Some Optimism
You know me: I am an optimist, even in dire times. Since most recent headlines, emails and calls are focused on the supposed “end of the world” angle of the COVID-19 crisis, here are some positive points that might easily get lost in the global hysteria that has befallen us.
Government response
- The complete shutdown – which is sensible for a brief time to halt the spread of the virus and buy time to develop a comprehensive plan – can only be temporary. Such a shutdown is viable for a maximum of 2-3 weeks, and every other crazy number floating around is just completely outside any political and economic reality.
- After 2-3 weeks of slowing the pace of infection and finding a proper strategy, life must and will go on, not only for economic reasons, but also for societal reasons. The amount of deaths indirectly caused by a longer shutdown would rapidly outnumber those caused by the virus itself.
- Important: In these 2-3 weeks, we should all follow the rules of physical distancing, self-isolation, etc. In short, stay at home!!!
So, what can authorities do AFTER a brief shutdown?
- What we need is NOT JUST a flattening of the growth curve – which will never fully work unless we cause a level of collateral damage that will defeat the purpose – but an additional FLATTENING OF THE DISEASE.
- For that, they are working – however too slowly from my point of view – on off-label use of previously approved drugs and fasttracked approval of new drugs (for example Remdesivir)
- Chloroquine (see below), which is already approved for malaria prophylaxis, can significantly disrupt the course of the disease. Germany and UK have already announced that they have ramped up/secured Chloroquine production, and President Trump just announced the rollout of Chloroquine state by state
- We should isolate and quarantine only those most at risk, namely the elderly and sick. It does not make sense to isolate everybody! The only reason the authorities didn’t make this distinction from the beginning is political correctness. (When I walk the streets here in Frankfurt it’s apparent that it is the elderly who are out and completely ignoring the risk. As harsh as it sounds, we must let the healthy go on with their lives and isolate the elderly for their own protection).
- Germany, at least, is able to produce many more ventilators and increase hospital capacity overall within weeks. I expect the same to be true in the US.
Economic measures
- Regarding the economy, Governments and central banks - especially in Europe – have reacted surprisingly quickly compared to previous crises.
- We are back in the “whatever it takes” era – and that’s a good thing given the circumstances.
Just an observation: As far as I can judge, the strategy of President Trump during this crisis most closely resembles that of Germany. Yet, while Chancellor Merkel earns widespread praise for her efforts, President Trump is criticized at every turn. Suffice it to say, there seems to be a “slight” bias.
About the disease itself
- Yes, people are dying. Yes, more than from the flu. No, globally the average is not the 9% we’re seeing in Italy. I am quite sure that, with all variables taken into account, the mortality rate will prove to be somewhere between 0.5% and 1%. Just look at Germany, even approximately 14 days into the crisis -- and thus not far behind Italy – the death rate has stayed below 0.2%.
- It is mainly the old and sick dying. I don’t want to sound cynical, but as one doctor told me yesterday: “Many are dying with corona in their body, not because of Corona.”
- Yes, young people can also develop severe symptoms, but this seems to happen only when virus goes straight into the lungs. Normally, COVID-19 starts in the upper respiratory track, and then takes about 1 week to get to the lungs; by then, a healthy person has developed enough antibodies to begin recovering. Yet, even if the virus does go straight into the lungs, young people survive (but may need breathing support).
- Only negative point on my list: In what circumstances does the virus go straight into the lungs? The risk is greatest if someone is breathing heavily, so people are most vulnerable when playing sports, dancing, and... having sex. BAN SPRING BREAK!
- The inconvenient truth not (yet) stated a lot publically is that aside from certain variables which lead to increased death rates (old population, smoking, maybe self-medication with Ibuprofen, not using the proper drugs, etc.), Italy and others are paying the price for political mistakes and omissions over the last decades and experiencing the consequences of an inferior healthcare system.
- I still believe – despite some other opinions – that summer will slow the progress of the virus (because of humidity)
- Most likely, large portions of the population could be immune: That’s the biggest flaw of the exponential growth models. For example, take a look at the data from the Diamond Princess (a perfect petri dish) where EVERYBODY got tested: Just about 18% got it, and half of those had zero symptoms. Given the environment on the ship and the ostensible infectiousness of the virus, far more people should have been infected.
Personal Health
- The previously approved drugs Chloroquine and Hydroxychloroquine seem to work for COVID-19, and it is only a matter of weeks until governments start using them. (Disclaimer: I am not affiliated with these drugs, I am not a doctor, just my opinion, think for yourself ??)
