One Year and Counting….

It was just a little over a year ago that the world was turned upside down by Covid-19. And one year ago, on March 13, 2020, I wrote the first of several articles on Pandemics and Covid-19. Now looking back at the past 12+ months, I would like to muse a bit about what have we learned or should have learned and what it means for the future. 

Bifurcation

Source Our World in Data

We all need to realize that Covid-19 has already and will continue to divide our world into countries that have achieved or are getting close to achieving herd immunity and those that have not. We are globally exhausted from the challenges, restrictions, and the enormous costs in terms not only of sickness and death but from the long-term physiological impacts from the virus. We are experiencing the cost of Covid-19 physically, emotionally, mentally, relationally, financially, and spiritually.  

No wonder we are seeing the growth of “Long Covid” and other ailments in individuals. Tens of millions of people having lost their jobs, we have experienced long periods of social isolation like we have never seen in history, hundreds of millions of people have become sick, and there have been over 3 million deaths to date officially and probably far more in actuality. New cases are spiraling in the southern hemisphere as the annual flu season progresses resulting in new lockdowns and restrictions for many countries. Much of Africa, India, Europe and Latin America are struggling to cope with and contain the pandemic. Mostly likely, many of these areas remain over a year or even two away from victory over the virus.  

Given the large percentage of countries which will not receive the vaccine in significant quantities before the first to middle of 2022 we can expect the chasm between richer countries and poorer countries to increase even more. Most of Latin America saw their economies decline more than 10% in 2020 and other areas of the world also suffered significant economic declines in 2020. While economic activity is expected to increase in 2021 many countries have a long way to go to get back to pre-Covid-19 economies. We can also expect to see a second divide emerge between those wealthier countries that have implemented a more aggressive vaccination program and those that have not.

India just declared new lockdowns as cases are increasing in many states. Canada announced a new lockdown in Ontario, France introduced new restrictions across the country. Sweden, which previously had famously tried to pursue a no-closure, no-restrictions policy to achieve herd immunity now has restrictions on par with the rest of Europe. Additionally, many other countries in Asia, Africa and Latin America continue to impose varying degrees of restrictions and move in and out of some form of lockdown.  

With Covid rampant in so many places there will be a growing call for “vaccine passports” or their equivalent. Already we have seen countries in Asia bar individuals from traveling, shopping, attending events and other social activities unless they can prove they are not sick and have not come into contact or proximity to those who are sick. In Israel, we have seen the introduction of the Green Passport, that allows vaccinated individuals to go to restaurants and bars and other social events while those that do not have the Green Passport cannot. Furthermore, several countries are also in negotiations to promote travel between countries but only by those who can prove “immunity”.  

US Estimated Vaccinations compared to actuals to date.

Given that much of the developing world will take over two to three years to achieve herd immunity, we can expect to see new vaccination requirements for individuals wishing to travel between countries and even within countries. We may even see this spill over to the movement of goods and services.  

Governments should double down on their efforts to provide vaccinations to their own populations and wealthy countries should substantially increase their support of developing, low-income countries.  

Targets for vaccinating developing countries by the end of 2021 need to be increased significantly. Allowing an extremely long vaccination period for large portions of the world’s population could result in Covid-19 variants emerging that have significant vaccine resistance. While this probability is small, the impacts to economies and society due to the continuing spread of Covid are extremely high in many areas of the world.  

Furthermore, it is critically important that all countries should provide unfiltered data and information regarding emerging new virus threats to prevent a repeat of the Covid-19 fiasco. Countries in Asia, the Middle East and Africa in particular, have been the source of most pandemics in the past and must be more transparent in sharing data about emerging threats. Countries unwilling to provide timely and accurate data should pay a price in terms of commerce, trade, and global relations. 

Additionally, countries should come together to learn what practices have been most effective in controlling and containing the virus and what could be implemented within a given country to help manage future pandemic events.

Social distancing can be effective, as seen by the results in many Asian countries, however, these accomplishments require an almost ruthless form of contact tracing and testing. 

Western countries may never be willing to introduce the level of “privacy intrusion” necessary for effective contact tracing and testing. 

Vaccinations also have a large impact on a new pathogen but require significant investment and resources to produce. Countries should consider how to come together to implement a combination of containment measures and vaccine development and deployment to effectively combat future pandemic events.  

Companies need to reassess their supply chains and assess their relative exposure to concentration risks, especially. These risks could emanate from production in a single country or region, to markets concentrated in a single country or region. Companies need to assess the ability to source, produce and market under a variety of pandemic stress scenarios including rolling lockdowns. Companies should assume that impacts and disruptions from Covid 19 will persist for at least the next 18 months.  

It is only by working together that we can exit this nightmare sometime soon and not repeat it in the future.

In the Beginning – Chaos

When the Covid-19 first appeared in the US and we learned the tragic story of the Diamond Princess cruise line, I put together a very rough model to estimate the potential impact of Covid-19 on the United States and by inference the world. This model included the history of the “flu” in the US since the 1918 Spanish flu, “normal” flu hospitalization and death rates since 1970, and inputs from what we were seeing in Europe regarding Covid-19 as well as data from the Diamond Princess.

