In my opinion, COVID-19 is well out of the box. There is no ‘window of opportunity’ to prevent a pandemic: it’s out there, and it’s spreading.

Let’s start with some stats. As of 22 February 2020 16:40 -8 UTC, worldwide:

  • 78,669 confirmed cases
  • 23,003 recovered
  • 41,654 currently with a mild case
  • 11,553 currently in serious or critical condition
  • 2,459 have died

In other words, the current overall case fatality rate = 3.125%. This is a lot.

But there’s another way to look at it. Worldwide, if you look at COVID-19 from the perspective of closed cases (resolved either by recovery or death) and open cases (still sick), the numbers seem daunting

  • closed cases (resolved by recovery or death)
    • 90% recovered
    • 10% have died
  • open cases (still sick):
    • 78% mild
    • 22% ‘serious or critical’

the story is a little different outside China where there are fewer cases and many are in rich countries with top of the line medical systems that were forewarned:

  • case fatality rate = 0.97%
  • critical/serious = 3.8%

These are still large numbers.

I’m not convinced any of them are reliable. For one, China’s method of counting has changed twice, and, for another, I believe many countries—North Korea, for example—are simply not reporting at all. We had no window into Iran, where in 24 hours they went from insisting there were zero cases to five people being dead; this does not inspire confidence. So far we have only one reported case in Africa—in Egypt—and a grand total of none in Indonesia (which I flat out don’t believe). My conclusion? Really, we have no idea what’s going on.

For several reasons I think we’re not in good shape.

  • A report from Imperial College London, Faculty of Medicine estimated that “about two thirds of COVID-19 cases exported from mainland China have remained undetected worldwide, potentially resulting in multiple chains of as yet undetected human-to-human transmission outside mainland China.”
  • The virus spreads asymptomatically—from people with no cough, no fever, no lung involvement that would show up in scans. Not only that, it spreads from people with such low levels of viral load that in initial testing is negative. How can you stop a virus if you have no idea it’s there?
  • According to the Journal of Hospital Infection, corona viruses can persist on surfaces for up to 9 days. So not only have countless people gone into the world carrying it, we can’t detect those people, and they can leave it on a table top or door handle to to picked up as much as nine days later.
  • Professor Gabriel Leung, the chair of public health medicine at Hong Kong University, said most experts thought that each person infected would go on to transmit the virus to about 2.5 other people. That gives an “attack rate” of 60-80%. If at some point (all at once? in waves?) 60% of the world’s population will be infected, then we’re looking at massive numbers. For the US alone that would be over 8 million people requiring hospitalisation, and a significant percentage of those in intensive care. If preliminary numbers from China hold up, that time elapsed from first symptoms to death are about 14 days, the system will be overwhelmed—and this is a top class medical system. What about those countries with fragile systems?

But the key to all this is how much no one knows about COVID-19. We don’t know

  • the R0 rate
  • how rapidly it will mutate—or in which direction
  • whether it will die down in the warmer months (given data from Singapore and Iran, where it is not cold, I suspect not)
  • whether infection confers protective immunity (many other corona viruses don’t; you can get them over and over)
  • whether the virus—which has been isolated from faecal samples—can be transmitted that way
  • why women die less frequently than men

Two good things: various anti-virals are being trialled, and there are indications that some like remdesivir may be effective. (But we don’t know how effective.) Several teams are racing to build a vaccine, and I think they’ll succeed in 14-18 months. But how easy will it be to ramp up production of both anti-virals and vaccines? How effective will they be? How fast will COVD-19 mutate?

So, basically: yep, we have no clue, and nope, there is no window of opportunity to prevent pandemic. The opportunity that remains is a) preparation and b) communication.

Preparation involves quarantine, disinfection and other strategies to slow down the spread as much as possible to give those teams time to get anti-virals and vaccines into production. It means assessing realistically what it will take to keep the world working during this crisis, and, particularly, keep the health systems functioning under an onslaught.

Communication means getting information out there to everyone on a) how to stay safe and b) what to do if you get the virus anyway. The CDC, WHO and others have lots of info on this. My quick and dirty take away is:

  • Wash your hands. All the time. Wash them for between 25-45 seconds in hot soapy water. Wash them front and back and between your fingers and your fingertips. Use 70% alcohol hand sanitiser. Do not touch your mouth, nose, or eyes—or anything that will touch mouth, nose, or eyes—without thoroughly washing your hands first. If it gets bad, I’ll be wearing gloves, and throughly washing, and thoroughly hand sanitising, once I take them off.
  • Antiviral surgical masks are only effective if you know how to use them properly—single use; wash hands before and after removing; don’t move it aside to talk or eat then just slide it back because now the virus is all over your hands, and possibly the inside surface of your mask—and then only in combination with serious hand-washing.
  • Wash surfaces. Use alcohol, bleach, and hydrogen peroxide because plain Lysol is not effective. According to the Journal of Hospital Infection, coronaviruses “can be efficiently inactivated by surface disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide, or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective.”

Everyone makes their own choices but what I plan to do, as always, is hope for the best and plan for the worst. Plan on a staycations, and buy a lot of hand-sanitiser.