Something has been in the back of my mind – a nagging concern – that I did not really want to acknowledge even to myself.
This is a new viral disease to humanity. The very basics are barely understood such as what type of disease does it cause and how severe is it, how does it transfer, and how do people become unwell and how many will become so unwell that they will die. There is still very much unknown. My friend Dr Shi Zhengli only discovered the viral cause of the new pneumonia-related disease, now referred to as COVID-19, just over 2 months ago.
Now think about HIV and how long it took for scientists to get a reasonable understanding on how it caused disease in humans. Sure, our tools have improved since early in the HIV pandemic but that virus was tricky compared with other viruses then known to science.
So what has been in my mind is that the superficially apparent aspect of disease visible as the pandemic ramps up may not be the only aspect of how this virus causes disease in humans. If we were unlucky, there could be some more chronic element – perhaps more chronic disease leading to mortalities or disability, or foetal defects – who knows, almost anything is possible.
Now many politicians would already consider me to be non-constructive – to their politically-oriented messaging – so I saw no point in talking about left field hypotheticals which are essentially infinite and of little value discussing other than to say that anything is possible.
That was until I went looking for an update on my friend, Zhengli. (I have not had a response to my emails over the last 2 weeks and I was a little concerned, hence my googling for recent activity by her – the last activity by her was some weeks ago when she found it necessary to defend herself from baseless accusations that she or one of her colleagues was the cause of the outbreak, from a lab accident or some other nefarious activities – that may be the subject of another post soon.) In doing so I came across a Lancet preprint from 2 March, which Zengli co-authors, entitled “Caution: Clinical Characteristics of COVID-19 Patients are Changing at Admission“. The concluding statement is:
All [of the mentioned observations] provide clues that the new coronavirus may gradually evolve into an influenza-like virus, or it may be latent in some asymptomatic carrier for a long time.
What will be the consequence of those latent infections will not be understood for some considerable time.
Having addressed that rather large elephant in the room, I want to go on and address the other elephant in the room – the mortality rate due to COVID-19. I am not going to discuss it in epidemiological terms, i.e. what current data suggests it might be – with the all of the inherent caveats including confidence over the quality of those data – and what may be the consensus views in several years when the dust has settled on this pandemic. Obviously, I am not qualified to do so, and whatever anybody suggests about the value of my writing here, I am trying to be constructive and not go beyond what my experience – in science (through my professional training) and economics (through my long passion during my adult life as shown in my public contributions over a decade or more) – allows me.
Firstly, surely common sense must tell any observer that this clearly is more serious than any other respiratory pathogen that has emerged in recent decades, and certainly more serious than the typical flu. Not anywhere in the world have we witnessed, to put it crudely but accurately, people dead in the street due to a respiratory virus.
This is the problem for deniers – like Donald Trump – where the obvious reality does not tally with what he is saying. Perhaps these types can get away with it on a medium-long term issue like Climate Change, but this crisis is so fast moving that these denials are quickly shown to be both ridiculous and dangerous.
Perhaps the markets like to work on narratives, and smart money likes to have ebbs and flows in narratives so that money can be made from volatility within medium to long term trends, but this is too fast-moving for such management of participant psychology to maximise profits to ticket clippers.
What I want most to talk about is the narrative that is being portrayed to the citizens of countries and I am going to use some examples from the UK because they do seem to be having a public debate about the right types of issues, even if there are some mixed messages.
There the Chairman of the Commons Health Committee and former Tory Health Secretary, Jeremy Hunt, on 28 February spoke on national radio of the need to balance the societal costs in terms of lives lost and the economic impacts. Mr Hunt spoke about how China managed to stem the spread of the virus in Wuhan and limit infections to 5% of the population, and made the point that that represents an enormous number of lives saved compared with it infecting 70% of the population.
On 8 March Prof Tom Solomon of the Walton Centre NHS Foundation Trust said that the coronavirus causing COVID-19 may ultimately infect 50-80% of Britons.
Thus based on these two comments there seems to be a view in the UK that the worst case scenario indeed may involve 70% of Britons infected by COVID-19.
Also on 8 March The Sunday Times reported that Government Ministers were preparing for up to 100,000 Britons to die with COVID-19 and were trying to make plans without spreading panic. Note that this was said to not represent the worst case scenario, but it is considered their “central scenario”, presumably meaning that it is considered a likely outcome.
That sounds like an awful figure, and there is no doubt that 100,000 deaths of group of people for any reason is absolutely a human tragedy.
Let us look at how the numbers run out on this to see how they have arrived at this figure.
