Coronavirus: What You Need to Know & Consider Right Now

Health is one of the most critical things that make us feel safe. It is something personal and affects our daily activities and experiences. When we are sick, we feel tired, unfocused and sluggish. And that’s when it’s just a cold or flu. When there is a global health threat, not only are we at risk from becoming physically ill, but we must worry about our loved ones, colleagues, the economy, personal finance, job stability and even physical security in the world around us.

COVID-19 is a time for us to reflect on ethical and strong leadership and what it really looks like- and most importantly, to act. Countries around the world have now put into place national policies and restrictions in an attempt to reduce the spread of the coronavirus. Even Donald Trump has mandated various reforms to prevent the spread of infection, though poorly communicated, coordinated and delayed. (Started as a real disaster, but now the Trump administration is about to approve Universal Basic Income or cash payments direct to citizens of $2,000! An extremely liberal and unexpected move...and one only seen implemented in Hong Kong so far to provide a safety cushion and encourage spending in rapidly weakening economies.) And, Boris Johnson and the UK have finally caved from a previously lax response to near lockdown and school closings- if you review the findings of the Imperial College report released on Monday, you'll see why (chart below).

Only weeks ago, we had no idea that Italy, Spain or Switzerland would reach the exponential growth of infection, death rates in the hundreds and thousands or now some form of lockdown in various extremes. We also did not expect to see the greatest crash to global financial markets since 9/11 or 2008 financial crisis and bank bailouts. So too, while some of us sit in countries where the full effect of COVID-19 has not surfaced yet, there is no reason to presume we will not follow these countries or even be hit harder. For example, I am in Kenya where just 7 confirmed cases of coronavirus have been reported in the last week, but it will undoubtedly grow and quickly.

Beyond the country leaders acting, the state, county, city, company and even family and community leaders must step up. These smaller more localized units are where the virus begins and then spreads. Each of these are made up of leaders and potential leaders who have an obligation to protect the unit or organization they oversee because their community members, employees and families look to them for guidance and effective response.

Start by Knowing and Monitoring the Facts: How Serious is COVID-19?

Waves of information and fake news have flooded social media. It is fascinating to see what is posted on Whatsapp groups to Facebook and more. Please do your research before you trust what you see. Here is some of what I have am seeing from resources I trust, such as the World Health Organization, U.S. Center for Disease Control (CDC), Johns Hopkins University, The Economist, Imperial College and more.

• 164,837 cases have been reported and 6,470 deaths confirmed, as of March 16th; and 146 countries have reported cases. Policymakers and researchers have called this the worst pandemic since the 1918 H1N1 Flu Epidemic, which .
• This is not just the flu, so stop making excuses! Unless you say this is similar to the Spanish flu of 1918, the other worst pandemic in recent history... COVID-19 is now at roughly a 3.4% average death rate globally with up to 15% death rate among the most vulnerable populations by age and physical concentration. Mortality rate increases dramatically to 3.6% for 60-69 year olds, to 8% for 70-79 year olds, and up to 20.9% for 80+ years! This compares to less than 1% death rate from the seasonal flu, and any day now it threatens to affect someone we know. Your grandparents, parents and elderly are at greatest risk. (see below)
• Easy transmissions results in rapid spread without strong discipline in place. The virus is transmitted through the air or through contact of bodily fluids, for example when spit flies when someone is talking to you. Masks may not be effective protection. Recent tests show that the virus can stay on materials such as cardboard for up to 24 hours, and in the air for 3 hours. (Chart below for a recent NIH study)
• Symptoms among the young and healthy can go unnoticed, yet lead to death among the elderly and immunocompromised. Don't put others at risk. A shocking Imperial College report from March 16th projects, based on current data, that 30% of coronavirus cases will be admitted to hospital and up to 50% of those admitted will die. Furthermore, it estimates that 40-50% of coronavirus cases went undetected, leaving those with milder symptoms continuing on and able to infect others. Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death. (Source: WHO. Also, see below)
• Coronavirus can hit the lungs and heart, and this is when it's most fatal. COVID-19 likes to bind to the proteins on your lungs, and thus why many patients have trouble breathing and in extreme cases, may need a ventilator. Patients who require a ventilator or suffer from cardiac effects have an extremely high death rate. Patients who have recovered still often show signs of organ damage to the lungs, and 20-30% lower lung capacity.
• A key issue is capacity constraint of our healthcare systems, and it may compromise our other systems too. The biggest threat in most markets- especially emerging markets are ones with large vulnerable populations- is rapid infection that will overburden our healthcare systems and cause panic among the general population. These are only the direct negative impacts before we consider healthcare costs, lost jobs from sickness and isolation policies, closed businesses, bankruptcies and crashing financial markets that can only be aided by strong, well-funded governments.

Mortality Rate by Age Group

Source: https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

WHO Common Symptoms Chart & Latest Findings

Social Distancing: Why Action & Strong Leadership is Need Now

Different cities take different approaches. The prevailing theory now is that “Flattening the Curve” by enforcing Social Distancing, aka. various levels of self-isolation, will be most effective in reducing overall negative impacts of COVID-19. Social distancing will slow the rate of infection, thus reducing the number of infected individuals requiring medical care at any one time, and thus not surpass current capacity of healthcare institutions such as hospitals, or medical supplies and equipment e.g. ventilators. A mass wave of infection can also have greater financial implications. Failure to implement effective social distancing will prolong the disease’s peak, allowing governments, companies, communities and healthcare systems to plan and manage everything more smoothly.

