Interim Corona analysis and some optimism

I believe it is a possibility that what’s happening in Italy is an edge case rather than the unavoidable future for most of the planet.

1) There is strong evidence indicating the virus originated in the US. All 5 known strains are present here, while everywhere else has fewer. Even Wuhan, the supposed source of the pandemic, has 1 of the 5 strains only.

This implies that the virus was already active in the US at least several weeks before any news of it started coming out of China. However, we are not seeing Italy-like effects in our hospitals.

2) The cruise ship “Diamond Princess”. 3700 people eating the same food, touching the same door knobs, and breathing the same HVAC air circulating throughout the entire ship. Mostly older people. Only 700 tested positive, some of which aren’t symptomatic.

The perfect grounds for the virus going out of control — way beyond what would be available for it in the wild — and only 20% of people showing any symptoms.

3) This lends credence to the theory that Covid-19 mostly unaffects the vast majority of people, who receive it, display little-to-no-symptoms, and then contribute to herd immunity, protecting even those who are otherwise compromised. Likely, these people who have responded more harshly have simply been treated as if they had a normal flu or pneumonia and released without anyone suspecting they had anything new or interesting.

4) Test results are likely completely skewed. We’ve only been testing for presence of the virus — and only in saliva. Some patients test negative in this manner while still showing presence of the virus in their guts and elsewhere.

The saliva-based PCR test only allows us to see who’s infected *now* rather than who has already recovered, like what an antibody test would show. Antibodies specific to Covid-19 would be present in every person who’d previously dealt with the virus. A widespread test of this sort would allow us to confirm or disqualify this optimistic hypothesis, and generally provide much more information than has been available so far.

5) Even if the above is completely false, the measures of complete isolation being practiced right now will not completely protect us. This is not a storm that we can wait out under the covers. It is only when a significant portion of the population have either had the virus and developed antibodies against it or until we have a synthetic one (~12–18 month estimated in best case scenarios) that we are truly past the danger. Otherwise, infection numbers grow exponentially again as soon as we return to our normal lives.

6) “Flattening the curve” is not practical. With the medical care capacity in the US, it would take years for hospitals working at capacity to treat the number of people current models indicate will require it. We, and certainly the economy, cannot survive years and years, or even 18 months until we can immunize most of the population, of social distancing and general isolation.

The solution that emerges from this all

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A combination of:

a) Attempting to navigate the numbers such that the rate of infection corresponds with what allows medical care to operate exactly at capacity — operating at the peak of the “flat curve”, and

b) Promoting herd immunity through isolating ~only~ the populations most at risk, allowing the economy to continue functioning at near norm while more and more people join the herd of those who can no longer participate in the propagation of the virus.

This seems to be what the Brits are doing, and it relies on this more optimistic interpretation of what’s happening. If they let the healthy people, those who will have less of an impact on the healthcare system, get the virus and remove themselves from the game, the pandemic becomes more and more predictable and manageable.

If they’re wrong, and we’re all Italy-fucked, we’re probably better off living in complete isolation whenever possible and waiting until hospitals ramp up their capacity, more ventilators are manufactured, better tests are available, and better protocols for dealing with the virus are implemented.

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The best solution, which I was hoping the US federal government was into until Trump showed he really was a clueless, bumbling idiot and not a mastermind trying to orchestrate a rise to medical care capacity without panic, is to allow some infections, isolate when models show we’d reach capacity, and wait until more information becomes available — through more advanced (antibody) tests, data from other countries, and so on.

This allows everyone affected to receive the best care available at any phase of the pandemic, allows the immediate and crucial development of herd immunity, allows the economy to function at the highest capacity allowable while this goes on, and prevents a potential exponential runoff. When isolation becomes a necessity and with R0 at 1 or lower, new critical information emerges, and the next steps become clearer.

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It remains to be seen, in the coming days and up to ~2 weeks from now, if we get another Italy. During that time, it is prudent to exercise all the precautions and distancing/isolating that have been recommended. As long as no one’s masterminding and coordinating a well-thought-out response, it’s best to take the best care of yourselves and of your loved ones, assuming the worst — and spreading the best information available, hoping it reaches those who need to see it.

Originally posted on FB, 03.14.20