My Personal Thoughts on the Coronavirus: 1. Making Sense of the Reality

Last week, I was supposed to be in Frankfurt delivering my keynote at Shift/CX. Instead, I was locked down at home in SF and giving the 1st part of my keynote digitally across the world. Thanks, and no thanks to the Covid19 Pandemic. Part 2 of my keynote will be delivered virtually this Thursday if you are interested.

Since this insidious virus has put me at home, I thought I’d take the extra time I gained from not traveling to jot down some personal thoughts about this unprecedented crisis. Most of you probably didn’t know that I have a Molecular Cell Biology background as well. After all, this is the 2nd time I am going through an epidemic (the first being SARS when my families were in Taiwan), although SARS wasn’t nearly the magnitude of Covid19.

The Biological Reality

Covid19 is a novel coronavirus, and that means we humans have no defense against it. That is just a biological fact, just as it’s the laws of physics. The sad reality is that it only takes 1 successful genetic trait for a virus to spread globally. For Covid19, that trait is asymptomatic transmission. We were able to keep SARS contained because only the visibly ill will infect others. But Covid19 is an invisible enemy, because you are infectious even when you have absolutely no visible symptoms.

Public Health Containment

How do we prevent the inevitable? Until we get an effective vaccine, we really can’t stop it! It’s only a matter of time for Covid19 to infect the global population. But we can slow it’s spread, and buy us more time to develop that vaccine. How? Isolate all the infectious sources and quarantine them! No one will dispute this, but how do we get this done in a country where anyone can be infectious without any visible symptom? This is a public health challenge.

1. We must first prevent further spread of the virus, otherwise, we may never catch up with the spread. The key here is to limit the movement of any possible infectious source, which can be anyone, because we have an invisible enemy. Unfortunately, this means we’ll need to lock down the country’s borders (potentially cities), and test and screen everyone crossing the border.
2. Since this enemy is invisible, our medical infrastructure must have enough capacity to test and screen broadly in order to find all the possible infectious sources inside a community. The key is to catch all the infectious sources before they infect another. This means we must trace, quarantine, and screen all contact histories of any known infectious source for at least as long as the incubation period of the virus (i.e. 14 days), because they are all potential new infectious sources.

The vastly different approaches taken by different countries depend on the screening capacity of their medical infrastructure. Countries that have a high screening capacity (e.g. South Korea, Taiwan, etc.) may not need to lock down their cities, although a city lockdown could help ensure a more comprehensive screening. If a country can screen faster than the movement of the infectious sources, they should be able to catch and isolate all of them. Otherwise, in countries with low screening capacity (e.g. USA, UK, etc.), a city lockdown is needed to ensure no infectious source is missed. If you missed just 1, then you will need to start from scratch again.

Will This Be Effective?

Watching the cases exploding in Italy, Spain, and New York, it’s hard to know if our containment measure is working? The effectiveness of the containment depends on how well a country’s citizens comply with the above containment measures. This requires a collective effort from everyone. Locking down the city would be useless if people (even just a small number) are still running around the street (e.g. Spain and Italy).

Although epidemiology and public health are very complex, because they involve humans with emotions, economics, politics, etc. Simulations from Grant Sanderson illustrate the validity of our containment measures.

Social distancing works if we are outdoor, where the sun’s UV can destroy much of the virus particles. If we are indoor (e.g. in subways, elevators, etc.), social distancing is not enough, we must also not touch anything touched by an infectious source. Unlike other virus, Covid19 can survive and remain infectious on hard surfaces for 72 hours. Since we can’t possibly know who touched what in the past 72 hours, if you touch something, anything, wash your hands!

Stay home, stay healthy, and stay tuned in. See you next time!