To be clear, there is a line between panic and preparation. Armageddon isn't coming. At the same time, dismissing the risks would be a huge mistake. To illustrate why, I'll go over three points of discussion:
1. The disease will be ubiquitous, but its spread may happen quickly or slowly
2. There will be many, many deaths, but they will be highly concentrated to specific demographics
3. Active involvement by the public can mitigate the impact
1. The disease will be ubiquitous, but its spread may happen quickly or slowly
In many countries, it's not that bad yet. But, if one were to ask if it gets worse, it's not a question of "if" but "when".
COVID-19 is already a pandemic, even if institutions like the World Health Organization refuse to declare it as such. It has, in fact, strenuously avoided using the P-word because of its chilling connotations and the implicit suggestion that containment has failed. While the latter is true in the absolute strictest sense—the virus is virtually guaranteed to continue spreading throughout the globe—the WHO knows that in practical terms containment is a spectrum. Continued efforts to slow the virus's spread will result in better patient outcomes.
Its pandemic status was evident weeks ago with the scale of the outbreaks in South Korea, Italy, and Iran. In our interconnected world, continued spread from city to city, country to country was all but guaranteed. Sure enough, there have been now been over 100,000 confirmed cases in nearly 90 countries, with no sign of slowing down. Indeed, the growth curves illustrate just how quickly the virus spreads.
All of this is because the virus is very contagious. The basic reproductive rate, R0, is defined as the expected number of cases directly generated by one case. For reference, the R0 of the seasonal flu is 1.3. Estimates for the R0 of COVID-19 range between 2 to 3, which experts believe could result in 25-70% of the world being infected. The severity, however, will ultimately depend on how much R0 differs from R, the effective reproductive rate. The greater the difference, the slower the spread and the lower number of people affected. But, no matter how much public policy and behavior widens this gap, it will eventually be everywhere because there are now too many cases distributed over too wide an area.
In the US as in many other countries where many still retain a false sense of security, community spread has begun. In these cases, transmission occurs where there is no contact with people or places known to have the virus. This is important because an outbreak its infancy can be steeply curbed by diligent ground work, tracing the paths that the virus has taken to prevent further spread. Now, we have completely unknown cases creating new completely unknown cases.
In addition, it's believed that the current extent of the spread of the disease is dramatically underestimated. Part of the problem is that many people are asymptomatic or display very mild symptoms consistent with other infections. In addition, the number of confirmed cases is limited by the very governments that report them. Many countries, especially poorer ones or those already overwhelmed by outbreaks, lack the resources for adequate testing. Other countries have intentionally suppressed the numbers for political benefit.
Many scenarios have millions of cases developing around the world over the next couple months. This may happen on a slower timeline, but it will eventually happen.
One caveat, however, is that it's unknown how transmission will be impacted by the weather. Many viruses are seasonal largely in part because of their weakness to warm, humid climates. If COVID-19 behaves similarly, regions of the world like the US that are about to enter springtime may be given a slight reprieve for the next 6 months. Or, we may not be allowed even this, because many experts believe that seasonality may not apply to this virus. As a population, our immune systems are encountering a new virus for which we have zero prior immunity.
2. There will be many, many deaths, but they will be highly concentrated to specific demographics
OK, so the disease will be widespread. But how deadly is it?
The current WHO mortality rate of 3.4% is overstating the case due to, among other factors, severe underreporting. Estimates for the true mortality rate of COVID-19 largely fall between 0.5% to 2%. This may not sound dire, but we are applying that percentage to a truly vast population of people that will eventually be infected. For comparison, the seasonal flu has a mortality rate of just 0.1% and kills hundreds of thousands of people every year.
So, we have on our hands a contagion that is both significantly more infectious and significantly more fatal than the flu. And unlike the flu, no vaccine exists for COVID-19. It will be at least 12-18 months on an ambitious time scale before a potential vaccine could be deemed safe and effective. Following that, manufacturing and distribution of the millions or billions of doses needed could many months or years, especially if supply chains start to break down. A vaccine will be needed, but it will come too late to save many.
