Coronavirus (COVID-19) Update 4 September

WHO has stopped releasing daily Situation Reports and wisely is publishing a dashboard (similar to Johns Hopkins). As at 6:31 pm CEST 3 September, there have been 25,884,895 confirmed cases globally with 859,130 deaths.

Source: John Hopkins University. Now that exponential growth in case numbers, and consequently deaths, has taken it’s toll, these trends now resemble fully-laden tankers which deviate from their paths only slowly (except for Peru, which is a little odd but probably reflects reclassifications). The Americas remains the worst affected region, and that upward inflexion in US deaths is now visible, though Brazil (and soon Mexico and then Columbia) has overtaken the US in term of deaths per 100,000 people. There is no other way to describe this for Americans but very sad, because it should be obvious to all that the self-proclaimed leader of the free world, and the world’s richest nation, should have done a whole lot better at protecting its people than this…

It is difficult to believe that one whole month has passed since my last “Update”. Of course, I have not remained silent over that time writing 3 COVID-19-related posts which I consider some of my most important work:

The outbreak in Melbourne has been dampened by the introduction of stringent social distancing measures but daily new cases are not yet consistently below 100. Moreover, the psychology of the situation, understanding that stringent measures will not be eased until confirmed cases fall, may be making people with only minor symptoms reluctant to be tested. That is why I agree with mass testing (initially based on pooled testing such as households, etc.) In my previous update on 4 August I spoke of my concern of a northward progression to the outbreaks, and indeed NSW is having a difficult time constraining the growing number of cases (though, being a conservative government, officials are extremely reticent to introduce stricter measures.) And in my state of Queensland authorities are throwing everything at contract tracing what seems to be increasing numbers of flare-ups. While I feel very indebted to the contact tracers, I have serious concerns that (especially) NSW is straining to sustain the effort and prevent a dangerous escalation.

I have to be honest – I am wondering whether we in Australian have been duped by conservative politicians, because I have not heard anything recently about that aggressive suppression strategy defined by an aim for zero community transmission. Instead all I hear from them is pressure, in the other direction, on loosening measures. Worse still, a recent past conservative PM spoke out in very dark Trumpian/BoJo-ian terms (which means it is definitely time to call it out in another upcoming post).

This contrasts with New Zealand which has dealt swiftly, including promptly introducing strict social isolation measures, with an outbreak centred around a frozen food importer and distributor. These measures aimed at minimising loss of life have a high level of support and their people are justifiably proud of their achievements which seem to have enhanced national confidence and cohesiveness.

On a personal note, while I have settled into my new normal, which will persist for some considerable time, and which will never return to its pre-COVID state, but will eventually settle somewhere between the two – the exact positioning largely determined by how effective are the vaccines currently under trial – I have been dealing with a persistent melancholy causing significant intraspection even though my region of Australia has had only minor restrictions over the recent months.

(I should be clear that my family’s behaviour, other than our children returning to school, has not altered greatly since March as we well understand that by the time we learn of clusters often many will already be infected, and we consider it a better psychological strategy to consider life under a COVID suppression strategy to consist of rolling periods of greater restrictions interspersed with only slightly greater freedoms.)

If I am accurate in my intraspection, the sadness that I feel is not really that my freedoms have been impacted by the ongoing pandemic. Rather it is the knowledge that humanity still suffers unbearable loss, and I remain at risk of personal loss, while the pandemic is ongoing.

We are in a flat period of waiting for news on vaccine trials – the hoped for silver bullet. Donald Trump has set a deadline of 1 November for the initiation of a mass vaccination program – conveniently before the election, but not too early before the election so that the undoubted issues will become well known.

As I said in my 23 July update, it is difficult to overstate what is at stake for vaccine companies. In investing parlance, I would describe the risks around an early vaccine delivery to be asymmetric for the vaccine companies, in that they have much more to lose from it going wrong then they have to gain from delivering it a few months earlier.

Of course President Trump only cares about the risks to his re-election.

