COVID-19: How I Presently See Things

I know I’m not alone in wondering and worrying about where the COVID-19 pandemic is taking us. Our current circumstances are highly uncertain, variable and complex and are in constant change. We seem to have little control over them.

However, if approached from a high enough level, I don’t find it too difficult to form a general, big-picture understanding of what is happening. And based on that understanding, it’s not too hard for me to envision some reasonable scenarios as to how things may unfold over the next year or two.

I’m motivated to understand and analyze this pandemic for three reasons. First, so that I might make better decisions as an individual. Secondly, so that I can participate responsibly in society from an informed, rational basis. Two practical, pragmatic reasons. My third reason is altruistic. I want to understand and think about this pandemic so that I might see opportunities for transcendence, for this experience to significantly raise us, individually and collectively, the I and the We, to a higher, better way of being.

I’ll start with summarizing how I understand things to be right now. My understanding is based on what I observe and read. I try to discern between fact and opinion and focus predominantly on the former rather than the latter. I try to gauge the uncertainty associated with data and the reliability of its source. I try to distill and simplify. This gives me some confidence that my understanding is mostly correct, but I’m sure I don’t have it all right. I welcome corrections and suggestions for improvement.

So here is how I presently see things.

The virus that causes COVID-19 will be present among humans for the foreseeable future. That might seem obvious, but it’s very important to recognize that what’s happening isn’t a singular event, like an earthquake, fire or terrorist attack. This virus is now part of our ecosystem and we will probably need to learn to live with it. The virus does not care which humans it infects; all of us on this planet are in this pandemic together.

The response to the COVID-19 pandemic will vary greatly around the world. We are still at the beginning of the pandemic and are seeing tremendous variations in rates of infection and deaths not only between countries, but also within countries. Some parts of the world are able to take significant measures to prevent spread of the virus, others are not. It is important to recognize that the pandemic occurs in the dimensions of both space and time. At any given time, different places will be in different stages of infection; beginning, peaking, recovering, beginning again. We are not responding to one big, homogeneous event. We are responding or not responding to many different events in many different places. The pervasive interconnections of the modern world mean that response or lack thereof in one place can affect many other places.

Hospitalization and fatality rates increase with age and when there are underlying medical conditions. Another point that may seem obvious, perhaps, but is important. The consequences of COVID 19 infection are not spread evenly among the population. The old and the poor are disproportionately affected, both in terms of frequency and severity. What may be an acceptable risk to a younger, healthy person may be a fatal one to an older or unhealthier one. This will result in some difficult ethical decisions.

Widespread “stay-at-home” is not a sustainable strategy for managing the pandemic. At the beginning of a pandemic, social distancing is an essential measure to reduce the peak number of infections of a population in which everyone is susceptible. It reduces the surge in demand on medical resources and buys time for response policies and resources to be developed and put in to place. At some point, however, socio-economic factors become critical, the most basic being that most people have to work in order to eat. Richer societies can afford for people to stay at home longer than poorer societies, some of which cannot afford social distancing at all. There is a limit to how much governments can borrow from tomorrow in order to provide support today. Even in rich economies that can sustain social distancing for longer periods, economic inequalities result in the poorest and most vulnerable being hit the hardest by its effects. Social cohesion is of paramount importance in managing a pandemic that pits individual versus collective interests against each other. Compromises between managing the pandemic and managing other societal crises will be necessary. An article published by John Hopkins University states succinctly, “In short, the virus is lethal, but so is poverty.”

Availability of testing will significantly increase. The lack of testing for infections has limited our understanding of the pandemic, distorted data and is an impediment to relaxing social distancing. However, this seems to be a problem that can be solved relatively quickly, despite the political and media drama that surrounds it. The technology for testing exists and is being expanded and improved. The capacity for testing and its distribution just needs to be ramped up, processes that our global economy actually does very well. When testing with rapid results becomes available worldwide, it will open up tremendous opportunities for understanding and managing the pandemic better – a game changer.

Medical treatments will be developed that reduce the severity of illness and fatality rates. The medical community does a good job of sharing information and learning from each other. Many different treatments and interventions are being tried and improved upon around the world. It is only a matter of time for these efforts to result in effective treatments that will reduce need for or length of hospital stays and increase survival rates. If the consequences of contracting the virus are reduced, some increased risk of infection from relaxing social distancing may be tolerable.

Technology will be developed for effective contact tracing. Contact tracing allows those who have been exposed to someone infected by the virus to be notified so that they can be tested and/or quarantined. For more developed, more urbanized parts of the world, smartphone-based technology looks very promising. Apple and Google are working together on such technology. In other parts of the world, existing software (such as Salesforce) can be adapted to leverage the effectiveness and efficiency of health agencies. This technology can be implemented in ways that preserve individual privacy. Being able to narrow the focus of social distancing from everyone, everywhere, to only those who are identified as being at risk in specific locations will be of tremendous benefit.

The duration of immunity after infection is a critical factor. All of the epidemiological models typically cited and publicly accessible right now are Susceptible-Infectious-Recovered (SIR) models. These models essentially look at one instance of an epidemic where susceptible people get infected and recover and then have lifetime immunity to the disease. The SIR model estimates the peak and total number of people who are infected and the time period for a single infectious event. These models are of great tactical value for responding to the initial outbreak of COVID-19 in a population.

However, to understand the pandemic from a long-term perspective, a Susceptible-Infectious-Recovered-Susceptible (SIRS) model is needed. This model considers that those who recover from an infection are only immune for a limited time and become susceptible again. The SIRS model starts off with a high peak infection (the same as the SIR model) and then continues as a stable oscillation of infections over time with peaks lower than the initial infection.

If the period of immunity after COVID-19 infection is relatively long, say a year or more, then it will be something like how we live with the flu among us, albeit with different pathology and infection outcomes. If the period of immunity after COVID-19 infection is short, its impacts and required interventions will be much greater. Unless a vaccine is developed, the duration of immunity is the factor not within our control which will have the biggest effect on how we live with this virus.

A vaccine is likely, but not soon. If a safe and effective vaccine for SARS-COV-2, the virus that causes COVID-19, is developed and can be widely disseminated, we can celebrate an end to this pandemic. It is likely that such a vaccine will be come to be; there are 86 or so candidates currently being developed around the world. One of these might become practical by the end of the summer, and then it is likely to take 18 months to produce and distribute. So, we are looking at living with this virus without the full benefits of vaccination until early 2022. We don’t know if the vaccine for SARS-COV-2 will offer complete protection, like vaccines for mumps and measles, or limited protection, like current influenza vaccines. But even limited protection will make a huge difference once a vaccine is available. And if we never find one? Well, that will be unfortunate and what happens will depend on the characteristics of our acquired herd immunity.

In my view, when I cut through all the politics, sensationalism, fear and speculation, these are the defining realities of our current circumstances. I think I’ve drawn a pretty accurate sketch of what’s happening. Do I have it basically right? Have I missed anything important? Comments encouraged!

Though there is a lot of uncertainty, there is much that is within our control. Theoretically, it is entirely within our reach to manage this pandemic with limited socio-economic damage by testing, contact tracing and limited, focused social distancing. It is also possible that the world’s political and economic systems are not up to the challenge, just as they seem to be impotent, adverse even, to countering the risks and consequences of climate change.

So, what is likely to unfold over the next year or two?

I’ll lay out what I believe to be reasonable scenarios in my next blog post on this topic.