The worldwide spread of the coronavirus disease (Covid-19) is the black swan of 2020. It is the main cause that spurred a chain of events that are currently devastating our ordinary life and the economy.
While we all hope that conditions improve as quickly as possible, the real middle-term consequences of the coronavirus are still unknown and to some extent unforeseeable.
Just one month ago, hardly anybody would have seriously imagined the world economy in almost complete lockdown and over a million infections.
This article wants to put things into perspective and provide some useful links and data to further investigate the phenomena and seriously think about the potential outcomes for our future.
One thing about the Sars-CoV-2 is that it is extremely contagious compared to other kind of diseases. This makes the containment a real big challenge. The chart below should give an idea about what happened just within a month.
The expansion of the virus in Europe is currently going on with some weeks of advantage over the US and, starting with Italy on the 23rd of March, all the governments adopted strong isolation and social distancing measures.
The overall number of cases is still rising, this means that the virus keeps expanding. However, some countries started to record a decline in daily new cases and are progressively adapting to manage the burden.
In the first week of April 2020 the spread of coronavirus seriously picked up in the United States making it the first country as for the number of cases and while it mainly started in large cities, it is progressively reaching communities in the coming weeks.
The availability of large and capable hospitals will make a huge difference for communities, a luxury that not everyone has. Despite no one has precise idea about what the total number of cases will be, estimates projects a serious number of deaths while the virus keeps expanding. This chart, updated at the 8th of April 2020, shows what the worldwide coronavirus outbreak looks like:
This chart is updated every day, make sure to book mark this page if you want to follow the evolution.
Adding up all the countries reports, the total number of worldwide cases keeps rising and it seems that we are still a long way before the aggregate curve starts to flatten.
This is all happening while most of the countries adopted restrictive measures and we really don’t know whether we’ll see a wider expansion of the virus or whether this is just one of the waves of a pandemic that could come back in multiple seasons.
Although isolation and physical distance work to slow down the spread of the virus, we don’t know if they are suitable for a long-term containment and besides that they are unsustainable from an economic standpoint (but that deserves another article).
The development of a vaccine is another potential option, although it requires months or more than one year.
Social Distance and Flattening the Curve for Covid-19
Starting from the very first data about contagion in China, the Covid-19 pandemic showed and exponential expansion. China immediately reacted with aggressive quarantines. Three months later the situation looks quite different and the virus seems to be under control.
It is absolutely necessary to adopt social distancing to flatten the curve. This response truly works, it has been proved by China and also in past epidemics.
The curve we are talking about charts the trajectory of the number of infection cases across time and gives a picture of how quickly the virus is spreading within a particular area.
When you hear about flattening the curve think about all the effort put in place to try to slow down the contagion, including you and me (hopefully) staying at home.
Social distancing is needed to slow down the contagion. This might be the only certainty that we have in this crisis and yet some policymakers are still weighing if, when, and how aggressively to enact them.
Flattening the curve is so important because it makes the difference between life and death since an exponential rate of contagion makes a nation healthcare system to become overloaded and reach the breaking point.
Flattening the curve allows to reduce contagions and delay the spread of the virus preventing large portions of the population from being sick at the same time.
This chart shows how fast the number of cases rises in each country, which is mostly the result of how well we are managing the situation.
I strongly recommend to head over to Our World in Data and check out the interactive chart where you can select different countries, see the evolution at a certain point in time or play the animation.
With the Wuhan model, China wanted to eradicate Covid-19, not only flattening the curve. All the current estimates for the Covid-19 death trajectories assumes social distancing and uninterrupted vigilance respect of the measures by the general public, this what determines how the curves ultimately play out in different countries.
This is something that is often times overlooked when analyzing official reports. There is surely and underreporting of total cases due to difficulties to arrange large scale testing and ways in which numbers are calculated.
A study from the University of Texas used the available data to estimate and project the likelihood of the outbreaks in all the different counties of United States concluding that “COVID-19 is likely spreading in 72% of all counties in the US, containing 94% of the national population.”
This chart shows the probability of ongoing COVID-19 outbreaks for the 3142 counties in the United States. The chance of an unseen outbreak in a county without any reported cases is 9%. A single reported case suggests that community transmission is likely.
This is true for everywhere, not only the United States. There is a high probability that the number of cases reported in every chart and table is far too low.
