Redux: MacroEdgo’s Coronavirus Update of 11 February

I quote this particular update so frequently that I thought it prudent to have it in a separate post for quick and easy access. It also adds perspective to a great many aspects of the pandemic. Note that as of today I wrote this update 47 days ago. Then there had only been 1 death outside of China. In the WHO situation report for today the Global death toll stands at 30,000 with 26,700 outside of China. Just soak that in for one moment before reading on to my update from less than 7 weeks ago!

11 February

My optimism/pessimism level – from 10 to 1 in decreasing optimism – stable at 2

This is a scale that can move daily depending on latest developments. Extreme pessimism of 1 would entail confirmation that the virulence of the virus is such that infections result in a mortality rate of 1% or greater (10x the virulence of severe flu) even under optimal conditions, continued indications of very high transmissibility (a reasonable proportion of infected individuals infect several people), and a lack of effective treatment and/or prevention (vaccination).

WHO Situation Report 21 for 10 February (released at 6am 11 February Brisbane, Australia, time)

China: 40,235 (3,073 new); 6484 (296 new); 909 deaths (97 new)

Rest of the World: 329 (12 new); 1 death (0 new)

Because the WHO is compiling the data globally the Chinese Government data is more recent and I will include that here also:

Deaths in China in previous 24 hrs: 1,021

I get these figures from Bloomberg television when they are released at around 8am Brisbane time. Bear in mind that politics will play a part in how data are treated and publicly released. It is the case in all countries, though the degree of effect varies.

Significant developments over the last 24 hours:

  • another 66 people that were on the Diamond Princess in quarantine in Yokohama have tested positive bringing the total of cases to 136 (the total on-board population was around 3,700)
  • the WHO Situation Report 21 states that around 50% of confirmed cases in Singapore, of a total of 43, were cases “with possible or confirmed transmission outside of China”
  • UK has declared the coronavirus outbreak a serious and imminent threat to public health, meaning that people with coronavirus can be forcibly quarantined and will not be free to leave, and can be forcibly sent into isolation if they pose a threat to public health.

Those people on the Diamond Princess complaining about their conditions need to accept that quarantine is not about the people held in quarantine, it is about protecting the broad population, as the UK directive makes clear. Perhaps they should be grateful that if they do contract the infection then they are in about as favourable a position as one can be given it will be detected early and they will receive excellent treatment within a sophisticated and well resourced medical environment. Other people should be so fortunate!

We remain in a wait and see situation but everybody should be taking this threat very, very seriously.

I asked my 11 year old son yesterday whether the children at his school were talking about the outbreak. He said that initially there were jokes in the school grounds, but now nobody has said anything for days. I asked if he thought that was because they were not worried – he said he thought it was the opposite. He said he thinks that the parents are not talking about it so that is making the children more scared.

I can understand in some ways why the parents are not talking about it with children, because the Government is not talking about it, probably for political reasons (concerned about impacts on opinion polls coming after the bushfires, and concerned about the impacts on the economy which would also impact on views of the Government). 

It is time these people realised that anxiety builds in people when they sense a threat. (Jo Hockey might think it is OK to abrogate leadership to the Facebook masses which lead the politicians via them picking up on trends through focus groups – as he said on 7.30 recently – but unsurprisingly what people need most is real Leadership, with an intentional capital “L”.) Not talking about scary things only amplifies that anxiety because people assume that the threat is very serious (anyway) if they are not being told about it. And they have no information on which to confront those fears.

I understand that it is a very challenging situation to handle. But, as usual, prioritising political self interest will always result in inferior outcomes for the people. And I am concerned for the psychological damage being done to the young who sense the anxiety within society at present.

Finally, and I place this last because on the one hand the range of estimates is so wide to make the work very preliminary (as the authors note), and because those likely to see the glass half full will jump on the low range of estimates (as has been reported in the press today), while others more inclined to the see the glass half empty may be frightened by the high range of the estimates. The Imperial College London, the WHO Collaborating Centre for Infectious Disease Modelling, has produced their latest research providing case fatality ratio (CFR) for three categories of coronavirus infection from this outbreak.

“For cases detected in Hubei, we estimate the CFR to be 18% (95% credible interval: 11%-81%). For cases detected in travellers outside mainland China, we obtain central estimates of the CFR in the range 1.2-5.6% depending on the statistical methods, with substantial uncertainty around these central values. Using estimates of underlying infection prevalence in Wuhan at the end of January derived from testing of passengers on repatriation flights to Japan and Germany, we adjusted the estimates of CFR from either the early epidemic in Hubei Province, or from cases reported outside mainland China, to obtain estimates of the overall CFR in all infections (asymptomatic or symptomatic) of approximately 1% (95% confidence interval 0.5%-4%).”

