Holistic scenarios how to manage and end the Covid-19 - Coronavirus crisis

It becomes more and more visible how government strategies and vigor are the decisive factors in how this crisis will end. This article shows how bad decisions caused havoc, that there is light at the end of the (test) tunnel and announces a “Corona Exodus” program that allows elderlies to escape to a safe haven when suppression programs are not consequently implemented and followed up. 

Why I wrote this article

I am not a public health expert but, through my work as a lithium battery technology consultant, I am well-versed to guide customers on strategic decisions in a rapidly changing marketplace. In the opaque information jungle, my mission is now to endlessly analyze, distill and report the best strategy for the near and distant future. This places me in a more than average position to discuss this crisis. My objectives are to avoid repeating mistakes again and to fuel the discussion on strategies on how to end this crisis in the best possible way and -if necessary- set up the Corona Exodus program.

The Ugly

The ugly strategy is to let the virus go along until herd immunity is reached. In -amongst others- the UK that was the initial strategy, but withdrawn soon after hefty opposition. This strategy is characterized by a fast, intensive cycle and involves many deaths by “calculated nature”. To add insult to injury, this also overwhelms the healthcare system such that most patients do not even make it to the hospital. Luckily, this scenario was not followed all the way through.

A potential danger is that this scenario may be the only one in countries with inferior medical infrastructure, such as in Africa. It did not happen yet, but as explained later on, the higher temperatures in the southern hemisphere Summer may have helped to prevent a massive outbreak. Fall just started…

The Bad

The bad strategy is waiting with measures until the contamination gets out of control. Italy is a sad example, which was unfortunately followed by many other countries, neglecting the warnings. The economy and the way of life were considered too precious. Many elderlies were the victim of countries being utterly unprepared.

In the Netherlands, the question was raised by a senior official, that we should "ask ourselves whether to assign an intensive care bed to very sick 80-year-olds". This is where the bad strategy meets the ugly. The lack of protective materials (caused by ordering too late) for medical and elderly care staff worsened it.

This table shows the approximate connection between fast and decisive government action with associated lower deaths and critical percentages per # cases (green) as well as deaths per 1 million people. High deaths/critical percentages per # cases indicated either many more (not tested) cases, high mortality because of overstressed hospitals, or a combination of both.

Note: In some of the “red” countries people who die without having been tested are not registered as Covid-19 cases. This table may be updated on LinkedIn from time to time. When interested, please follow me on LinkedIn.

The Good

The good strategy is simply: strong measures and very soon. In China, this turned a very bad position into being fully under control in just about a month. In South Korea, massive testing helped to manage the situation quickly. Unsurprisingly, South Korea also had a strict quarantine and isolation program, as well as contact tracking.

I live in Thailand and experienced how good leadership, vision and decisive implementation make the difference. In early February, when the Chinese New Year vacation brought ~1 million Chinese tourists to Thailand, the government was well aware of the threat. At the borders, everyone was temperature-tested and questioned on symptoms upon arrival.

Visitors from Hubei, and of course in particular from Wuhan, were followed during their stay. Part of them proved to be infected and was isolated and/or treated and contact-traced. By this strong strategy & implementation, Thailand was in full control.

As Thailand was still in the containment (“phase 2”) stage, no limitations in daily life were deemed necessary. Unfortunately, mid-March one infected person visited a boxing game, became a super-spreader and infected >50 others. Just 3 days after this became apparent a lockdown was in effect.

This fast response, combined with good compliance of the population to social distancing, protective materials even available to the general population and closure of non-essential shops (similar to Western lockdowns) create the conditions to get back to Phase 2: containment.

Examples of what went wrong

The above evaluation shows that government measures are of decisive influence on the development of such an epidemy. Looking backward, when China would have locked down Wuhan one week earlier, the outcome would have been so different: 5 Million Wuhan residents went to their home towns, mostly in Hubei province, but also all over China and the world.

China’s lockdown was an extreme, strict, but successful implementation. As painful as the lockdown was, almost all Chinese I talk to support the approach of their leadership.

At the end of February, the carnival started in the Netherlands without restrictions and was only interrupted after the epidemy started rolling out. Until then there seemed to be ignorant wishful thinking that the virus would not hit here. Now, the carnival province Brabant is the epicenter in the Netherlands. There was a constant shortage of protective materials and tests, which caused caretakers of elderlies to assist their clients untested and unprotected. A test in a Brabant hospital revealed that > 8% of the medical staff was infected.

Meanwhile, Italian doctors urged other countries: “take this very seriously or we will be your future”. At the same time, people flocked the beaches and DIY markets. “Anti-Corona” parties were the extreme example of ignorant denial. The reason why I discuss the Netherlands is because as a Dutch citizen and father I care about and followed the situation very closely. In other countries, where the epidemy went out of control, similar events must have taken place.

