably only a couple of weeks away. To find out whether the SARS-COV-2 virus has spread far more widely than the WHO position suggests, we need to test for blood serum antibodies across the population. If you've had Covid-19 and recovered, you'll have antibodies, even if it was months ago and even if you never noticed you had the disease in the first place. Contrast this with the current swab tests, which can only tell if you're currently infected with the disease - enough for its RNA to show up on the swabs. Even with widespread testing, it's a only a snapshot of infections today, and therefore a far less useful indicator of the overall progress of the disease.

Thus, if we randomly sample 1,000 people from a population and 50% of them have antibodies, the epidemic in that population has already passed its peak, current cases will be dropping and a drop in mortality numbers will follow a few weeks later. Whereas if only 1% of the sample have antibodies, there's still a very long way to go.

The Netherlands announced a week ago they would start testing samples from blood donors - about 10,000 a week once they've ramped up. Their results will soon tell us whether their epidemic - which looks fairly average for Europe right now - is being caused by a large incidence of a very infectious but mostly-mild virus, or the early stages of a potentially much more dangerous disease.

To be completely clear - no matter how bad the immediate future is, it's natural to want the "very widespread but mostly-mild" theory to be correct. If it is, this means almost all the consequences will be near-term and we won't all be spending the rest of 2020 learning how to either totally suppress or otherwise live with a pathogen that's still out there and still wants to get us. That would be a reprieve of monumental proportions.

However, wishful thinking is not a strategy, as quite a few governments have already discovered. If, as most expect, the Netherlands finds a relatively low rate of spread, the human race has a real fight on its hands to minimise the profound human, social and economic costs of this pandemic. We need to find smart ways to restart our economies while still protecting the most vulnerable people from this thing - leastways until we have really good treatments (arguably possible but zero guarantees) and/or a vaccine - which is a year or more away.

In this scenario, don't be surprised if novel ideas are (re-)advanced such as promoting herd immunity in the young and healthy, hopefully with far more consideration and detail than the UK's earlier abortive attempt. Everything will be on the table, but I expect South Korea's model to be to the fore, along with an aggressive war-economy style bump in production of things like protective gear, pharmaceuticals and devices like ventilators and smart thermometers. I wouldn't expect the travel, tourism and entertainment industries, in particular, to recover until a vaccine is widely available - tight border restrictions will be in place for the foreseeable future and large chunks of our economies will remain under pressure.

Personally, I believe the current tension between the two theories is probably because the actual numbers are "middling" - meaning we aren't in either scenario above, but instead are coping with a virus which is rather spreadable and moderately dangerous, especially in certain demographics. That means we won't come out of lockdown knowing we've already got the bonus of substantial herd immunity - but we would have a range of feasible-but-inconvenient measures for minimising harm while restarting our economies.

For a time, we will have returned to the world of the early 20th century, before antibiotics and widespread vaccination, where it's simply more dangerous to be out and about and mixing too intensively. Those who are vulnerable and careless - or who are exposed by careless people around them - will be in for a tough time. Quite possibly millions will die, especially in poorer countries - though it's also possible most of them will be overlooked since the deaths won't happen in Italy, Japan or downtown New York. And for the vulnerable, staying out of danger will itself be a trial, because it will require a reasonable degree of continued self-isolation.

The rest will get on with life. In time, either herd immunity, treatments or a vaccine will bring the risk down towards swine flu levels, and life as we knew it will largely resume - albeit with some new and interesting styles of remote interaction, and far better preparedness for the next pathogen that crosses our path. It's much harder to predict the political changes, such as towards authoritarianism or perhaps the opposite in some cases - but for sure there will be some!

Oh, and one interesting consequence of lockdowns, which arises because the virus is mutating - though luckily not so fast as to make the idea of a vaccine untenable. Lockdowns by their very nature encourage mutations that favour lower lethality. A pathogen that kills its host in 14 days will not spread very far in a lockdown; a pathogen that keeps them around and infectious might. So, as long as we keep our hospitals as safe as possible (because that's where the more lethal strains inevitably end up), the virus that is most prevalent in our populations as lockdowns start to ease will likely be less lethal than the one which originally provoked Wuhan's crisis. Again, no guarantees, but this is a natural evolutionary process that may be playing out right before our eyes.