The authors qualify these results with the following statements:

“All CFR estimates should be viewed cautiously at the current time as the sensitivity of surveillance of both deaths and cases in mainland China is unclear. Furthermore, all estimates rely on limited data on the typical time intervals from symptom onset to death or recovery which influences the CFR estimates.”

Those figures are concerning to say the least – I do not believe that I need to unpack these data any further.

Today I am going to discuss likely actions by Governments, likely economic impacts and discuss any reasons for optimism.

Likely Actions by Governments

Authorities in all countries will have been drawing up plans for many years on how to deal with this type of event. This represents the most serious challenge to that planning.

Presently every developed country will be asking themselves these questions:

  • what is our capacity to test everybody displaying flu-like symptoms and at what point do we start and at what point do we stop (and devote resources elsewhere)
  • at what point will we stop large public gatherings (sports events, conferences, concerts)
  • at what point will we close schools
  • at what point will we stop public transport and encourage employers to ask employees to work from home
  • how will we ensure that we can continue vital services such as health, water, electricity
  • at what point do we close the borders completely to all non-citizens or residents

As I said in my original post, being in the southern hemisphere – heading into the seasonal flu period – and our proximity and links to the original outbreak area – will mean that there will be greater pressure on our authorities to act decisively. They will be balancing up the impacts on society – the damage of scaring people when it is clear just how concerned authorities really are about this outbreak versus the significant benefits to slowing the spread of the virus within Australia. They will also be balancing things in relation to impacts on the Australian economy which is incredibly vulnerable (I have been talking on MacroEdgo and in earlier blogging activities for the previous 12 years about those vulnerabilities.)

I expect that this outbreak will take over a year to clear – we may well be living with it for several years if none of the current anti-viral drugs are effective and if there are challenges to developing and producing a vaccine.

Economic Impacts

Bad… very bad… under virtually all reasonable scenarios from where we are now.

I expect that central banks will try absolutely extraordinary actions (as opposed to the already “extraordinary” actions that we have become desensitised to over the last decade). The problem will be how to safeguard the economy by creating activity when most activity runs counter to the best way to reduce the spread of the virus. We hardly want more people out and about shopping, or even working together. As I said above, I believe most workplaces will need to either put people on paid leave or working from home.

Any stimulus to create activity will need to be activity that does not require people to come together. Thank goodness for electronic communication, if our networks hold up.

In the developing world, I wonder what might happen. It might be that they have no choice but accept the mortality rate as it is while their people go about their business relatively normally. As I said in my original report, these people need to work in order to eat. A 2% mortality rate is not such a huge departure from their normal life experience unlike those lucky enough to live on “islands of prosperity”.

This might even end up being the case amongst blue collar workers in China, though I suspect that nobody is going to want to take delivery of products out of factories where there has been no biosecurity efforts. So who will they produce for?

The realities of an inequitable world!

Reasons for Optimism?

At this stage I have not seen any data or anecdotal evidence that I would trust which increases my optimism. What is being said about a levelling off in case numbers in Wuhan and the relatively few deaths in the rest of China thus far does not provide a lot of comfort – the political situation in China now decreases the incentives for accurate reporting of any data which would suggest a worsening of the situation. In any case I would imagine that diagnostic capacity in China and definitely Hubei would be fully stretched (as I discussed in my initial report).

For me all eyes are now on what happens in countries where we can have more trust on the reporting of the outbreak (based not just on incentives to report accurately – or less inaccurately – but on capacity to do so). How quickly will it spread and how virulent is it really. There are no good indications on either of these points pointing to a more optimistic outcome, unfortunately, not yet anyhow.

Will any of the antiviral drugs currently available or in late stage development be effective? Will a vaccine be relatively straight-forward to develop, manufacture and administer?

I am certainly not qualified to estimate about pharmaceutical responses, but I am guessing that even experts within these fields will have a great degree of uncertainty around their views.

Eventually humanity will emerge from this event. We will never be the same, as I made clear in my initial report. That is sad.

We will all suffer loss. We already have. But humanity will go on. Even if the mortality rate turns out to be greater than 2%, the majority of people infected will survive the infection even if we (they) need to endure its spread for several years.

Nobody is immune and viruses do not discriminate. Our elderly and young are more at risk.

Let us hope that humanity can get its act together after this event.

I am for a united humanity!

Are you?

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© Copyright Brett Edgerton 2020

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