There is not any broad testing on the majority of the population and testing procedures might still end up skewed towards some categories.
No one really knows how many people have been infected and making sense of who actually contracted the virus, when and where, is even more difficult due to the incubation period that can be up to 14 days.
When talking about what can happen, we should always keep in mind that data do not always accurately reflect the state of the world.
This isolation of so many people in their home for months is an unprecedented scenario in recent history. It’s not even clear how the situation will evolve and what are the pitfalls that will emerge along the way.
In the beginning, hopes were to start rolling again pretty quickly. Now it’s clear that this won’t happen. We are still weeks away from the pandemic peak and there will be different peaks for different places.
At the moment, intensive care units of hospitals around the world are in the midst of a public health crisis and everything is happening into an environment where various measures of social distancing were adopted.
As long as the number of people that need intensive care keeps rising, we shouldn’t expect measures to be relaxed.
Relaxing lockdown measures would risk many more deaths
This means that extreme preventive measures like stay-at-home orders could last months, not weeks, and only when the curve starts to flatten we might consider an ease, keeping in mind that stopping too early will land us right back where we started.
Given how contagious the virus is, as long as someone in the world has the virus, breakouts can and will keep recurring without stringent controls to contain them.
An analysis from the Imperial College London proposed a way to deal with the question of easing and tightening of restrictive measures.
The proposal basically links the intensity of the restriction to the number of people that need intensive care unit (ICUs) treatments, rising the restriction standards when ICUs rise above a threshold and lowering them when they drop below another threshold.
Something quite different than what we consider as normal. Researchers concluded that under this model social distancing measures would need to be in force two thirds of the time until immunity is reached or a vaccine is found.
Building more ICUs and treat more people at the same time is not feasible due to the lack of materials, nurses and doctors to treat everyone, estimating that without social distancing the number of critically ill people would result eight times bigger than the US or UK system can cope with.
How long is this really going to last? The real and honest answer is that we really don’t know.
Some experts say that life could go back to something that we might recognize as normal when 60 to 80% of the population becomes resistant to Covid-19, either because they’ve had it and developed immunity or because we found a vaccine. This could take years.
Right now (8th of April 2020) the virus keeps expanding. Some countries in Europe are starting to see the pandemic curve to flatten while other countries around the world like the United States are still into an exponential contagion phase.
It appears that social distancing is here to stay for much more than a few weeks.
The time it takes for the number of new cases to decrease will depend on several factors like density of population, the number of vulnerable people, how many measures are taken and when.
But it also depends on how well everyone follows the rules of social distancing. Current projections for the contagion assume continued and uninterrupted restrictive measures. However, if people don’t respect social distance and don’t adopt all the precautions, the trajectory of the pandemic will change dramatically for the worse.
It is absolutely critical to break the infection chain. You can’t be sure you aren’t part of an infection chain unless you’ve had no symptoms for over 14 days from any interactions with the last person who might have been sick.
The drawback is that the time of physical distancing needs to be counted over multiple incubations of the virus. One person may encounter multiple infected persons during a period of time, and so multiple chains need to be broken while the clock starts over each time.
To find a solution we need first and foremost to test more people. The more evidence-based insights virologists and epidemiologists will gather, the more we’ll understand the disease better, including how it spreads and who spreads it.
Doing a large number of tests is not feasible at the moment, due to current test methods and logistics. Getting back to normal life, therefore, isn’t possible for another few months. We better prepare for that.
While lowering the standards is sure to cause a second wave of infections that could undo any progress made in trying to slow the disease, it’s less clear what day-to-day life will be like for a while.
In the short-term it’s the start of a completely different way of life that unfortunately will produce damages on a large portion of the economy.
Many compare this situation to a war and I think that there are good reasons for that.
The General Director of the WHO, Dr Tedros Adhanom Ghebreyesus, said that “this is an unprecedented crisis, which demands an unprecedented response”, while the International Monetary Fund warned that global economy is set for its sharpest reversal since Great Depression.
This crisis will end. Hopefully many projections that you read about will be wrong and we will start coming back to some element of our normal lives.
Meanwhile, we should take the pandemic seriously because everyone has a responsibility, not only to protect themselves, but to protect their friends, family, neighbors, and community.
Thanks for reading!
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