Finally, a reminder that we live in the 21st century, not the 19th:
A company that makes cloud-connected thermometers (yes, apparently that's a Thing!) has sold them all over the US and has anonymised access to their readings. This means in real time they can update this map of current fevers across the country, an amazing independent tool for tracking disease spread. Though it shows current atypical hotspots in (especially) New York and Florida, the trend view shows how the lockdowns now happening in most of the US are actively reducing fever - not just Covid-19 and the flu but anything else that comes with a raised temperature.

In case it helps, I've added a couple of additional resource links today (tagged with NEW) - one on breathing techniques to help those in the middle of an infection (or related anxiety), and one on sterilising and re-using different kinds of masks. Remember, be kind, be safe, and be ready for the long haul.


March 23 - The Blind Men and the Elephant

On this day, Donald Trump asserted: "America will again and soon be open for business... ...Parts of our country are very lightly affected." Cases worldwide surpassed 350,000 and fatalities reached 15,000 - more than four times the total reported for China.

Humans detest uncertainty, and this pandemic is delivering it in spades. As most of the world moves into varying degrees of physical distancing and lockdown, these facts seem to be clear:

But that seems to be where the facts run out. Pity the government agencies and political leaders who are trying to thread the needle between "how much clampdown is sufficient to control the virus?" versus "how long can we sustain this level of economic damage?" They are having to make these decisions very quickly, with far too little solid information and far too many contradictions.

Best example: is the true risk of illness and mortality from Covid-19 represented by its progress in Italy? ...or Germany? By Wuhan? ...or the rest of China? By South Korea? ...or Spain? By Taiwan? ... or Iran?
The answer, of course, is none of them and all of them - mainly because they are all at different stages of their local epidemics, plus there are very significant testing, management, treatment and demographic variations as well.

Yet that is such a wretchedly unhelpful conclusion, because there is a vast difference in the decisions you would make for your country if you thought Covid-19 was widespread, hard to stop but not very deadly (say, merely two or three times as bad as the flu) compared to if you thought it was still fairly limited in spread, containable with great effort, and as potentially deadly for your population as Wuhan, Iran, Italy and Spain all suggest.

There is significant tension in the international scientific community between those who assert the former, and those (specifically including the World Health Organisation) who believe the latter. At their extremes you could characterise them as deniers versus doomers - though to be clear, most scientists are far too careful to commit to one pole or the other. While the truth almost certainly lies somewhere in between, the error bars on rates of infection and mortality are still wide enough that either view could end up being true after this pandemic has ended. But that will be way too late for decisions that need to be taken right now.

Governments know that there are very real costs associated with drastic lockdown measures. Those costs include additional illness and deaths because an economic depression, especially a lasting one, has major consequences for most of your population. Nonetheless, in the face of an immediate health threat, one by one they have taken those measures. Even the UK was quick to abandon its radical "build herd immunity" plan, though I notice that its lockdown is still a good way behind most of its European neighbours.

My view remains as it was previously - China, South Korea, Taiwan and Singapore are showing us how to stay on top of this pandemic. It doesn't have to be complete country-wide lockdown. But it does have to be a flexibly-deployed and aggressive range of measures including local lockdowns, testing, case isolation, contact tracing, yet more testing and proactive treatment regimes - along with behavioural changes including universal and consistent physical distancing and yes, mask wearing!

Other countries which take this path early enough should see similar successes - and hopefully won't tank their economies as they work through the process of achieving containment and control. Countries which delay further, or which don't do enough testing, or which simply don't have the resources to manage their epidemic properly, are going to be in for a very rough time at some point in the next month or two. And inevitably they'll end up with a side order of economic damage as well.

There will be an end to this - when treatments and processes are found that render Covid-19 not much more harmful than the flu, or when enough of us have been infected that it becomes just a background threat, or when an effective vaccine is widely available. What each government must decide at the moment is how to best get to that point - which in the most hopeful scenario is a couple of months away, but in reality could be a whole lot longer. In making those decisions, economic, structural and cultural factors are unavoidable and will have major effects on how things look in each place when this is all over.

