The following is a letter that I wrote and have sent to a few family and friends. Given the news today I decided to I would post it here for my broader family and because I haven’t had time to write individual messages to all those I intended but know most of them will see if through the links to my posting here.
RE: Thoughts on the global coronavirus crisis – February 25, 2020
Dear friends and family,
Good afternoon. I’m sending this email to many of my friends and family. I’ve debated for several weeks about how to write this email or if I should at all. The events of the past weekend moved me to action. What I am about to say may initially sound a bit alarming if you have not been tracking the progress of the coronavirus over the past two weeks and given the generally dismissive feelings among the general public but I know that not saying something now will result in a possible loss of a window of opportunity to prepare oneself for a variety of possible outcomes. Please take what I write below as my informed observations and thoughts on the current SARS-CoV-2/COVID-19 viral epidemic and likely soon to be pandemic.
I’ve been following the coronavirus story very closely since early January. I’ve tracked its progress every single day and follow multiple virologists and their scientific discussion forums. I’ve read many of the latest papers written about this particular virus and the coronavirus family in general. I have also been reading scientific papers that have analyzed the history of pandemic flues. Some of my research was done so that I could discuss the virus with a college course on Genomics that I am currently teaching. All of this this combined with my admittedly paranoid-tendencies has caused me to lose much sleep over the past several weeks. However, I’ve talked to enough experts to realize that my thoughts and conclusions are not without merit. My search through what I believe are trusted sources providing realistic outcomes to this viral outbreak have forced me to conclude that there is a good chance we are watching a slow-moving black swan event sweeping the world. Thus, at a minimum these events warrant at least thinking through possible actions we might take or at least maintain awareness of for the time being. The time is very near that world leaders will have to say that it is not a question of how the virus will effect each of your lives, it’s a question of how much. Already our economy is being effected and will continue to be even if the virus never catches hold in the US. However, that unfortunately is now our best-case scenario: some economic discomfort.
We have to consider that this virus is probably unstoppable at this point (and just confirmed today after I wrote this letter: https://www.statnews.com/2020/02/25/cdc-expects-community-spread-of-coronavirus-as-top-official-warns-disruptions-could-be-severe/). By unstoppable I mean that it is going to find its way to nearly every corner of the earth over the next year or two with hundreds of thousands and possibly millions of people eventually contracting the virus. Therefore it’s all about mitigation of the effect of the virus not extinction of the virus as was the case with SARS in 2002/2003. Efforts will soon turn to slowing its progress so that we can learn more about it and how to treat it more effectively. It’s very likely now that the virus will come at some point to your community in the US. The question is when? Two weeks, two months, a year or maybe even longer? I don’t know and no one can know for certain. It won’t come to each place at the same time and in many places it will only effect very local pockets. Even if there were one million cases in the US your odds of getting the virus would be very small but it is still worth considering how to be ready for when it arrives since we can’t know where it could have a local breakout. Your measured reaction can also help to prevent further spread and reduce anxiety of your friends and family.
How much should we worry?
With respect to the latter question it is still hard to say since there are many unknowns. We don’t know how lethal the virus will end up being. We know it spreads easily but still don’t know how long a person with the virus can spread it or how much they can spread it without showing symptoms. The Chinese data not not be completely reliable and so we don’t know how bad it is but we can say for certain that virus is something we cannot ignore.
Many people are saying it’s just another flu (or worse yet, it’s just a virus that causes a bad cold) and look around and say “my life isn’t that different because we are having a bad flu season so what should I worry about?” At this point the coronavirus becoming another flu is probably the most optimistic outcome. Yes, maybe it will be just another flu but all indications at this point are that this “flu” will cause far more serious illness and death than the “seasonal flu.” A normal flu season has a fatality rate of about 1 in 1000 or less of those that get symptoms of the flu. This coronavirus (SARS CoV 2) which causes what is being called COVID-19 has a case fatality rate in China right now of about 3.3% (78,000 cases and 2660 deaths so far as of February 24) with huge variation depending in the regions examined. It is very likely that the number of cases is under-reported or known and so that fatality rate is probably too high. On the other hand there are thousands of people in critical condition and people are dying three or four weeks after first falling ill and so the total fatality numbers you see are lagging behind infections identified. The fatality rate may be as high 3% but could be as low as hopefully 0.5% (5 in 1000). The latter seems to be a rather optimistic number but is still five times the regular flu and so can’t be ignored or treated as if it’s “just the flu”.
