Data based Prognostication

Let me give my 2 cents worth. This may give pause to all 3 of you. I am a retired academic physician who is trained in human genetics and has learned a lot of viral genetics during the last 8 mo, especially listening to the podcasts by Christian Drosten (https://asm.org/Podcasts/TWiV/Episodes/Das-coronavirus-with-Christian-Drosten-TWiV-601). My fellowship is in diabetes and I have studied a great deal of immunology and taught that and epidemiology. I have written several articles on COVID-19 and reviewed them with colleagues who treat a lot of COVID patients, especially those with comorbidities and a PhD statistician. Since July 31 I have been carefully analyzing the data from John Hopkins and WHO. (Facebook won’t let me post 35 page dissertation, and I am still editing, although I am ready for my next interview on JPR regarding international consequences of COVID for the US-it has been postponed due to the Alameda fire).

I have not considered making a prognosis as to the status of the pandemic in the US, as there are so many factors and all could change in January (or not).

Comparisons have been made to 1918/1919, but this is a very different world a century later. Gunnison, CO isolated itself for nearly a year and had no cases of H1N1. But Gunnison could provide all necessities for all of the county. It could grow its own food, people made their own clothes and supplies were stockpiled before shutting down the county borders. The US can’t come close to supplying our own food needs, let alone clothing and shelter. The supply lines are disrupted (today I could not get ink  for my printer, as it is made in China) and production is down worldwide.

This virus is not seasonal. Even with restricted travel, the virus is crossing borders and new genetic forms are coming into the US.

The immunology of coronaviruses is very different and tenuous. I do believe a vaccine will be developed in record time. The current record is 4 years and with so many labs all over the world working on this, it should take less than 2. Likely, inoculations will be needed 2-3 times per year. Production and distribution will be a huge challenge and we can’t just vaccinate the 385M in the US, but at least 5B worldwide.

The virus will mutate and vaccines will need to be altered, unless the vaccine being developed by the US Army is successful. The virus will mutate and eventually SARS-CoV-2 will only cause a common cold. That will take about 100 years. In the meantime another major, deadly respiratory virus will jump from animals to humans.

Herd immunity requires vaccination. How cooperative will Americans be with that? Herd immunity from infection was tried in Sweden. Sweden has the highest death rate from COVID of any major country in Europe (Belgium is higher, but much smaller, as is Spain, but they are having a huge spike now from European tourists this summer). Mexico is second to the US. It has a younger population, but a high incidence of diabetes and other comorbid factors, so young Mexicans are dying, as is happening all over Latin America, where the virus is spreading most rapidly at the moment. (I think India will soon pass everyone else, but they are unable to adequately test). Much of our food comes from south of the US border and workers there are often too sick, so harvests are rotting in the fields.

Most young people are ill for only a couple of weeks, but if 20% of your workers are out sick, production grinds to a halt. Also, many previously productive workers over 40 are not coming back to work. Countries of Latin America have few capabilities to institute good social distancing and other measures to stem the spread, so their economies are suffering drastically.

New Zealand has had to shutdown briefly for short periods, but mostly things are functioning like 2019. However, there is no tourism, importations of essential items is very limited. They can attend a concert, but the performers must be local and if your dishwasher dies, start washing by hand.

Denmark and Slovenia have both done well without being isolated islands. In Slovenia, it is because young people trust the public health officials (although not the rest of the government) and have been social distancing and not gathering indoors since February. Meanwhile, their neighbor, the Czech Republic has rampant COVID, tried to open the economy, and now the economy is collapsing because of lack of workers.

Denmark is testing at 6 times the rate of the US.  They have a very functional public health system. If people have to take time off work, they are still paid. Many more child care workers have been hired to keep children in small bubbles. Positive cases isolate with excellent support. New were high in March and April, needing a tight shutdown, but now are less than 16 per day per million inhabitants (including a large number of migrants living currently in Denmark from Middle Eastern countries, where COVID is raging). Denmark does more testing per capita than anywhere else in the world and less than 2% of their tests come back positive. The US tests at 1/6th their rate and over 8% of our tests are positive and it takes a week to get results, so nobody is isolated to stop the spread.

Life is pretty much back to normal for Danes, as long as they stay in Denmark (although they can visit Norway, Finland, Iceland and parts of Germany, but not Sweden). Danes have a tremendous trust in their government, despite having a dozen political parties. Their government is very open and books are easy to read online, so Danes know where their tax money is being spend and know that they are getting a very good deal for their money. Danes are also willing to allow their cell phone GPS data and credit card data (cash is almost nonexistent) to be used to track contacts. This makes tracing contacts of new cases very quick. Danes are likely to be designated the Happiest People on Earth for 2020 (they want the title back, as they dropped to 4th in 2019 (not because Danes were less happy, but 3 Norway, Iceland and Finland worked to imitate what Denmark was doing and moved ahead).

Are Americans willing to do what Danes have done, or even Germans? Is the US government willing to invest in the testing and tracing that is needed to really bring the pandemic under control? Everyone is relying on a vaccine miracle. Have faith, and like Peter, you too can walk on water.

The world could actually eradicate COVID any time it wants.  All the world needs to do is set aside all politics and bickering and wars for 6 mos and work together to get the supplies in place to allow everyone to isolate in a bubble for 50 days and do extensive testing with a yet to be developed rapid, accurate test (although science could develop such a test easier than a vaccine), isolate all positive case and after 50 days, all active cases would be isolated. In another month, the virus would be as rare as Eboli is today (it still exists, but cases are very few and quickly isolated).

So if we continue on the current course with minimal cooperation from young carries, intermittent mask wearing, bars and indoor restaurants still open, schools in a hodgepodge, etc. we will continue to see 55,000 new cases per day through January. Of those, with better care, only about 550 will die, but 40,000 will miss some work or school (ideally all 55,000 should quarantine for 14 days). 25,000 will miss 2 weeks and 5500 will miss a month or more. Nearly 2000 will never return to work or school. This will kill the economy for the next 3 years.

Hopefully somebody will decide at some point (Feb, Mar, Apr, even later) that we need to tightly shutdown and aggressively test and trace with adequate resources for six weeks. That will bring the new case load down to about 60 per day for the entire country. We can easily track and trace 60 per day. Then we can open up and have a normal (like 2019) economy, but we will still have to face the fact that foreign supply chains, especially food will be substantially disrupted for years.

A 60 day shutdown would actually be better for the economy than the status quo.

Since there is a high likelihood the government will not change course, or the American people will not cooperate with a new set of restrictions (even if temporary), many people are going to get ill and productivity will decline. Fear will keep people out of restaurants and theaters, even if they open fully. Lack of workers will force businesses to close and cause even more layoffs.

COVID is not like any previous plague. We will not have the death and destruction like the Black Plague of the Middle Ages, but we could face worldwide economic depression that could last a decade as in the thirties. Will universities be able to remain open without huge government assistance, if many faculty are ill, students are hesitant to attend, as there may not be a job for them upon graduation and many young people are forced to provide for their ill parents and siblings?

If we can unite as a country 2022 or maybe 2023 will become a new normal that is quite tolerable. If not, the virus will finally run its course in a decade, but it will be a very different world.

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