Which means, just as we can't yet get a good picture of the entire Covid-19 elephant, you can expect that its worldwide impact is also going to be incredibly variable and hard to predict. We live in interesting times.

Ending on a positive note, the image below was sent out by our local residents association, along with an exhortation for willing younger folk to add their contact info and distribute it in local letterboxes. Along with New Zealand's headline pandemic-control message of "Be Kind", this is the sort of practical, helpful, local and doable thing which will help get most of us out the other side:


March 17 - Diverging Paths

On this day, the New Zealand government outlined a $12.1b rescue package, describing it as "the most significant peace-time economic plan in modern NZ history". Many other governments enacted similar policies, but few countries other than Italy and China were in any form of lockdown.

The pandemic is now evolving differently according to how each country deals with it. In Italy - as was once the case in Wuhan - the containment efforts were too little, too late. They are now adopting increasingly rigorous efforts to lessen the damage to their health systems. The rest of Europe - and even now the US - is rapidly following suit.

In the UK they are trying the second-most radical experiment thus far (China's delayed but apparently-successful massive lockdown in late January will always head the list). The British government wants to try and build herd immunity by letting the disease gradually infect those who are likely to have the mildest symptoms, while theoretically keeping those most at risk out of its way. If this approach turns out to be feasible and successful, scientists all over the world will be in awe. Regretfully, I predict that reality will win out - meaning that the original plan will steadily morph into the same kind of lockdowns as elsewhere. But the sternest measures will be days or weeks later than they should have been, therefore the consequent damage will be higher than it needed to be. This virus does not negotiate.

By the way, the case numbers out of the UK are quite misleading at present - like Sweden, they are currently only testing the most serious intensive care and pneumonia cases (they say this approach may change soon, with ramped up testing). For now, watch the daily fatalities number to get a real idea of the underlying numbers of people who must be infected. Today the UK's 20 fatalities are comparable to those in France, whose reported new cases are almost ten times higher.

South Korea - and China outside Hubei province - point the way to how this disease can be successfully managed. As the World Health Organisation stated firmly today - test, and then test some more. The tests are not perfect, and won't catch every positive case. But by knowing where the disease is, early testing allows very explicit and effective isolation and ultimately containment. The South Korean death toll yesterday was zero, with 75 new cases reported. Italy's was 349, with over three thousand new cases. There may be differences in treatment too, and of course in demographics. But testing and aggressive followup actions are the key to controlling Covid-19; every country that fails to do that will risk being the next Wuhan, Iran or Italy.

The most important thing about South Korea (as with Singapore and Taiwan and lately China) is that they haven't closed down their economy to achieve this. It turns out that not testing and blindly hoping it will go away of its own accord is neither a disease control strategy nor - in even the short term - an economic strategy: you just end up a couple of weeks later with a vastly worse outbreak with a side-order of trashed economy. China had to go the full closedown route to get on top of this, but now the provinces outside Hubei are back at work - albeit with partial lockdowns, meaning people only get permits to leave home to go to work, not for casual travel or outings. It's a strategy we may all witness eventually.

In New Zealand, we seem to have been blessed by early government action to limit spread, track cases and isolate possible carriers. There may be underlying community spread that is currently undetected, but it can't be very high or our health and monitoring systems should have spotted it - or so I sincerely hope! Now that air arrivals and cruise traffic have been radically restricted, the number of detected cases here over the next couple of weeks will be very telling indeed. But even if they remain low, we simply can't be complacent - effective treatments are still very uncertain, there won't be a vaccine for many months, and winter is coming.

The most gloomy news in a very tough week is economic - the airline and tourism industry worldwide is rapidly shutting down, and those two are just the most prominent among many others. From local businesses to huge manufacturers like Boeing, there will be significant staff stand-downs and layoffs. Stock markets are reflecting the pinch with their usual perfect 20-20 hindsight, and governments are doing their best to stoke their economies - likely with very mixed success. Supply chains are going to be further disrupted - most passenger flights carry cargo after all, and the container-logistics snafu resulting from China's February lockdown will take a long while to untangle, even as other major ports are now being disrupted by local outbreaks. It's very early days yet. The best hope has to be that we get a lid on this thing soon and the inevitable recession is a V-shaped one - quick in, quick out.