But there is a bigger problem. Even if the fatality rate were 0.2 (just twice the regular flu or about what an especially bad flu from the past 50 years has been) it’s not the number of people dying, as tragic as that would be, that is the biggest problem. The larger problem is that a high percentage of people that catch the virus will need to be hospitalized for 10 to 20 days with intensive care. In Wuhan China a study of 77,000 of those that have contracted the virus revealed a very high 19% requiring intensive hospitalization (see: https://jamanetwork.com/journals/jama/fullarticle/2762130?). Hopefully that very high percentage is the result of only testing cases that were already expressing pneumonia and other factors not shared in other places but even if only 5% needed to be hospitalized that would be a serious strain on any health system. Less than 1% of people with the seasonal flu will ever need to be hospitalized. So this virus has the potential to be extremely taxing on the health care system. This is why social distancing and other measures to slow (not stop) the spread will probably be necessary. If it spreads quickly the hospital system will not be able to treat everyone.
It doesn’t take much imagination to understand what could happen to society if this should happen? The panic could be worse than the disease. That would probably be limited to small pockets in affected areas but since we don’t know where it will show up it’s something one should think about how one would be prepared for something like that. I’m still hopeful that the virus will have a lower hospitalization rate and fatality rate than it seems to have now. If it is on the low end, most of us will be moderately inconvenienced. In rural areas very few may be infected. Some cities might see outbreaks but others may see almost no cases at the same time. Even in an outbreak area is there are thousands of cases that still might only represent a small part of the population so even then your chance of contracting the virus would be small but obviously not insignificant. As a result, in outbreak situations it would not be surprising to have schools out and sporting events cancelled and so forth for weeks or even months at a time to allow the virus to slowing work its way through and keep the health system working well. Hundreds of businesses, especially retail shopping and restaurants would suffer significant economic damage where hotspots of infection break out.
In many, and maybe most cases many of you will not be near a significant outbreak and experience strong social distancing measures but there is no way of knowing where it will be breakout and where you may be spared so I believe it is not unreasonable to start preparing physically and mentally for the more serious scenarios. Those would include more lengthy and strict social distancing measures. This might result in loss of income for a period of time, difficulty getting basic necessities and shortages of medications. All experts I follow say that right now, at a minimum, people should be getting their prescriptions renewed, building up a larger supply of non-perishable foods and water, hand sanitizer, wipes, and gloves and thinking about how to care for sick relatives. This is just common sense and the earlier one does it the less panic there will be if the time comes when everyone in a city, town or state is told to stock up on supplies. Just look at what is going on in Italy, videos of cleaned out supermarkets within two days of cases reported in the area.
We are already seeing the signs of shortages and pandemic stocking in the US. Face masks have become difficult to purchase. When I I found that Amazon is essentially out of them now with only high scalping prices on meager supplies. Walmart and Target on-line are out-of-stock. I went to the local Home Depot and all the masks in the paint section where gone and there was a sign saying there was a limit per customer. Remember, this is just the result of a very small percentage of the population attempting to prepare early.
Why isn’t there more talk about this in the news?
Am I just being an alarmist? I ask myself that question all the time. What I hope that I am doing is gathering as much information as I can, sorting through it to make sure the data is legitimate and determining what sources I can trust and which are spreading fear or over-complacency and then doing a risk assessment analysis. At this time I could say that there are many outcomes that are possible and one of those cannot be excluded: that the virus will become a pandemic and cause at least mild social distress. Almost no outcome can be excluded except for the now rosy thought that we will quickly drive the virus to extinction as we did with SARS in 2003.
