COVID-19: A Laycat's guide to what to consider / watch for
Sources of information are sufficiently easy to find, and developments fast enough, that I"m not going to keep up with all developments. I cannot. See my comprehensive post from 4 days ago for sources.
Items covered here:
- What to consider.
- What to expect and look for.
- Basic safety tips.
What to consider
Again: China appears to be containing the epidemic. Growth is now several times larger outside China than in.
Outside of China, COVID-19 seems to be entering its epidemic / growth phase. Testing and monitoring have been insufficient, widely criticised, and are likely to continue to be in many regions.
Writing of Iran two days ago, I suggested that the case count given death rate looked too low. That hunch was rapidly corroborated by experts, and Iran's case counts have since climbed into plausible territory for surveillance, but likely represent the ground truth of two weeks ago. Spread both within and outside Iran based on travellers monitored elsewhere suggests a current widespread epidemic.
Similar logic holds true epecially for Egypt which likewise has a low official case count but numerous travellers passing through Egypt testing positive for SARS-CoV-2.
In South Korea, by contrast, the total tests administered are high in number, the possible cases fairly large, but the death count low. Many tests are returning negative, suggesting that test coverage is wider than the epidemic's reach, a good thing. The corresponding mortality rate is also low, suggesting marginal cases are being detected.
In both cases, the key information is that incomplete reporting and monitoring may be identified by comparing the high-severity case count and deaths to the expected averages. That's about five perecent severe cases, and a total case fatality rate (CFR) of 3.4%. (Revised upwards in the past day.)
The U.S. has recently eased limits on who is tested and taken measures for more test kits to be produced. Expect total case counts to rise, quite possibly by large amounts. Key is to look at the case-mix: mild, moderate, severe, deaths, and recovered cases. More mild and moderate cases relatively is a good sign and indicates more complete monitoring.
U.S. leadership of the COVID-19 effort, particularly at the White House, leaves much to be desired. This is unfortunate, but a reality. I'd prefer not to focus discussion on the who, though the what should be done is open for discussion.
Characteristics of COVID-19 other than its raw transmissibility are major considerations. The long asymptomatic-but-infectious period, relative ease of spread through droplets, possible airborne or other transmissions (the Diamond Princess spread raises questions of how 600+ members of the 3,500 passengers and crew were infected), possibly re-infection or re-emergence, and a fairly high 3.4% CFR, nondistinct early symptoms, faulty test protocols, limited test kits, long lag between infection and test reports (2 weeks), rapid growth rate, and institutional and governmental denial, all increase the risks posed by this epidemic.
There's a very long lag between an infection occurring and it being counted, about two weeks. This means that all available infection count data in growth regions is a look into the past, and actual _current infections are likely as much as 100x greater. This fact has been missed in virtually all mainstream coverage I've seen, though some medical sources are discussing this. The problem is that we simply don't have current confirmed measurements to tell us how bad things are, we have to extrapolate based on existing measurements and models of epidemic spread and growth.
If you're in the U.S., stop thinking in terms of "the outbreak in Washington State". That outbreak has already been detected in North Carolina, and has all but certainly spread elsewhere. Given test protocols, we won't know, probably for another few days. Hopefully in less than a week or two.
What to expect and look for
There are an increasing number of event cancellations, largely voluntary. Google, Facebook, Adobe, and numerous other tech companies have either cancelled conferences or moved them online-only. There are several notable holdouts, most particularly the 2020 Summer Olympics scheduled for June in Tokyo. In Europe there are mandatory cancellations of events and performances as well as school closures. Anticipate further cancellations and the possibility of widespread mandatory cancellations of large gatherings. I would see these as a sign of taking the epidemic seriously and a rational response.
Travel restrictions are also likely to broaden. Outside of China, these have largely involved international travel. WIth a case of the Kirkland, Washington, strain of SARS-CoV-2 appearing in North Carolina, internal spread within countries is a growing issue. Anticipate possible internal travel restrictions within Europe and the United States as well as elsewhere. Again, an inconvenient measure, but one not unwarranted or unreasonable.
Product rationing and supply-chain disruptions are likely. Logistics pipelines tend to lag by 2-8 weeks minimum for products arriving from China to elsewhere (which is to say most products). The late-January shutdown in China, somewhat muted by the anticipated closure due to holidays, is likely to start impacting European and American retailers and manufacturers by now. Disruptions within local ports and distribution networks will further snarl distribution, and it's likely that it will take several weeks to start things up again on the other side, when that happens. Logistics tend to be fairly robust, but they've not been tested against shocks like this since major globalised trade began. Exacerbations by panic buying and similar behaviour are also likely.
Financial markets will likely continue to reflect lowered outlooks. If you have no need to sell assets, you're likely ultimately better off not doing so. If you may need to sell to cover obligations ... phasing an asset reallocation over time is less risky than attempting to time the market in one big move. Either way, be prepared for a rocky year.
Again: second-order effects are likely to be the biggest impacts of this outbreak. Worst-case estimates of deaths could number in the tens of thousand to possibly millions, which remains a small fraction of the global population. But disruptions simply to avoid or slow that possibility are likely to have major impacts on local and global economies. Forecasts currently are for growth to halve for 2020, and it's possible that is an optimistic viewpoint. Monetary policy alone can ensure available cash, but won't address supply shortages if those exist of key commodities.
Look for local announcements by state and local health authorities. These should include measures along the lines outlined above, including requests, or requirements, for public-facing institutions and stores to make use of disinfectent and hand gels. Request your local agencies provide this information.
Measures that help the poor and underserved help all. This means sick leave (so your meal or groceries aren't being prepared or stocked by someone who's infected), free coverage for testing and quarantine treatment, healthcare for all, and public health monitoring and preventive measures. Press for these from your representatives and officials.
Keep an eye out for school and work closures. Talk to your manager / employer about policies. Again: request state and local authorities create policies on these points. Sick leave, work-from-home, and other measures should be among those discussed.
Basic safety tips
If you're NOT already sick, MASKS ARE WORSE THAN USELESS. The wrong masks, maks worn or used incorrectly, or when simply not needed, don't help and may increase your risk of disease. Medical personnel are trained in correct use, are at greatest risk, and must be healthy to be able to serve the public. Hoarding masks only limits their access.
If you ARE sick and are travelling among others, a mask may help avoid infecting healthy individuals. It won't help all that much, but even modest protections help reduce spread.
WASH YOUR HANDS. 20 seconds, with soap and water. The virus has a lipid sheath -- a fat-based membrane -- and just soap or detergent alone will break that down and destroy the virus. Warm or hot water is not necessary.
Alcohol-based hand sanitiser is useful when you cannot wash your hands. Barrier protection (gloves) can be used where you must touch public surfaces (transit, elevators, shopping).
See Laurie Garrett's reccomendations on these and additional points in Foreign Policy magazine.
#covid-19 #ncov2019 #coronavirus #epidemic