The same message applies as always - take this seriously, help others to take it seriously, and also help them to weather it well, especially those at the pointy end. That will get us through all this more quickly and with less damage than anything else we could do.

And do set your pace for the long haul - look for things to occupy the unexpected spare time you may soon have, take up new studies or crafts or other creative hobbies. This feels like such a fast-moving situation, especially at present - but sadly it won't burn out in a fortnight. Look and plan ahead at least a little bit, so you don't get too surprised or overwhelmed when the future comes suddenly calling.


March 13 - The End of the Beginning

On this day, the US and UK stock exchanges suffered their worst performance since Black Monday in 2008 - not long after they recorded their worst drop of all time. Confirmed cases of Covid-19 worldwide surpassed 130,000.

It seems that the tentative forecasts in my original article, mostly hit the mark. I'm unhappy about that, because I had hopes that an earlier and more effective response from our governments would minimise the damage now being done across the world. Far too many people weren't taking the issue seriously, and some are still in that boat - that is, until the virus and/or its many side-effects hit them directly.

Still, it's not all bad news:

I need to balance the positive news with these reminders:

My general message is unchanged: these are uncertain times and together we'll have to bear very much inconvenience and losses of one kind or another. However - we do have the tools to manage this thing if we only apply them consistently, and more tools are being found every day. Please encourage the widest possible use of those tools by modelling effective behaviour, and sharing the best information you can find.


March 5 - Through the Fog of War

On this day, Donald Trump tweeted: "With approximately 100,000 CoronaVirus cases worldwide, and 3,280 deaths, the United States, because of quick action on closing our borders, has, as of now, only 129 cases (40 Americans brought in) and 11 deaths."

Since I wrote the article below, a few things have become a little clearer - although there's going to be continued uncertainty over any numbers until this thing is in the history books:

Help your community by explaining the situation to others in a measured fashion and modelling the best behaviours as widely as possible. Social habits can be more contagious than a virus - we'll get the best result if we encourage the good ones and discourage the worst. Let's beat that peak!


Original article (published Feb 22)

On this day, Italy documented its first Covid-19 death, and the UK's New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) were given the latest global data on the outbreak... and concluded that the official risk assessment need not change. New Zealand had no confirmed cases.


I'm writing this mainly for my family and friends. Anyone else reading, please make of it what you will. It's based on the best information I could glean from many international sources - see A Few Useful References. This is a rapidly-changing situation which will be rife with uncertainties for months to come.

COVID-19 is the respiratory disease caused by the SARS-CoV-2 virus, which jumped from bats into humans in China late in 2019. It has demonstrated sustained human-to-human spread similar to flu. Its carries a significant risk of serious complications like pneumonia – perhaps as high as 15-20% of detected cases. The risk of death seems to be significantly (perhaps 10 to 20x) higher than flu, and it is especially risky for people aged 50 or older, for immune-compromised people, and for those who have other illnesses such as diabetes, respiratory problems and heart disease.

Unlike the seasonal flu, there is no tested vaccine for COVID-19 and we should not expect one to be widely available for 12-18 months and quite possibly longer. Some existing anti-viral treatments are currently being tested – a few may be somewhat effective and available much sooner than a vaccine. It is not flu, so Tamiflu and the flu vaccine don't help it at all – but not getting the flu is an excellent way of staying as healthy as possible when there is another risk around, so get that flu vaccination when you can!

Much of the early information we have about the disease comes from China and may not apply directly to elsewhere due to differences in health systems, smoking rates, air pollution and other environmental and social factors. However, there's now little doubt that the infection and complication rates are high outside China, even if final mortality rates might end up noticeably lower in countries with better healthcare systems. That is, provided those systems are not themselves overwhelmed by large numbers of serious cases requiring intensive and prolonged treatment.

There's excellent reason to resist the spread of the virus as much as we reasonably can, both to lessen the impact on national health systems - which are already overstressed at each flu season peak - and to allow more time for effective remedies to be found and proven.

And if you and your closest contacts can avoid getting it altogether, that's even better!