I am following many experts who study past and present epidemics and I watch what they are talking about and what they are doing. They are preparing and they are talking about the need for these preparations but little of what they say gets out the general public partly because it still seems like the virus is far away from us personally and there are other pressing items to talk about in the news but also because the official words from our government is that “we have it under control.” That isn’t necessarily a lie at the moment (though it is clearly putting the most optimistic spin on the data) but it’s also not providing the public with how to prepare in the event that everything is not OK. It’s not laying the groundwork for a situation with more gravity. It’s kicking the preparation step down the road which is very dangerous.
It has been reported that Trump has told his advisers not to talk about the coronavirus because it might spook the stock market and cause issues with the economy which he is worried will affect his re-election. (Update 2/26: at the time I wrote this the official US government response was to play this virus down but that has now changed in the past day) This is not the time to politicize events. By not talking about possible outcome it leads to the false impression there is no problem and then people will be shocked when the news suddenly changes. It also leaves more room for a variety of conspiracy theories and other bad information to take root. By the time the US government informs the pubic formally that this virus is coming and can’t be stopped it will likely be right upon us.
Added this paragraph after writing this letter: Less than an hour after writing the paragraph above Trump tweeted (Feb 24) the following: “The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!” This is on a day that the DOW is down 900 points at the time and while true there are no new reports of virus in the US, he has no way of knowing that it isn’t being transmitted in the US without us knowing given our very limited testing. I also discovered that Rush Limbaugh at nearly the same time suggested the coronavirus was being weaponized (or was originally even made to be a weapon) to get rid of Trump and then he said that “The coronavirus is just the common cold, folks.” He also suggested that it isn’t that bad because 98% of people that get it survive and barely get sick. These are irresponsible and false (many more people get very sick) words from someone that millions of people listen to. Imagine I said to you that you have a cold and you go into a room and cough and end up killing two people, would you think that was no big deal? We should hope that 2% is not the fatality rate rather than suggesting that it isn’t a big deal.
Thus far we are not preparing people calmly and rationally and little is being done to improve our infrastructure. France has already announced they will start work on a dozen or more new hospitals dedicated to COVID-19 treatment even though they only have a few confirmed cases at this time. No such talk in the US that I have heard of. We are still in the mode of: “this virus might be stopped and so don’t worry.” No, the virus wont’ be stopped (OK, maybe a 0.1% chance it still will be) before becoming common in some locations. Addendum (Feb 25): I see this morning that the White House will approve 2.5 billion dollars to combat coronavirus. That’s a nice start and sounds like a lot but previously they committed 4.5 billion to combat the Ebola virus and there never was much of a chance that that virus would become widespread in the US though it is much more deadly. If the virus becomes as common here as it is in Iran, China, South Korea and Japan 2.5 billion will be nothing compared to what will be needed.
People need and deserve to be informed of what the possible outcomes of this virus may be including best and worst-case scenarios. We should be given advice about what we should be thinking about and given plenty of advanced warning so that preparations can be made in an orderly fashion. The door for doing this well and early has already passed, which is part of the reason I am writing to you.
A second problem is that many Americans have a false sense of security. They believe we have a superior health-care system and country than other places currently effected by the virus and so it won’t be so bad here. OK, let’s grant maybe it won’t be as bad here but there is no guarantee of that, and it’s pretty clear our health system isn’t as prepared for epidemics as those in some other countries. We have a severe lack of coordination within our system at this time. We also have a Center for Disease Control (CDC) who should be overseeing this that has been seriously handicapped over the past 2-3 years. Washington has cut the CDC budget each year and completely axed several directors who oversaw worldwide pandemic research and preparation projects. Since they were looking at diseases such as Ebola and emerging viruses in other countries many in the Whitehouse saw these diseases as other countries problems and not worth spending out money on and cut the pandemic preparation programs. Vaccine development for SARS and other emergent diseases had been dropped over the years with private companies unwilling to invest in rare diseases. This neglect has led to many people being forced out or leaving for better jobs elsewhere leaving the CDC far less prepared and able to respond that it was three years ago.
