I pulled my first all-nighter in a long time diving deep into the SARS-CoV-2 / COVID-19 affectionately known as “coronavirus”.
The virus is called SARS-COV-2 and the disease it causes is called COVID-19. Think HIV = virus, AIDS = disease.
Here are some facts that I have taken seriously:
1. Initial mortality estimates from the WHO ~2% skewed heavily to the elderly. This chart was from preliminary data out of China.
2. The countries that have done a good job of containing the virus Hong Kong, Singapore, and S. Korea, all have amazing health care systems and have managed containment through a combination of proactive measures, scenario planning, mass population testing, and luck.
3. The countries that have been slower to act, such as Iran and Italy have fared much worse. Current mortality rates in Northern Italy are exceeding 5% and rising… Members of the Iranian parliament have died.
4. Most people have no or moderate symptoms, some people get a bad cold/flu /indigestion symptoms. Current estimates suggest that ~15-20% of cases require hospitalization and some fraction of those are critical. Meaning, severe pneumonia managed via a ventilator and experimental anti-viral medications.
5. A woman in Japan tested positive and received hospital care, then after testing negative and being released, she got sick again, and again tested positive for COVID-19. Was the second test a false negative? Does the virus recur like Malaria? Do we not develop immunity and therefore, can we get sick an infinite number of times? Did the virus mutate that rapidly? Can we ever develop immunity? or was the woman just an outlier with a weak immune system?
6. So far we know that the virus SARS-COV-2 like influenza can be spread via droplets and can live on surfaces. Unlike Influenza, however, SARS-COV-2 appears to also live in the digestive tract and spread by fecal transfer. In affected areas where people have had symptoms of indigestion, diarrhea, and vomiting, it appears that the virus can also spread by way of fecal plumes also. Some evidence suggests the virus can live outside the body for longer than standard influenza.
7. COVID-19 has, even under the most optimistic scenarios a 10x death rate to the flu. Some epidemiologists estimate that 30-70% of the USA will get infected. Quick math says a 2% death rate times 30 – 70% of America’s 329 million people, means if our healthcare system continues to function properly and IF the death rate is only 2% then we are looking at 1.9-4.6 Million Deaths in the USA alone, plus an order of magnitude more people requiring hospital care.
8. Quick estimates of the number and availability of hospital beds at various locations around the USA suggest that we don’t have nearly enough if these estimates are true. What has happened in Italy is that the medical system is starting to fail. Hospitals are full and can’t take more patients, doctors are getting infected, burned out and exhausted. Thus ALL CAUSE mortality is spiking in Italy in addition to COVID-19 since physicians are now forced to triage heart attack and stroke patients along the long line of infected virus holders.
9. Americans w/o health insurance and ~70%+ of Americans live paycheck to paycheck. It seems that social and healthcare disruptions are the problem in most developed countries. Some people on the west coast of the USA are starting to panic, and are making a run on Costco and Walmart to stock up on non-perishable food, water, and medical supplies. This will be a time for us all to remember that we are in this together and that we might need to help our neighbors, friends, and family while staying calm and avoiding panic.
10. I spoke with a contact doing work overseas and the situation in Asia on what I had considered paranoia, he considered prudent precaution. Mortality numbers seem low (which is good!) in the first wave of the virus, but as hospitals around the world start to fill up and run short on beds, ventilators, and PPE, the mortality rate seems to rise, making the virus deadlier than the 2% on the average.
At the time of this writing, there many unknowns about COVID-19. Here are a few questions that I have:
1. What are the long term health effects in people who contract COVID-19, and are hospitalized, but then who recover?
2. Can we build immunity or is the virus immune-suppressive?
3. How infectious is it? Models suggest case count doubling every 3-8 days. In an exponential, that’s a huge difference.
4. What is the actual mortality rate?
5. What health consequences does the virus cause?
6. Which antiviral therapies have proven effective? What medical interventions can we use?
7. What will be the short, medium, and long term economic, political, and social disruptions of this disease?
8. What will happen to our doctors, nurses, caregivers, and primary care / mental health professionals?
9. What is the likelihood that this virus mutates into one with an even higher mortality rate?
10. What fraction of our drugs, PPE and medical equipment comes from China? Will we face global supply disruptions due to this shortage?
11. What else should we be asking?
How I am getting prepared?
I’m taking a ‘belt and suspenders’ level of precaution for the next 3-6 months. I canceled all travel. group activities, and live meetings for the next 2+ months. It pains me to say this includes martial arts training sessions, the gym, and various social occasions, events, and conferences that I had planned to attend. Here are a few good articles I found for how to think about preparation here and here.
” Don’t let anyone shame you out of talking about the virus, preparing for it, or reallocating resources accordingly. The time for winning internet points via above-it-all sarcasm and condescension towards people who took this seriously has now officially drawn to a close.”
After speaking with friends currently living in Asia, I am taking this thing seriously. Epsilon Theory has some thoughts on The Fall of Wuhan and the build-up of incentives that might lead to governmental irresponsibility similar to the negligence in the aftermath of Katrina, The 08 Financial Crisis, etc.
It’s hard to separate fact from fiction when watching the news. Here are scientific sources + some good follow on Twitter:
Situation Updates from the CDC
Situation Updates from the WHO
John’s Hopkins COVID-19 Tracker
Harvard University’s School of Public Health COVID-19 Updates
Here’s what journalists, business leaders, and media commentators are saying:
Virologist interviewed on Fox https://www.foxnews.com/world/how-coronavirus-stacks-up-to-other-coronaviruses-sars-and-mers
Updates from the New York Times: https://www.nytimes.com/news-event/coronavirus
Updates from Al Jazeera: https://www.aljazeera.com/news/2020/01/coronavirus-symptoms-vaccines-risks-200122194509687.html
Possible Long-Term Social, Technological and Economic Impacts of CoVID-19 by Azeem Azar
Bill Gates has a talk from 2016 that now seems prescient.
Elad Gil on Advice for Startup Founders on (COVID-19)
Here’s a good synopsis from Last Week Tonight with John Oliver
Update 3/10/2020: I have decided to reformat this post to make it more clear. I have gained a lot of new information since I wrote this two weeks ago. I will continue adding to this post and publishing revisions to the extent that the information might be valuable to my friends and family.