Current Status

At first, this was an outbreak limited to one large city in China. But this changed very quickly, particularly because early reactions to the outbreak didn't prevent the huge annual Chinese New Year migration in January. This meant that the disease was spread throughout China and, indeed, worldwide. Subsequent travel restrictions and monitoring within China and internationally seem to have slowed – but not stopped – that spread.

Recent data from China suggests that their unprecedentedly-vast isolation and quarantining actions have slowed the progress of the disease - but we have to be aware that there has probably been significant under-reporting of cases and, especially, infection rates.

This is reinforced by the rates of infection found in, say, South Korea or the Diamond Princess cruise ship, where more active monitoring of non-symptomatic cases has been undertaken. On the plus side, more people being infected suggests that a lower proportion of cases end up as serious or fatal. That is, hospitals are mostly seeing and reporting the worst cases, not the people whose immune systems simply shrug it off after a few days.

But we can't be complacent because COVID-19 seems to be a slow-moving disease, with serious complications often not setting in until a couple of weeks after infection. That means we aren't really seeing the full effects internationally yet – except perhaps in Iran, where it has clearly been spreading unreported for weeks before the first cases (and fatalities) came to light.

Although not fully confirmed, the virus shows some signs of being temperature, humidity and UV sensitive, like the flu. This means we can expect it to fare less well in summer but reach a peak each winter. That's somewhat positive over the next few months for countries in the northern hemisphere, far less so for those in the south. And unfortunately for the anyone living in a temperate climate, winter comes around every single year. (The "Spanish" influenza of 1918-20 had multiple peaks, corresponding to the winter seasons of 1918 and 1919 in various countries).

Perhaps 80% of those who get COVID-19 – especially younger, healthier folk – seem to experience it as little worse than a common cold, and hopefully even gain a degree of subsequent immunity – although how much immunity and for how long is still unknown. These folk are not the immediate problem. The problem is the other 20% - their more-vulnerable family members, neighbours, close friends, co-workers, fellow commuters and customers who catch it off these "healthy" people and then go on to develop serious complications. The most recent best estimate for mortality rate for all those infected is about 1% - but it's still very early days to be drawing conclusions.

As well as the slow development of the disease, we're also handicapped by its apparent ability to be spread by people who have no symptoms – or who at least aren't aware of symptoms. This makes it much harder to prevent spread, because in some cases it might be well established in a community or neighbourhood before there is wider knowledge of it. That in turn delays the useful preventative reactions that would otherwise result.

There's also plenty of evidence of "super spreaders" – people who are far more likely than most to infect others. Paradoxically, this might make it easier to contain - but only when such people can be quickly identified and contact-traced, which gets progressively harder as the case numbers rise in a region.

Finally [this is Feb 22], after a weeks-long abundance of caution, the CDC, WHO and other disease specialists are all now starting to line up and label COVID-19 as a real and imminent threat to communities outside of China.

My Forecast

Although I had some doubt and plenty of hope initially, I now believe this will be a serious global pandemic. After recent reports of local spreading in South Korea, Japan and especially Iran and now Italy, it's clear that the virus has a foothold outside China - and indeed outside East Asia. Furthermore, some very large pennies such as India, Indonesia and Africa have yet to drop - though they may never be well-reported. The virus spreads easily enough that it hasn't been stopped by the China-specific travel restrictions applied by some countries earlier this month and by the (admittedly fairly minimal) increased monitoring that followed.

Realistically, this means that, even if undetected, it is probably spreading in a community near you right now.

As China attempts to ramp up its return to work in coming days, we can expect to see renewed outbreaks in March in cities outside Hubei province. How and whether these outbreaks will be contained will have a profound effect on already-stressed worldwide supply chains of essential goods (pharmaceuticals, electronics, machinery, medical equipment, components…). This will have noticeable knock-on effects on the world economy. Internationally, this means that many jobs, certain supplies and, in a few cases, social order will all be at risk for a sustained period.

Outside China, different countries will handle the pandemic in different ways, depending on community knowledge, the degree of spread, the season and social systems. Some (like Singapore) will be far more effective at limiting the spread than others (like Iran) – at least initially. Western democracies such as the UK and New Zealand will be somewhere in between, mainly due to an initial lack of direction and cohesion.