- Many hospitals have started to use Chloroquine and Hydroxychloroquine off-label; these drugs are already the first line of defense in many Asian countries (which could explain their low mortality rates)
- If you were able to secure either, here is the protocol: Start early, ideally once a test has confirmed Covid-19 and/or symptoms have developed. In short, the earlier the better (Please note the different doses between Hydroxychloroquine and Chloroquine)
- Hydroxychloroquine: A loading dose of 400 mg twice daily of hydroxychloroquine sulfate given orally, followed by a maintenance dose of 200 mg given twice daily for 4 days; would take together with azithromycin and ZINC
- Chloroquine phosphate: 500 mg twice daily for 5 days; would take together with azithromycin and ZINC
(Stock) Market sentiment
- We are living in a paranoia right now, like the inverse tulip mania.
- China is already more-or-less back to pre-virus levels
- I am a venture capitalist and private equity investor, not a trader, but if the crazy headlines of “the world is ending unless we stay at home for 2 years and here is the exponential curve why”. combined with the tears of Bill Ackmann don’t mark the – at least emotional – low, I would be very surprised... If not, then I feel safe predicting that the emotional bottom should be sometime this week or next.
- In Germany we will have around 1-2 more weeks of negative headlines (e.g. growing total number of infections, a more complete shut-down, slightly increased mortality rate, negative economic consequences, etc.) but then we should see a flood of good ones (e.g. Chloroquine approved, death rate stays low overall, spread slows down, etc.)
Overall, I am quite sure that life will normalize by the end of April. We will shortly have treatment options, and as soon as the healthcare system is able to give every patient the care they need, COVID-19 will become just another normal disease. We will still see deaths from coronavirus, but people die for a host of reasons every day, ranging from cancer to car accidents. I hope we can avoid as many casualties as possible.
Life is fraught with risks – but we will be able to manage them.
Links, references, sources
About Hydroxychloroquine
German death rate
https://inews.co.uk/news/health/coronavirus-germany-death-rate-confirmed-cases-2502388
Why younger people can have severe Covid 19
Weather
Diamond Princess Data
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.10.2000180
Why exponential growth models could be wrong
Conduit Performance EdD Sport and Performance Psychology, MS Clinical Mental Health
4 年I love the near real time review board regarding the post. Need more of that to get into the details. Stay optimistic but the details matter on what others are doing. Cultural response is also important to consider.
General Partner and CEO Coach at Walking Ventures
5 年These are the drugs that Donald Trump says he "feels good about". Reporting at Trump’s Embrace of Unproven Drugs to Treat Coronavirus Defies Science https://nyti.ms/2QzfDjg suggests that the two drugs recommended here are urgently needed for thousands of patients with lupus, and that encouraging asymptomatic people to get them is already causing potentially life-threatening supply shortages. The situation may change if there's evidence from trials showing their efficacy against COVID-19.
@Talbo
5 年There are some big concerns with the information you shared, hence I question the entire article. 1. Italy has the 2nd best healthcare system in the world. Understand why the mortality rate is high by doing some research, not blaming it on false assumptions. For example, read this - https://medium.com/@andreasbackhausab/coronavirus-why-its-so-deadly-in-italy-c4200a15a7bf 2. Do not suggest people medicine without knowing their underlying conditions, especially since you are not a doctor. You might cause deaths. The best thing they should do is to visit a doctor. 3. Trump didn't take any concrete action for several months. He's been mocking the gravity of the virus all along. If there's a place he should be, it's not in charge of things. 4. You cannot isolate just the elderly... look into this conversation between 2 biowarfare experts and the host: https://www.youtube.com/watch?v=lWOYj8hjjjM. 5. The shutdown will last for months, just like it happened in China. It can be contained if you do it early (China did it before they had 1000 cases), but we're past this phase in EU. 6. Medical people are dying regardless of age - they are exposed to the virus in large doses. And if we allow millions to get sick, those young people that need ICUs and cannot get any will also die. So will other people that won't be able to access healthcare because it will be over the limit. If you look at the famous curve in the "flattening the curve" chart, in order to prevent the health care systems to shut off, this social distancing needs to happen for many, many months. Given all the above, and more - but I don't want to be rude - I'll say your estimate for things to go back to normal by end of April is unlikely to happen. And a recession will start inevitably during or right after the crisis. Stocks won't rebound..
Exec Director | Customer experience | Digital Transformation | Data Strategy | Product & Technology | Having Fun
5 年Great article, I think getting 2-3 weeks of action (and people inaction) is key and then things will start to stabilise
Founder & CEO at Mindbloom - come build in psychedelic medicine!
5 年Thank you for sharing, Christian ??