The human toll will be enormous. Applying a 1% fatality rate to a 20% world infection rate, the bottom end of Harvard epidemiologist Marc Lipsitch's recent estimate on the spread of the disease, indicates that eventually as many as 15 million people or more may be dead.
But the overall mortality rate is only part of the story. Outcomes vary dramatically along a few specific demographic factors, most importantly age and preexisting conditions but also sex.
In children, relatively few cases have been reported and zero deaths. On the other end of the spectrum, the elderly are several dozen times more likely to die than younger adults. Ages 60-69 (3.6%), 70-79 (8.0%), and 80+ (14.8%) are at the most risk.
Those with comorbid cardiovascular disease (10.5%), diabetes (7.3%), chronic respiratory disease (6.3%), hypertension (6.0%), and cancer (5.6%) are between six to twelve times more likely to die than those with no preexisting conditions.
Males are roughly 1.7 times more likely to die than females.
Segments of the population who are older and sicker will be at much, much greater risk. They will bear the brunt of the burden, but there are things we can all do to help protect them.
3. Active public involvement can mitigate the impact
Despite the eventual spread of the disease everywhere, it nonetheless remains imperative to slow it down as much as possible.
Flattening the virus growth curve has three main benefits. First, it delays the epidemic in places where it yet lacks a foothold. Healthcare systems will be better equipped with the supplies, staff, and training needed to treat large outbreaks. We will learn more about the disease and how to combat it. And the deployment of a vaccine will be ever closer within reach. Second, it reduces the height of the epidemic peak. When hospitals are flooded with large amounts of patients at once, mortality rate spikes. This was seen in Wuhan, where completely overwhelmed healthcare systems contributed to a mortality rate of 6%, compared to 1% elsewhere. In the US, I believe the systemic overload could actually be worse. Third, the total number of infections is reduced.
Slowing down the spread involves collective action, and that's why it's not only dangerous but immoral for so many people to be complacent. An infected person is an often unwitting vector for further transmission; endangering yourself is endangering everyone that you come into contact with.
Wash your hands frequently and thoroughly. Don't touch your face. Keep some distance between yourself and others whenever possible. Avoid public gatherings wherever you can. If you start to develop symptoms, isolate yourself. If these best practices were universally adopted (and effective public policy measures put into place), the disease will take on a much more manageable trajectory.
As a live tournament poker player, I have come to terms that if and when the epidemic reaches certain proportions, my livelihood may be at risk for the foreseeable future. I don't believe we're at this point yet, and I am currently traveling as planned, but I'm monitoring the situation closely. When Timex made his prop bet with ODB, I thought he definitely got the better end of it. Now, I think that even if the growth curve is slow enough that WSOP organizers decide to continue as planned, I may be forced to skip it. I can think of few places in America that could spread the virus faster. Hand washing may not be enough given the potential level of exposure. The "Rio flu" would be particularly deadly this year.
This is not just out of consideration of myself. Even if I contract the virus, I expect I very likely (>99%) would be fine, and the risk to myself would probably be small enough to justify the income I expect to gain during the series. However, my risk contributes to that of the public at large. Propagating the spread means my sickness might very likely find its way to the over 50 million elderly in America and millions others with a high-risk condition. Acting morally according to the public good, minimizing the amount of human suffering, will involve a degree of self-sacrifice by everyone even if it won't be easy.
I don't claim to be an expert, and there is a degree of extrapolation involved, so it's possible that I'm overestimating the impact. No one knows for sure what will happen. But I have confidence that my underlying assumptions are correct and that the conclusions I've presented are the most likely outcome. And, at the very least, I believe it's better to err on the side of caution.
This post was focused on the human cost of the virus. There are a myriad of other far-reaching social, economic, and political consequences that I won't go into. Suffice to say that the virus is worth thinking about, following, and planning for, even if it isn't fun. I take exception to anyone who is still downplaying the risks. Take care of yourself, take care of each other, and spread the word.
