SARS CoV-2 is an exceptionally dangerous virus that threatens our way of life, because:
- It’s highly infectious.
- Each person infected with Covid-19 will infect far more people than would a person with seasonal flu under ordinary circumstances.
- Not everyone who is infected has symptoms, so even people who seem perfectly well can transmit the virus.
It is too early for us to know whether those who have survived Covid-19 are immune from being reinfected, nor even if those who seem to have recovered might still be able to infect others. We need an effective, stable, complete vaccine before we can return to a semblance of normal, but that will take some time.
Furthermore, vaccines against viruses average 13 years to develop. The novel coronavirus is in a family of viruses for which vaccines are difficult to develop; so far, no vaccines exist for any human coronaviruses. Its ability to mutate to evade vaccines and antivirals is
Our world is vulnerable to global pandemics like COVID-19 for several reasons:
- We’re more mobile and more social than humans have ever been before.
- Populations are highly dense in concentrated urban areas.
- Face-to-face service industries are ubiquitous.
- Global travel is pervasive.
- Economies depend on global supply chains, which the virus is disrupting.
We are being flooded with often conflicting information about how bad the crisis is, how long it will last, and what we should be doing about it.
America is playing catch-up
We are paying a huge economic and human price for being so unready for this crisis.
- Unlike countries who learned from prior epidemics (like Singapore or Taiwan), we lack the infrastructure needed to manage an uncontrolled novel virus.
- Testing, tracing and monitoring systems to prevent infection spikes are at only a fraction of what we need.
- Hospital beds, staff and equipment to treat those who are infected are insufficient.
- Centrally managed decision systems for ensuring compliance are lacking.
The consequences are unimaginably devastating. If we do not move quickly and decisively, the virus could kill over 100 million in a year or two.
Vaccine development outlook
Huge resources have been committed. Today there are 78 COVID vaccine confirmed candidates under investigation. There is no consensus yet about most likely candidates, an indication of early days.
An unprecedented diversity of vaccine types is being pursued. There is coordination between some efforts, but most remain independent. Regulatory agencies have promised streamlined processes.
We need to plan not for one battle but for a war. How long will it be?
- 19 months (~20% chance). Including the time needed to get enough of the population vaccinated to achieve herd immunity, we are looking at some time in 2022.
- ~5 years (~60% chance)
- ~10+ years (~20% chance)
If we put the needed infrastructure in place, our lives will improve after each battle.
Phase One: until we have better treatment and prevention tools, our only means of slowing its spread is social distancing. Social distancing substantially damages the economy, but prevents worse damage.
When the disease has reached its peak, and if we have the capacity to handle the next outbreak, we can reopen parts of the economy until we see early signs of another exponential virus outbreak.
Six cycles, 18 months of economic and social “boxing”
As time goes on and we understand the trajectory of the virus as well as develop the tools to more precisely track it, each of six cycles of boxing will be shorter and shallower. As we develop improved treatments and a more robust health care system, we may be able to lengthen the periods between these periods of enforced social distancing.
Our ability to understand and respond will improve over time. It is still the early days. Data is fragmentary, and coming in fast. New data about the virus will help us improve our ability to fight it.
Our diagnostics will improve, which will help us contain its spread and manage the economy more precisely. Efforts must include:
- Monitoring with a good test for antibodies, which could predict immunity.
- We will begin to introduce non-vaccine therapeutic drugs.
- Anti-viral cocktails (such as for HIV-AIDS).
- Treatments to reduce immune system over-reaction.
- We may develop partially-effective vaccines (such as for the flu).
- We will develop more effective care protocols that will also improve patient outcomes.
The range and diversity of pharmacological responses thus far is unprecedented.
Stay informed but beware of certainty
Review new information from an informed perspective. Beware of certainty (economists, scientists, politicians, pundits, investment advisors, relatives). We are in the early stages and much is unknown
This is a surprising virus and an unprecedented economic event. Realize that government and industry leaders are naturally biased on behalf of their institutions; evaluate their statements accordingly.
Economic forecasts and policy models that do not directly include COVID-19 epidemiologic models may be off by an order of magnitude (Exponential Growth vs Linear Response).
Realize that what may seem like an over-reaction is the appropriate reaction.
The post-vaccine future: What is “normal”?
We can’t yet predict the exact capabilities of such a vaccine: how complete it will be, or how permanent it will be.
A very permanent and complete vaccine, very widely deployed around the world, could free us to create a new normal as much like our old normal as we wished.
Less permanent and complete vaccines would still be effective if they lowered the infection rate enough for us to manage the disease at the individual case level instead of the population level currently required.
When the disease’s infection rate is low enough for us to manage the disease at the individual case level, then we will no longer need to employ economic and social “boxing.”
With case-level management, even without a complete vaccine, we would mostly be able to live normally again, but might retain thermal scanning at crowded entertainment venues, mandatory use of PPE in crowded work areas, and different layouts for places that bring clusters of strangers into close proximity for significant periods of time: retail stores, bars, restaurants, planes, buses, trains, waiting rooms, and so forth.
COVID-19 will cast a long shadow cast over our lives, but at the end of it, we will be far more capable than we’ve ever been before of preventing future pandemics, and we will undoubtedly lay the groundwork for hitherto-undreamed-of advances in life sciences.
Future generations will benefit by our efforts, and perhaps knowing
this will make it easier for us to bear the burdens of the next few years.