Our success at dealing with the pandemic will depend primarily on education followed by effective personal responses, and subsequently on governmental actions such as forbidding public gatherings, careful case isolation and so on. Treatment options for the most seriously affected will be limited at first, i.e. few known-good options other than oxygen and associated palliative or (if need be) intensive care. As the pandemic peaks in each region, healthcare systems and staff are at risk of being overwhelmed by serious cases, to the point that people will be just as well off at home as in hospital. Hospitals and clinics may become risky places to be, and best avoided unless/until someone has serious symptoms, i.e. pronounced fever and shortness of breath rather than a dry cough, sore throat and feeling blah.

Some parts of the world economy – air travel, tourism, forestry, car manufacturing among others - are already stressed by the reaction to China's epidemic and this will only compound as the pandemic arrives in each locality. Jobs, investments and national tax bases are all going to be at risk.

To prevent the worst effects of the virus on our societies, modelling suggests that the most important actions we can each take are ones that limit or delay the spread of the virus. Crucially, at the peak of an epidemic, those actions reduce the numbers of worst-affected people seeking medical help at any given moment. That matters hugely for over-stressed health services and staff, and can help make the difference between a result like Wuhan's, and one like Singapore's.

Dealing With the Consequences

When systems are under stress, the effects can be really hard to predict. People who have lived through natural disasters know that social cohesion is often fine – even strengthened - but communications and basic supplies can be a problem, at least for a while. On the plus side - compared to most other disasters - a pandemic leaves infrastructure intact and working, so long as key people are there supporting it. So, my recommendations fwiw:

Regarding the risk of catching the virus – it's really a numbers game. All the protective actions you take are designed to minimise the viral load you might encounter from other people, objects or surfaces. Completely eliminating such encounters is unrealistic for the vast majority of us who don't have well-stocked bunkers deep in the woods - but fortunately our multi-layered immune systems can generally ward off small doses. However, even younger, healthy folk will have trouble if subject to repeated, sustained or heavy transmission – as evidenced by many deaths of healthcare workers in their twenties in China.

So, as with many things in life: doing something because it will help is better than doing nothing because you're concerned it's not enough.

The New Normal

As a species, we've gotten used to rapid disruption and social change caused by technology, new ideas and high-impact political movements such as globalisation, liberalism or populism. We're also pretty good at dealing with one-off and limited disasters such as an earthquake, flood, bushfires or hurricane. Communities and nations often pull together really well to deal with (at least the initial) effects.     [US citizens: YMMV, but do remember that disaster movies are fiction, not documentaries.]

A serious pandemic is likely to be a bit different from "normal" disasters – not least because its consequences are fairly prolonged and extremely widespread, meaning that there probably won't be a cavalry available to ride to the rescue from somewhere else.

One of the immediate psychological effects is a reduction in trust and increase in suspicion. Part of this comes about simply because of the actions and decisions involved in minimising infection. "They" are not some different political tribe or far-off opponent, but rather the people next door who just might be infected. Or they may be the government who are acting in the country's interest - as they see it - but not in yours. As a result, you may feel more inclined to believe conspiracies, pursue half-baked remedies or support knee-jerk authoritarian responses - none of which are likely to help the situation.

It's important to actively resist those worst effects while at the same time encouraging and reinforcing behaviour that actually helps to limit the disease. So, my recommendations:

Finally, a helpful reminder from an article in Forbes:
"The best way to protect yourself from any of these infections is to avoid people who are coughing and sneezing, and to keep your hands away from your face so you don't inoculate your nose, mouth, or eyes with infected secretions. Wash your hands after touching any potentially contaminated surface and be sure to turn off the faucet handle and open the bathroom door using a barrier, such as a paper towel. Then use hand sanitizer. If you wash your hands and then turn off the water with your bare hand, you will have just re-contaminated your hands. Knowing how to perform hand washing correctly is the key to avoiding many infections."

References and Resources

The first few references are more interesting before you know whether COVID-19 has arrived in your community. The last few matter much more after that.

New Zealand COVID-19 Healthline: 0800 358 5453 or +64 9 358 5453 from overseas
NZ Regular Healthline: 0800 611 116