The CDC is still underfunded and is woefully behind in designing and coordinating test kits. We had tested fewer than 500 people as of yesterday whereas South Korea had tested 25000 and have a testing capacity of more than 5000/day if they have to. Our capacity seems to be only a few hundred per day and samples have to be shipped to one of only four locations and takes a day or two for results. We are way behind in testing which means we are probably missing many cases since we are only testing people with direct connection to China. Canada on the other hand identified a person that had traveled to Iran and had possible symptoms and they are willing and able to test people that have symptoms no matter where they have been. Other countries at this point can be more confident they understand their own problems. We needed to authorize billions of dollars weeks or even a month ago to fully fund every possible agency and create a coordination system and yet we still don’t know who is in control and coordinating our response. I’ve looked and there is no clear oversight and decision-making process in the US. No one knows which agencies are responsible and for what parts of the response and who has the final call on important decisions. These are concerning signs that must be factored into your confidence that the US will do a better job than other countries that are dealing with the virus at this time.
This is one of those times where free enterprise/private companies doesn’t get the job done because the cost of developing vaccines fast makes it non-profitable and so the government must incentivize and just outright pay for CDC research and other private companies to turn their attention to this virus. It will take time get drugs and vaccines ready (see this article for some background about drug development: https://www.theatlantic.com/health/archive/2020/02/covid-vaccine/607000/ ) Every week of delay could be huge. Yes, maybe it will all turn out to be not that bad but not doing anything or the bare minimum is a huge risk to take. I would rather be wrong and have wasted money preparing than done nothing and ended up paying a massive price in lives and social upheaval.
There is growing—and correct—criticism of the Chinese government for ignoring the warnings in late December that a new virus was circulating. Party leaders played it down and held all kinds of huge parties in Wuhan which spread the disease in early January. The leaders clearly hoped that it wouldn’t be bad and that everything would be OK. They didn’t want to spend money, raise alarms or close down businesses because that would be too damaging to the economy. Now they caused countless dollars-worth more damage than was necessary if they has just taken the hit early. It easy to be over here and say they were stupid not to listen to doctors giving warnings and yet it appears our government is ignoring nearly every virologists we have warning that we need to be more prepared and proactive if we want to reduce the risk of great harm to ourselves and our economy. This is the time for making decisions for the future not what is politically expedient and gets us just to the next day. At some point the next day won’t come because of such poor decisions made in previous days.
What can you do?
I’m not talking about building bunkers or selling all your goods and moving to a mountain cabin. This isn’t the end of civilization and production of good will go on. But it does mean inconveniences, even if you are not near a viral outbreak and it does mean that some people will experience much more difficult circumstances for a time. So it would be prudent to think about what you would do in a variety of scenarios and do some planning. That planning might not include actually purchasing much now but at least knowing how you might prioritize your future purchases. You may think that the chance of your family being affected by the virus is very low–and it is. For example, maybe you live in low-population area and can have little contact with people for a while and you have job that isn’t necessary or doesn’t include working with other people. Even in this situation, you may want to think about extended family and how you could help them if some of them get sick. You can educate yourself so that you can be a calming influence. Most problems are caused by panic and poor decision making rather than the disease itself. If you are elderly, you might take more precautions than if you are young since this virus clearly effects those more than 50 with young people feeling fewer effects though they could be spreaders of the virus.
You may want to have your will in order (always good to do anyway), do you have a plan for who would take care of your kids if you are sick? If you are on medications get those prescriptions filled. These are all good things to do that will reduce your anxiety later if you should become sick or have to take care of the sick.
