I’ve been experiencing a writer’s block for some time now, though I don’t really qualify as a writer. During many of these lockdown days, I would start write something, only to delete the draft moments later. My position in leading a team to help the CDC forecast COVID-19 supposedly gave me a close-up view of the COVID-19 pandemic, but I don’t know how I feel about it anymore. Anger? Sadness? Disappointment? People always say one goes through 5 stages of grief, but I think I am stuck somewhere in the middle of the process, and far away from “acceptance”.
But perhaps above all, I feel pain. Pain that people are dying around the world due to this disease. Pain that we didn’t stop this early enough as we did for SARS. Pain that despite my best efforts to help combat the COVID-19 pandemic, I did not have the resources to reach far and fast enough, or convince enough people of its seriousness in its early stages.
But there is no use in reminiscing the past. COVID-19 isn’t done with the world, whether the world is done with it or not. Thus, in the following sections, I would try to summarize what we currently know about the future of COVID-19.
The COVID-19 pandemic is here to stay for at least the rest of 2020, and potentially far beyond.
Despite the efforts of many people and many countries, we have failed as a society to successfully contain COVID-19 in its initial stages. Currently, the world has over 8.7 million confirmed cases, and we are still registering an increasing number of cases every day (roughly 150k cases per day, a majority of which due to US + Latin American countries).
So it is perhaps obvious that this is not going away anytime soon. Our own results estimate that the United States would still have daily 10k+ cases well into August/September, and that is assuming the lack of an organic second wave. With even the most optimistic candidate vaccines not available till at least the end of the year, it is more than likely COVID-19 would still be on your radar by then (among many other things).
We would have to learn to live and love in the time of COVID-19, which is hard. I more than understand the sentiment of people wanting to go outside to do anything, just anything, than being stuck at home anymore. As of today, I have been basically stuck at home for more than 3 months myself.
However, we must not let our efforts go to waste.
Despite the relaxing restrictions, one must still exercise caution outside, as unlike other flu viruses, COVID-19 is still relatively potent in the summer (demonstrated by the large outbreaks in hot and humid places such as Singapore). And trust me, you do not want to get it.
Even if you are living in a country where the second wave is controlled or eliminated (e.g. China, South Korea, Vietnam, Italy), you should not fully let your guard down. With the resumption of international travel even as many countries are still battling an active pandemic, there are many opportunities for the virus to take hold again.
So, avoid crowds when you can, and stay on high alert.
The “Herd Immunity” strategy doesn’t seem to work (yet). Lockdowns saved many lives, but they can be more targeted to reduce the social cost.
When every country in Europe hurried to lockdowns of various form, one country stood out — Sweden. Its state epidemiologist, Dr. Anders Tegnell, said that lockdowns would be ineffective long term, and the only way out is to ensure everyone gets infected as soon as possible so that there is herd immunity, because everyone would have antibodies. He even stated that herd immunity would be achieved in “weeks top”.
This unorthodox opinion resulted in a major debate, and a lot of fire was thrown at Dr. Tegnell. I also didn’t really believe his strategy based on our projections, but we had no data back then. No data means no evidence, and thus I thought I had no right to judge.
But now we do have initial evidence, after 3 months of spread. Compared to its neighboring country Norway (which shares very similar demographics and population density structure), Sweden has 8x the number of detected cases and 20x the number of deaths, despite only having ~2x the population.
This means that during this initial phase of the pandemic, Sweden had roughly 10x deaths compared to Norway after adjusting for population. Not great.
However, in the herd immunity strategy, this is sort of expected — by allowing more people to be infected at first, it is natural that one has more deaths. Such “sacrifice” is necessary so that there is a high degree of immunity in the population.
But what is perhaps surprising is that Sweden doesn’t have herd immunity. Not even near. The latest antibody report (with samples collected from end of May) suggest that roughly 6.3% of the population has been infected. For herd immunity to work though, we need at least roughly 60% of the population to be infected. This is also not higher than many of the countries who went into lockdown mode, such as Spain.
Of course, as mentioned above, COVID-19 isn’t leaving us soon, so the jury is still out. But currently, there is no evidence that this strategy could work, while it has already costed many lives.
In contrast, there is ample evidence that lockdowns did work, and saved millions of lives. That is a win in my book.
This of course not to just brush away the social cost of lockdowns. By conducting a lockdown, a significant proportion of the population lost their jobs, and there are significant mental health implications of a prolonged lockdown, where a lot of people are effectively on “house arrest”.
A potentially significantly better strategy is to conduct a targeted lockdown, where only the extremely vulnerable group (which we know to be people with cardiovascular disease + advanced age) are quarantined, plus high-risk areas such as care homes. The remaining population observes social distancing measures, while contact tracing is utilized to identify any new outbreaks. There is research to suggest this strategy could save >50% of the economic cost of a full lockdown (and a majority portion of the mental cost), while keeping the same humanitarian benefits.
However, while this is a great strategy in theory, This was unfortunately not an option for many countries around the world when it all started. A successful implementation of such strategy would require mobilizing logistics of an unprecedented scale to identify and quarantine the specific communities, while keeping such communities safe during the pandemic. Very few governments successfully spun up even just a reliable contact tracing regime, but those that did suffered much fewer deaths, such as Germany and South Korea.
With a looming potential second wave in the fall, it is up to the individual governments to setup the correct infrastructure so that we are prepared if and when the second wave hits. And most importantly, this needs to be done soon enough.
Masks work, but good hygiene habits work even better.
The policies on mask wearing in Western countries have been perplexing to say the least, especially for people from East Asian descent like me. (Mask wearing is customary there, and people wear them to combat anything from pollen to flu)
Late February and early March, many countries issued notices saying that masks are useless, and encouraged people to stop buying masks. Some even went as far as saying that wearing masks would increase the chance of infection due to improper wear.
In just less than 2 months, there has been a massive 180 degree turn. CDC now recommends cloth coverings for everyone, and Costco even mandates it.
Has science changed in the last 2 months? No (though we have learned a lot). Even before the coronavirus pandemic fully hit many places, we had ample evidence that masks do work. After it started, we now have even more evidence that masks work for COVID-19. So why all the initial denial?
When asked recently, Dr. Fauci, member of the US Coronavirus Task Force, said that the original intention of this policy was so that people wouldn’t panic buy to allow health organizations to have enough masks.
You could’ve said that in the beginning.
But anyways, please do wear a mask in public, especially in crowded areas, and especially if you are in the vulnerable group (cardiovascular problems, 60+).
However, it is true that improper hygiene could negate or reverse the effects of a face mask, and there is research to suggest that just improving hand hygiene could make the difference between a significant reduction and an insignificant reduction in the likelihood of getting infected. So, wash your hands frequently, and perhaps sing Happy Birthday if you are really into it.