Social Distancing Goals: Minimize Shock & Overload to Our Systems

Source: NY Times

On March 16, Imperial College released a new report modeling various response scenarios to coronavirus based on existing data and trends for infection rate, hospitalization and mortality rates. It also compared various mitigation strategies or NPIs, Non-Pharmaceutical Interventions, such as suppression (an aggressive mix of social distancing, isolation and institution shut downs e.g. of schools) and mitigation (milder forms of limiting contact)- all of these also known as our only options until a vaccine or cure is developed.

A Recent Modeling of the UK: Critical Care Beds Occupied By Coronavirus Patients, By Different Mitigation Strategies

Source: Imperial College COVID-19 Response Modeling, March 16, 2020.

History Repeats Itself: There are no excuses not to act.

We’ve seen this before with the Spanish Flu (or H1N1) 1918. Social Distancing works and history repeats itself. Why should we presume this is substantially different?

The following chart is from the PNAS (National Academy of Sciences) journal, on Public Health Interventions and Pandemic Intensity During the 1918 Influenza Pandemic, comparing to U.S. Cities’ responses. The 1918 influenza pandemic resulted in unprecedented mortality, with an estimated 500,000–675,000 deaths in the U.S. and 50–100 million deaths worldwide. St. Louis implemented social distancing and closed public venues such as theaters, schools and churches very early on in the outbreak, realizing there was no vaccination in place to treat sick patients. In contrast, Philadelphia did not implement social distancing policies, deciding to let the pandemic run its course. Also, the peak in the St. Louis line suggests social distancing may have been ended prematurely, causing another wave or uptick in infection and mortality rate.

Yes, 1918 was a long time ago, but our modern healthcare systems, especially in emerging economies still has far to come- and capacity constraints beyond that. And just as in 1918, there is no known vaccine or effective treatment for COVID-19 as of yet with estimates of 10-18 months to go before one is confirmed and approved for use.

Public health interventions and epidemic intensity during the 1918 influenza pandemic

Source: www.pnas.org

Africa will be hit the hardest next.

Today, beyond China, Iran has suffered some of the most severe impacts with over 14,000 confirmed cases, and 724 deaths. This compares to recent figures in Europe of 6,655 cases in France (148 deaths); 7,588 cases in Germany (17 deaths); 27,980 cases in Italy (2,158 deaths); 8,320 cases in South Korea (82 deaths); 4,661 case in the US (83 deaths); and 1,553 cases in the UK (55 deaths). Many attribute higher spikes in infection rates and death rates to weaker healthcare systems.

Developing economies were late to the start of infection, but will very likely be the most affected as they are least prepared, and their citizens with limited access to sanitary supplies, soap, masks and health services or information. Countries and leaders in these countries use climate (e.g. warmer weather) as an excuse to not act, but even if the virus does not like warmer weather, it does not mean the country is immune. Others should alert their populations that skin color does not protect them from catching a respiratory virus…

Several Latin American countries have now been hit hard with rising infection rates; and while Africa has only seen the early days, many experts predict severe consequences, especially to dense cities and slums. Hospitals have limited capacity in equipment, supplies and beds; supply chains could soon become a problem with trade routes closing and transportation routes already weak. Here in Nairobi, Kibera, a 1M+ person slum, has people packed into small homes and limited access to sanitation services. While many volunteer and non-profit groups are deploying hand washing stations, clean water and hand sanitizer, proximity and existing health conditions in these places plus coronavirus is a lot of strain. Matatus or mini buses that serve as the main means of transportation are crammed, definitely not being disinfected. And to put additional pressure on, 80% of workers are informal or casual workers with unsteady income as shops, schools and companies close their doors and slow operations...This will surely lead to panic, increased stress and unrest.

Coronavirus Tracker By Country, Infections, Deaths

Source: Johns Hopkins University of Medicine (figure above from March 17, 2020)

Reliable Information Resources

• World Health Organization Coronavirus Information.
• COVID19: The State & Future of Pandemics. A recent virtual conference hosted by Singularity University. Thank you in particular to Dr. Divya Chander, Dr. Daniel Kraft and Amory Lovins whose presentations inspired some of the figures and charts in this article.
• Harvard Health, Be Careful Where You Get Your News About Coronavirus.
• U.S. Centers for Disease Control and Prevention.
• Johns Hopkins Coronavirus Resource Center & Map of Confirmed Cases, Deaths.

Other Interesting Initiatives

• Help with COVID: Projects Looking for Volunteers. List of local initiatives seeking volunteers.
• COVID-19 Solitary Response Fund. Funds will go towards actions outlined in the COVID-19 Strategic Preparedness and Response Plan to enable all countries – particularly those most vulnerable and at-risk, and with the weakest health systems – to prepare for and respond to the COVID-19 crisis including rapidly detecting cases, stopping transmission of the virus, and caring for those affected.
• COVID-19 $125M Therapeutics Accelerator. The COVID-19 Therapeutics Accelerator will work with the World Health Organization, government and private sector funders and organizations, as well as the global regulatory and policy-setting institutions to research, coordinate investments, and pool resources to accelerate findings. It will have an end-to-end focus, from drug pipeline development through manufacturing and scale-up.
• FundsforNGOs COVID-19 Call for Grants. The following site lists various grant funding sources and calls for solutions to the coronavirus outbreak.
• Frontier Tech 4 COVID Action Challenge. This challenge is for new ventilator technologies to help coronavirus patients. Currently, most hospitals and countries have a limited number of ventilators and countries such as Italy are in short supply.