Diamond Princess Summary

 Given the information from the Diamond Princess we could think of a simple SEIR model as follows (this type of model is used to estimate the potential spread of any given disease):

Susceptible – Everyone on the ship could have become infected.

Exposed – Given the time it took to become aware of, contain, and stop the spread of the virus; we can assume that all or virtually all the passengers and crew were exposed.  

Infected – 19% of the Passengers and Crew were infected.

Recovered – 98.03% of the infected recovered and 1.97% died.  

Since the Diamond Princess population tended to be skewed to older individuals, I took approximately half of the death rate and assumed this would be the worst case, assuming measures of some type would be put in place to contain the virus. Furthermore, the chaotic response aboard the Diamond Princess offers, in a microcosm, a glimpse into the responses and outcomes that have been typical of many countries around the globe. 

Anatomy of an Outbreak

On the Diamond Princess, the virus entered via a passenger who boarded on January 17, 2020 and left the ship on January 25, 2020. The ship then made stops at Taiwan and Okinawa and finally in Yokohama on 3 February 2020. While the virus had been identified on February 1 and the ship was notified, the crew did not inform the passengers. In fact, the crew continued having large scale events over the next few days and not until February 5th was the ship put into formal quarantine. But by that point, certainly all the passengers and crew had been exposed to the virus.  

Given the response on the Diamond Princess resembled the chaotic responses of governments in the January to March 2020 timeframe, I believed it provided a good basis to determine a “worst-case” scenario.  

Based upon this information, I expected the US to have around 327,000 deaths over an 18-month timeframe in the most likely case and 613,125 deaths over that same timeframe using a worst-case scenario. 

Unfortunately, as of March 31, 2021, we have 552,072 deaths (officially) in the United States and 2,825,940 globally. Given the poor quality of data around the globe, these estimates certainly dramatically underestimate the infection and death rates, especially in developing and “data hostile” countries.

Given the current trajectories in the United States, we will most likely approach 650,000 deaths before the end of September 2021 and be at or slightly above my worst-case estimates.

World Divided

Absent significant “breakouts” by variant strains, the death rate in the US will continue to drop dramatically over the next 3 to 4 months as we move towards herd immunity.  

Deaths should move from over 60,000 deaths per month in January and February to under 20,000 deaths in June and under 1,000 deaths in the month of September 2021.  

Additionally, the US should achieve herd immunity sometime in the summer of 2021 (number of people infected and recovered plus the number of people receiving vaccinations). Israel is already nearing herd immunity levels and the UK and a few other countries, who have adopted an aggressive vaccination campaign, should achieve herd immunity by late summer or early fall.  

However, other countries/regions, including most of Europe, will lag by many months to a year or longer to develop herd immunity. Developing countries and regions such as Africa, portions of Latin America, and Eastern Europe will be challenged to bring the virus under control over the next 24+ months unless significant changes are made.  

World 

Source Our World in Data

While initiatives such as COVAX (global initiative working with governments and manufacturers to ensure COVID-19 vaccines are available worldwide to both higher-income and lower-income countries) are striving to deliver Vaccines to lesser developed and poorer countries, less than an estimated 20% of the population in these countries will receive the vaccine by the end of 2021. COVAX focuses on vaccinating the most vulnerable populations in these countries, but much more needs to be done. Furthermore, in Africa, many doctors and health care workers have already been infected and died. In countries with few physicians Covid-19 is even more impactful, due to the high death rate of front-line medical professionals.

Countries in Europe, Asia, Africa, the Middle East and the Americas have administered more than 330 million shots to protect people against COVID-19 since December 2020, with most countries giving priority to medical workers. However, only a few countries in sub-Saharan Africa have even started immunizations leaving health care workers vulnerable and dying in places where they are already scarce.  

Africa

While official statistics seem to show that Africa has fared better than other regions supposedly due to lower average age of the population, experience in past epidemics, and other factors, the real death toll is likely far higher than the official numbers.  

South Africa has had over 140,000 excess deaths since the beginning of the pandemic, yet only reports a little over 52,000 Covid-19 related deaths. Furthermore, most countries in Africa do not have official requirements to report deaths, nor do they have adequate systems to track deaths and their causes.  

While, the youthful population of Africa can provide an advantage, the data from South Africa suggests that the infection rate and death toll is significantly higher than that which is being reported. Furthermore, Covid-19 is causing a significant brain-drain in many African countries as older people with critical expertise succumb to the disease. Many of these individuals are in the front-line and will not be easily replaced.

Americas

While the United States and Chile have strong vaccination programs, most countries in the region are substantially lagging in their efforts to vaccinate their respective populations. Lack of actions by most of these governments and suspicion of both the governments and the vaccines by their general population groups continues to hinder progress across a broad range of countries. Few countries have more than 10 per 100 people who have been vaccinated and will be challenged to reach even 25% vaccination of their countries by the end of the year.  

Countries such as Brazil, Argentina, Paraguay, and others have seen large scale public protests in response to their respective governments handling of the Covid-19 virus. Additionally, portions of Canada just entered new restrictions to try and contain the virus.