I doubt very much that many Americans will be given the opportunity to receive the vaccine prior to their winter.

My family, like all others, are in search of some light to the end of the tunnel and I wanted to share how I have come to rationalise our future and how I have been preparing them for it as I do believe it to be one of optimism from where we currently stand if one basic condition is met – that Australia does actually prioritise protecting human life and does authentically aim for zero community transmission.

(If we were to listen to the likes of Tony Abbott, who like to pretend that only “old people” are killed by this virus – as bad as that is in itself – then our misery will certainly escalate along with case numbers and deaths as all but the most ignorant people fear loss of their own and others’ lives.)

I believe that one major key to feel optimistic about the future is to have worked hard on accepting that our pre-COVID reality is lost forever. I said it from my very first writing on the subject in February, and I said it to my family then, also. I also believe that once that has been accepted broadly within society, at that point we will have been through the worst of the psychological challenges because I am certain that things will improve from here if only because we have so much lower expectations. (Of course for some of us it will get worse as we experience personal loss, and that should never be forgotten or downplayed.)

Based on what I am hearing from vaccine experts, I think that we should prepare for (again in investing parlance, my base case is for) a vaccine ready to be administered en masse in about 6-8 months throughout much of the developed world that is around 50% effective and which will require a booster at least half yearly. If we are lucky it may be 70% effective.

I think hoping for more would be to set ourselves up for disappointment, and we also need to be prepared for a lower effectiveness for some (hopefully not all) of the earliest candidates.

I think it will be difficult to make vaccination compulsory, especially given how “new” each of the vaccines will be, especially if they have low efficacy – so lower benefit at the individual level. However, at the population level a lower efficacy level increases the importance of a very high vaccination rate. That will be a very difficult paradox for politicians to deal with.

At the individual level, those who are vaccinated will gain appreciable advantage even from a 50% effective vaccine. If I am confident that the safety protocols have been followed on the vaccine development, then I will certainly be very pleased for each of my family to have a 50% reduction in the probability of becoming infected, and then introducing infection into our household. When that probability is multiplied by the probabilities of adverse outcomes from being infected, the worst of course being death, then I see this as a significant advance for my family.

At the population level, however, a 50% effective vaccine would mean that many measures that have been introduced – by Government regulation and/or by individual choice (such as wearing of face masks) – will need to be continued to reduce the risk of infection to both vaccinated and unvaccinated individuals.

Complacency and fear will continue to drive responses by people. The hard-hearted right wing types who have been pushing for looser measures all along will seek to encourage complacency and over-confidence in the benefits of the vaccine. However, the trauma of the pandemic will mean that many will remain cautious and fearful, which to a point will be justified, but for some that anxiety may create lifelong risk aversion (as the Great Depression did for young adults who remained distrustful of banks for the rest of their lives to the point of stashing cash in their houses and even in their yards!)

The opportunity for a 50% reduction of risk is significant, and those with the capacity to logically think through risk will recognise that quickly and behave accordingly, especially if those additional risk measures are maintained. On the whole I think the population will only gradually shift away from “pandemic behaviours”, and the longer it takes to develop a vaccine with 80-90% effectiveness against the novel coronavirus, and preferably coronaviruses in general, the more long-lasting on a society-wide basis will be those “pandemic behaviours”.

To conclude, the more effective a vaccine and the higher the vaccination rate, the more measures can be loosened without increasing risk to the entire population. These reductions while being at least as safe will improve sentiment amongst the population. For that reason I do believe that for those prepared to accept that we will never go back to how things were before will find this as a source of optimism. (I will discuss in that upcoming post that this inability to let go of the past, as encouraged by conservative politicians including Tony Abbott, is holding people back from feeling greater optimism.)

Bear in mind, again, however, that all of this is predicated on the pandemic not worsening from where it is now. If that occurs, then there is significantly less reason for optimism going forward because our expectations will first need to re-base even lower.

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© Copyright Brett Edgerton 2020

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