Update April 4, 2020:

The grim consequences of unprotected caretakers are now visible. In some old-age homes, a sizeable part of the population gets sick and dies. The intensive care capacity is already filled to the max and they don't even make it to the hospital.

Most likely, at least part of this group dies because they cannot sufficiently breathe. As I knew there are personal ventilators on the market I checked this out and found that the (Chinese) manufacturer who makes one of the more advanced versions (so-called BiPAP ventilators) is producing 1,000 per week, while they sold 15,000 during the past 3 years. That gave me a clue that many consider this a COVID-19 solution.

These BiPAP ventilators work fully automatic and hence do not need professionals to operate and cost in the range of 500 . . . 1,000 US$. Of course, these low-cost devices do not have the same sophistication as the very expensive ICU versions, but I found several remarks that for patients with not the worst condition, this should work. Here is the one I selected:

I am now considering to offer this BiPAP ventilator directly to the public, after some more discussions with (hard-to-reach) medical specialists. Updates will follow - make sure you "follow me" to be advised hereto.

What the experts say

The Internet is flocked with contradicting opinions; I will not try to discuss them all. Rather, I take a close look at the comprehensive report by the UK’s Imperial College, by the highly respected COVID-19 Response Team. This report summarizes that mitigation is not the right way to go, as in each of the scenarios the intensive care beds are way too short, leading to many deaths:

Suppression is obviously the only alternative and -like China and South Korea have demonstrated, works effectively. When comparing the two graphs, the big difference is caused by general social distancing, but I noticed that the all-important contact tracing was not mentioned. To suppress effectively, I am convinced that contact tracing is key, which also took place in China, South Korea, and Thailand. I believe that this, combined with testing, is the best procedure to localize and isolate/treat.

Proper contact tracing & testing should much reduce a second outbreak, I felt. As I am not qualified to quantify the effects of measures, I searched for opinions to support my suspicion and found a review of the Imperial College report by the School of Engineering of the New York University that confirmed my theory: https://www.academia.edu/42242357/Review_of_Ferguson_et_al_Impact_of_non-pharmaceutical_interventions..._. My conclusion: short lockdowns are the way to go!

Testing

The World Health Organization promoted the concept of test – test – test from the early days. In South Korea, massive “drive-in” testing allowed authorities to determine the infestation locations. Testing is a sure key to resolve this crisis:

Medical staff and caretakers (professionals and family) need to be tested first. This may sound almost stupidly logical -and it is- and it is hard to understand and even harder to accept why this was so massively ignored for a long time.

Abbott (Chicago) claims to perform 50,000 quick tests ( 5-13 minutes)per day: https://www.abbott.com/corpnewsroom/product-and-innovation/detect-covid-19-in-as-little-as-5-minutes.html What helped is that the hardware platform, developed by Alere, was already available: https://www.alere.com/en/home/product-details/id-now.html America First will likely apply here, but this quick-tester shows that our society has the technology to fight this pandemic effectively and efficiently. All over the world, quick-testers are in advanced stages of completion, also in Thailand! There is hope.

Opening the economy after the lockdown

Once quick-tests are available in larger enough volumes, employees can be tested and return to work without big risks. Until (almost) all infected persons are identified and isolated, social distancing will, of course, remain necessary.

Impact of temperature and humidity (under investigation – not proven)

At this time, more and more indications increase the likelihood that higher temperatures and humidity (expressed e.g. as absolute humidity – “AH”) slow down the spread of the virus: https://abcnews.go.com/Health/humidity-stem-spread-coronavirus-early-specialist-hopeful/story?id=69624343 explains why.

Not evidence too (government response, first case are also factors), but my spreadsheet (below), shows a connection between high AH and low infection. Other sources come to the same conclusion, which confirms my observations:

https://www.accuweather.com/en/health-wellness/study-on-new-coronavirus-says-warmer-weather-may-slow-covid-19-spread-and-cooler-weather-may-accelerate-it/707177           https://covid-19calculator.com/en/

The temperatures (°C), relative humidity (RH) define the Absolute Humidity (AH), published when possible at the epicenter of countries with high (orange) and low (yellow) death/critical rates. Researchers state that above AH = 10 g/m3 the spread slows down, confirmed by statisticians.

This table clearly indicates that all the hard-hit countries have Absolute Humidity that favors the spread of the virus. Very few countries with unfavorable conditions are on this list. Southern hemisphere countries had their summer during the spread but now entered Fall. The Caribbean has been very mildly hit, even though millions visited them in Q1 from the USA.