Many countries across the region will likely continue to see spikes in the spread of the virus which will result in a continual cycling of lockdowns and easing restrictions which will in turn continue to hurt the region economically and socially. Tourism remains severely restricted and is not likely to recover for some time.  

Data from other, such as Venezuela, is certainly dramatically understated and does not come close to describe the suffering and misery in the country brought on by Covid 19 due both to the disease and the tremendous lack of medical supplies and PPE.

On their current track, achieving herd immunity by many of these countries will likely not occur until mid to late 2022 or perhaps even 2023 or beyond. 

Western Europe

Despite the rampant spread of Covid-19 in Europe one year ago, the continent remains substantially behind vaccination efforts except for the United Kingdom and Serbia. The ineffective approach taken by the EU, raises the specter that Covid-19 will wreak havoc for many more months with continuing periods of significant spikes. France, Germany and other EU countries continue to utilize restrictions and closures to battle the virus with little coordinated activities to gain control of the virus as vaccination programs continue to lag.  

The EU is now looking to potentially restrict exports of vaccines to try and increase vaccine coverage internally. If adopted this program could in turn significantly impact the ability of other lagging countries to improve their vaccination programs.  

Increasing spikes in cases across the continent will continue to occur and will more likely result in new restrictions being implemented on a country-by-country basis. Furthermore, due to the responses of many governments and government leaders a significant portion of the population of the EU remains highly skeptical of the vaccines and a significant effort will be required to put people's mind at ease about getting the shot. This reluctance combined with the slow rollout of vaccines will likely mean herd immunity is not achieved across the EU until sometime in the spring of 2022 at the earliest.

Eastern Europe

Eastern Europe continues to lag in vaccine distribution compared to leading countries. Russia, despite the introduction of the Sputnik vaccine, lags significantly in vaccinating its own population as do most of the other countries in the region. Given the lack of confidence in Russian data, the exact impact of the Covid-19 is difficult to determine. Russia and other parts of Eastern Europe will most likely continue to experience significant impacts from the virus for the foreseeable future.  

Middle East

Some countries in the Middle East are pursuing aggressive vaccination programs. However, countries such as Egypt lag significantly in developing an effective vaccine program and will likely have to contend with Covid-19 for the next two plus years.  

Asia

Outside of Singapore, all countries across Asia have very immature vaccine programs for Covid-19. However, in many of these countries it is also hard to determine the true extent of the spread and death toll related to Covid-19 due to many governments unwillingness to share accurate data.  

Some countries in the region do stand out as being successful in battling the virus and sharing information on the virus, such as South Korea, Japan, Taiwan, and Singapore. These countries have enacted strict social distancing, contact tracing and/or testing programs, severely limited travel, and introduced other restrictions to manage the spread of the disease in their country. Some of these successes can certainly be tracked back to experience and lessons learned from SARs 1, and the willingness of their populations to abide by social distancing guidelines.  

Given the potential and likelihood of future pandemics to originate from this area, it is critical to develop an effective approach for monitoring potential threats. The current processes are broken, especially given the fact that key countries in the area are not transparent and choose to willfully withhold critical epidemiological data.

Oceania 

Australia and New Zealand continue to have strict quarantine requirements. In fact, Australia just implemented new restrictions in Brisbane. However, these countries continue to experience relatively low levels of Covid-19 transmission.  They have been aggressive in enforcing social distancing requirements and provide ample evidence that strict controls and follow up can contain epidemics even without the use of vaccines.  

In summary, countries must come together to review the effectiveness of restriction measures utilized, requirements for rapid vaccine development and deployment, and sharing treatment protocols utilized to minimize the virus’ effect on individuals to develop a more effective global protocol that could hopefully limit the impact of future pandemics.  

Data Sources:

• Covid-19 Data Models and analysis developed by Steven Smelzer
• https://ourworldindata.org/
• https://www.bbc.com/news/world-africa-55674139
• https://coronavirus.jhu.edu/
• https://www.ft.com/india
• https://www.bbc.com/news/world-asia-india-56561095
• https://www.bbc.com/news/world-europe-56466223
• https://www.nytimes.com/2021/03/15/world/italy-covid-lockdown.html
• https://www.scientificamerican.com/article/hidden-toll-of-covid-in-africa-threatens-global-pandemic-progress/
• https://thediplomat.com/2021/03/how-covid-19-changed-asia/
• https://indianexpress.com/article/explained/from-france-to-kenya-heres-a-list-of-countries-that-have-imposed-lockdowns-to-curb-covid-19-spread-7248222/
• https://economictimes.indiatimes.com/news/india-lockdown
• https://www.usnews.com/news/world/articles/2021-03-11/the-latest-israel-vaccinates-vast-majority-of-its-soldiers
• https://www.bloomberg.com/news/articles/2021-01-29/why-sweden-has-tightened-its-light-touch-covid-rules-quicktake
• https://www.timesofisrael.com/fresh-lockdowns-record-deaths-latest-global-coronavirus-developments/
• https://www.cnn.com/travel/article/israel-vaccine-green-pass-wellness/index.html