The calculation for the proportion of people in a population who will die will be the proportion of people who become infected (let’s call this X) by the proportion of these people who die from the infection, or mortality rate (let’s call this Y). Thus:
X x Y
To arrive at the number of people in a population who will die you then have to multiply this by the total number of people in that population (N). Thus:
X x Y x N
As we know the population of Britain is 66,000,000 and we know the number that the Government has calculated may die from the infection, we can easily work out the proportion of the population which they are suggesting may die.
= 100,000/66,000,000 which equals 1 in 660 people or 0.15% of the total population of Britain.
To arrive at this figure, if it was actually calculated as opposed to it just being pulled from thin air (which is always possible, too), we know that it is the product of X and Y. So what may be some of the combinations of X and Y that may arrive at a figure of 0.15%.
Before we do that, however, note that it is vastly different to the figure that I used in my comment on The Conversation Australian website (which I repeated on Facebook) last week when I multiplied 70% of population infected by 3% mortality rate = 2.1%. In fact, the figure which UK officials are using is less than 10% of this figure, and it would be interesting to know what was their worst case figure, but in reality there is low value in publicly discussing worst case scenarios other than in trying to focus attention on pulling out all stops to throw the kitchen sink at the response.
Here are some combinations that will produce 0.15%
Infection rate/mortality rate
If I had to have a guess they might be working on 30% of the population infected with a 0.5% mortality rate, but it really is just a guess.
Given that COVID-19 is more infectious than the flu, and that is abundantly clear from the history of this pandemic without reading any analysis or modelling by epidemiologists, it is clear that to limit infections to under one-third of the population is going to require a very significant and ongoing quarantine effort.
Remember, also, that nobody really knows what will be the actual mortality rate.
So now we arrive at a discussion about my own country, Australia.
To pick up on one of the main issues of recent days, unlike the Health Minister for Victoria, I can understand how a GP recovering from what he thought was a cold which he acquired on a trip to the US would turn up to work and consequently interact with large numbers of patients and others.
Let’s think this through in the context of what I have written here over recent weeks about especially the consequent dangers of understating the risks associated with this pandemic.
The GP acquired the infection in the US which has been extremely slow to respond to the pandemic and with a leader who has continually sort to downplay the risks. The US has allowed this pandemic to get a good head start on it by bungling their diagnostic kits and that has meant that there has been little awareness of the circulation of the virus in American communities. So it is only recent visitors to the US that have been aware of the wide geographic spread of COVID-19 in the US.
The Australian GP only tested himself out of curiosity. As these health officials are continually telling us, 80% of cases have very minor symptoms if any symptoms at all. This much has been well known for a long time, so if we do not have blanket screening protocols, then why would someone with minor symptoms even consider the need to test for COVID-19. Moreover, there were press reports at the weekend of people feeling quite unwell and being refused testing for COVID-19. It is reasonable to say that the only reason why this gentleman was tested is because he is a GP and he did so in the belief that it was a very low probability that he had COVID-19.
How many people over recent weeks in Australia have had what they thought was a minor ailment, after travelling from a country that then was considered a very, very low risk for acquiring COVID-19, have gone about business as usual and may never know that they were infected. This GP would not have known himself but for his curiosity, and if he did not do the test he would have been none the wiser. And even when some of his patients fell sick, in trace back analysis it might never have been clear that he was the original source of infections.
The health officials and politicians really should not be pointing the finger at others for not having taken the threat seriously when they have sort for weeks to calm people by giving all indications to the effect that it may prove to be a storm in a teacup.
GPs are members of society as well, and they also receive those calming messages. It took a conversation with me for my GP to be woken to the risks posed by COVID-19 a few weeks back. And in a conversation with a mate who did his PhD on flu vaccines, no less, I was amazed by how complacent he was about the threat.
A lesson for me is just how much people are willing to accept at face value the messages put out by Governments and bureaucrats, and how little of their own intellect people put towards critically thinking through those messages.
It is certainly very rich for politicians and/or bureaucrats to then turn around and to suggest that anybody should have known better than to be lulled into a false sense of security when that has been the intention of the communication strategy that they, themselves, are prosecuting.
Finally, all of the above only goes to highlight how critical it is that Australia pulls out all stops and throws the kitchen sink at containment of COVID-19 as we head into winter. It should have been done on the precautionary principle, now it should be done on a growing weight of evidence of just how serious COVID-19 has proven to be, even before we begin to consider all of the unknowns.
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© Copyright Brett Edgerton 2020