You should ask yourself if your job is one that could be done remotely so you can maintain employment or could you be out of work for a month or two. If you are server at a restaurant and the virus comes through your area you might expect to lose your income for weeks or even months. Knowing that is a possibility you should think about saving now.
Church leaders should plan how they might react to an outbreak in their community. How can they help members of their congregation? Maybe delivering food or other supplies. When should they cancel Church or are their ways to make the gathers of church members less dangerous for spreading the virus. Maybe two services so people can sit further apart? Should you invest now in sterilization supplies? What about visitation policies for the sick and how might funerals be conducted if people are scared to come to a large gathering? There are so many potential questions that thinking early about and having a policy to explain to people when the time comes will help members feel less anxious. In times of trouble people will look to the church for guidance both spiritual and physical. Staying current with this story is important and preparing to meet people emotional and spiritual needs will be challenging. This will be an especially stressful time for church leaders and we need to keep them in our prayers.
This might all be for naught. Maybe the virus will not spread far in the US and maybe it won’t make people as sick as it has been to this point. After all, viruses do mutate and change their characteristics over time. But to simply assume this will happen and believing it will never affect us would not be prudent. Think of it this way. How much money do you spend each year for life insurance, car insurance, health insurance, home insurance and so forth? Do you say at the end of the year when nothing happened that you wasted all that money and decide not to pay for any insurance the next year. You could spend a small fraction of that money to prepare for social distancing and possibly missing a month or two of work. It’s like an insurance plan except at the end you will have all your resources and can spend them later rather than having lost all that money. Furthermore by preparing you may be able to help a friend in need as everyone will be effected differently.
It is also possible that some places will be infected with strains of this virus that have mutated and maybe cause even more damage than we see now. One community may see little viral activity while three blocks away large numbers of people will be infected. No one can say where it will be bad how bad it will be or how long it will last. The 1918/1919 pandemic took two years for three waves of the virus to circle the globe. Today it’s easier for viruses to travel the globe but where it breaks out you can assume that it will disrupt life to some extent for several months at a time.
It is easy to be anxious and this letter will likely raise your level of anxiety. But mental and physical preparation is one of the antidotes for anxiety. Being informed is also important. If you do nothing else, please pay attention to the news about this virus so that you can make informed decisions as soon as possible. As I said before, I may be overly anxious and I don’t want to alarm but I also felt like to not to share what I have learned when an early warning was still possible would be wrong. In a few weeks or months I might feel rather foolish for writing this but I’d rather be wrong and nothing happens than be correct and I never tried to share what I knew. It is up to you to determine what or anything you should do with what I have said.
Blessings to you at this time. Let us pray that God will bring the viral assault on our frail bodies to an end quickly.
PS. Permission granted to share this post in any format you wish and can do so without acknowledging me as the author.
Some links to information about COVID-19:
An comprehensive guide to what we have learned from China thus far compiled from a fact-finding mission by the WHO to China. https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
https://www.statnews.com/tag/coronavirus/ Open-access timely articles on all aspects of the coronavirus outbreak
https://nextstrain.org/ncov The genomes sequenced and ability to look at the changes happening to the virus in various ways (bonus: you can also look at the evolution of the flu, ebola and others here).
https://gisanddata.maps.arcgis.com/…/opsdashboa…/index.html… A dashboard of sorts showing the current stats for infections etc…
https://www.statnews.com/…/two-scenarios-if-new-coronaviru…/ A week old but this article talks about two of the most likely scenarios for how this virus unfolds. The worst of the options is now becoming more likely.
https://en.wikipedia.org/…/2019%E2%80%9320_Wuhan_coronaviru… Lots of information about the virus and the outbreak here.
https://www.cdc.gov/coronavirus/index.html Center for disease control information for US situation.
A few stories about vaccine development which are both hopeful but also present a realistic view of how long it will take for that to be the answer which is why slowing the pace of viral spread will be important over the next year.