Scenario 1: The virus slows down caused by the climate during the Summer

Based upon the indications above I will describe what I believe are the best practices in this scenario, not to imply that this is the only solution, but as a contribution to the worldwide discussion that no doubt will start soon and, in some cases, probably started already. I do not specify months as the climate conditions differ widely. Calculate the Absolute Humidity and remember: the higher the better, but definitely above AH = 10. https://planetcalc.com/2167/

In addition to the anticipated AH effect, the lockdowns and tests will also show a decrease all over the line, which returns many countries to a manageable (health) situation. However, a decrease does not mean that the danger is gone. Especially vulnerable elderlies need to be only cared for by tested personnel.

As soon as test capacity is available the economy can be re-opened completely. Until then, social distancing remains to be important to avoid a flare-up.

The breather that the lockdown, combined with the warmer weather, offers, should be used to prepare for the second wave. While nobody knows for sure that there will be a second wave, especially when the climate effect shows to be correct, it is better to be safe than sorry. This period will be the moment to arrange sufficient tests, protective materials and hospital capacity, especially IC beds. In addition, of course, to keep developing vaccines and other treatments.

Scenario 2: No virus slowdown related to the climate during the Summer

This is similar to scenario 1 with the exception that more efforts (in particular hygiene, social distancing and contact tracing) will be needed to suppress the outbreak while ensuring that elderlies are endangered as little as possible.

Other treatments:                        (under investigation/test)

While the effectiveness for Covid-19 is not yet proven, we should keep an eye on these proven, cheap possible treatments:

• Tuberculosis vaccine “bacillus Calmette-Guérin” (BCG) is claimed to strengthen the immune system and prevents about 30% of infections with any known pathogen, including viruses, in the first year after it’s given: https://www.bloomberg.com/news/articles/2020-03-30/century-old-vaccine-investigated-as-a-weapon-against-coronavirus
• Chloroquine and hydroxychloroquine have shown, in labs, to be effective against severe acute respiratory syndrome coronaviruses - including the SARS strain that causes Covid-19 - as well as other coronaviruses, the CDC said: https://edition.cnn.com/2020/03/23/health/chloroquine-hydroxycholoroquine-drugs-explained/index.html

Corona Exodus

A week before Thailand went into lockdown on March 26, I had developed this -currently still informal- non-profit program, which has a double focus: 

• To offer an affordable long vacation in a safe haven in Thailand (a pleasant environment) for elderlies who are in reasonably good health, fit & willing to travel and not too attached to their familiar surroundings.
• To provide income for the Thai hospitality industry, who suffer(ed) badly. In 2019, 39 million tourists vacationed in Thailand. In February the loss was 44% and in March it ended with just 500,000 stranded tourists.

In an ideal world, where all countries would implement a (short) lockdown with effective social distancing (not allowing social visits and children to play with others and no gatherings whatsoever), contact tracking and adequate testing, this program would not be needed. Unfortunately, the reality is that many countries take half measures.

To be effective for both purposes, this must be a large-scale program. The main focus will be starting in Fall when the virus comes back (or sooner when there is no virus summer-break of the virus). However, we prefer to do a smaller-scale version of the Corona Exodus program to gather the practical experience, needed to scale-up. This could start as early as a few weeks after approval by the Thai government AND Coronavirus tests are available before departure in participating countries. Inherent to the nature of this program, it will be important that the dates of both flight and stay are somewhat flexible.

Affordability is, of course, important and I am glad to report that we managed to keep the full-board price per day per person at just 22 Euro (29 Euro for single occupancy). Most Western retirees can easily afford this low price, which also includes one support person per 16 rooms and (after scaling-up) a helpdesk.

More information on Corona Exodus

This article will be updated from time to time on LinkedIn. Make sure that you allow notifications to be emailed (or SMS’d). Using additional social media is under consideration. For urgent (only please) questions, please send an email to [email protected]      

Please note that, once the program becomes operational, we will open the website: www.CoronaExodus.org

UPDATE April 2, 2020

My proposed second solution is to use "personal ventilators" (5-600 $) as an alternative when IC-beds with advanced ventilators are not available. Even when Trump would not have reduced the 40,000 "GM" ventilators to 6,000 there will be a huge shortage, just in the US. 

If we take 40% of Dr. Fauci's 100,000 minimum death toll estimate, assume the death % as 2% and the need for ventilation at 5%, then 100,000 is the resulting ventilator capacity. There is no way that this can be filled in time with the ICU-ventilators; with the automatic personal ventilators (that can be operated by laymen) we can at least give it a serious try. One of the options under consideration is a private crowdfunding campaign (as it takes too long to do via the usual CF-sites).

Whether this will work (in time) will depend on the support I will get.

Again, this is just for the US...

Disclaimer: This article was compiled from online data from sources deemed reliable, but the author cannot assume responsibility for the correctness of data.

Check my latest article as well: https://www.dhirubhai.net/pulse/covid-19-when-life-normal-again-james-post/