COVID-19: faq for friends and family

What you really wanted to know — especially for speaking with friends and family-but wished you had cogent, vetted explanations, and robust sources.

Image for post
Image for post
Find me here and the French Version here. Merci Pierre!

First published: 3/20
Updated: 3/28 NB: Now that the world seems to be taking the crisis seriously, I’ve stopped updating the projections
 — but the rest is current!

TL;DR — Quick Summary

Okay, let’s go…

What is COVID?

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) is the name given to the 2019 novel coronavirus. COVID-19 is the name given to the disease associated with the virus. SARS-CoV-2 is a new strain of coronavirus that has not been previously identified in humans. Coronaviruses are viruses that circulate among animals with some of them also known to infect humans [ECDC]. Check out these links for how it works in the body: here and here. I like this one the best.

Image for post
Image for post
NPR

Why is it so bad?

The virus combines both a relatively (1) high mortality rate, (2) a high transmission rate (every infected person currently passes it on to 2–3 people), and (3) long incubation period (5–14 days) during which people can transmit the virus without knowing it. Most viruses typically have one but not all of these features. This makes COVID-19 brutal to contain.

How did this start?

Humans contracted the virus directly from an animal. The most likely scenario is the virus originated from a bat, which transmitted the virus to another intermediate animal (possibly a pangolin) — which brought the virus to humans via a wet market in Wuhan in late Dec. 2019 Nature. These markets were also identified as the source of the initial SARS outbreak back in 2003. No, it was not created in a lab [Nature, Scripps].

Transmission Rates

It’s estimated that every infected person transmits the disease to 2.5 others [Nature]. By the end of the year, it’s estimated that 20% to 70% of the global population will be infected, ie 1.5 billion to 5 billion people per Harvard epidemiologists [The Hill]. Given the current growth rate, this leads to an exponential increase in the number of infections without anyone knowing it… until all of a sudden, it all blows up. And it’ll keep going, until we apply the brakes (more on that later).

Image for post
Image for post

How is it transmitted?

  1. Through the air by coughing and sneezing; even talking can unleash virus-containing droplets seeking a new host. [CDC]
  2. By touching an object or surface with the virus on it, then touching your mouth, nose or eyes before washing your hands. The virus can last:

And you spread the coronavirus without symptoms. As above, every known case of COVID-19, five to ten other cases are not documented, and those people cause “stealth transmission” of the disease. [Science]

NB: Young people are a perfect vector for this disease because they will not show symptoms. With Australia allowing people to continue to shop, go to school, and go to the beach for the past two weeks, the virus is out in the community and anyone who has been in contact with anyone who has been in public places should assume they are a vector and a death-risk to their family.

As of 3/22 (time of writing), Australia has about 1,000 cases. By 4/1, I’ll wager it’ll be 5,000. Let’s see.

Symptoms and Incubation Period

Symptoms include dry cough, chest discomfort, difficulty breathing, fever, lethargy, gastrointestinal discomfort. Symptoms can take 2–14 days to appear; this means people can be asymptomatic and contagious for 2 weeks! [CDC et al].

What’s it like to get infected? Click the image.

Image for post
Image for post

A Chinese Study of the Wuhan experience found that of confirmed cases:

Researchers estimate that for every 1 confirmed case, there are between 5- 10 non-confirmed [Science]—which means the number of asymptomatic or very mild carriers is huge.

Course of the disease [courtesy of @tomaspueyo and cf. BBC]:

Image for post
Image for post

Who is most at risk?

Older people and those with underlying medical problems, like high blood pressure, respiratory conditions, heart problems, or diabetes, are more likely to develop serious illness [WHO].

Per the CDC:, about 35% of hospitalizations are 65 and older, 35% are 45–64 years old, and 20% are 20–44! — note, 55% of people are less than 65! The notion that young people are immune is ….not correct.

Death rates

These are literally the vital statistics.

It’s important to know that there is a legitimate debate about the true mortality rate of the disease — we are still early in the game. However, the current best data are as follows:

Image for post
Image for post
cf. WHO, CDC, JAMA

Dr. Fauci — who has advised six Presidents on infectious diseases and global health issues, and who regularly steps up after the President during televised briefings, is quoting a 1% mortality rate. Placing my decision analysis hat on, here are my calculations based on WHO and Ioannidis forecasts: Given an expected global infection rate of 35%, where 15% of the infected population develop symptoms, and of those, 1.9% expire (ie. p-weighted midway between low and high estimates), it is reasonable to expect:

Note, these are conservative calculations that attempt to strike a balance between the most optimistic and conservative models from the sources above. In the comments section below, Sam Odio suggests I shouldn’t attempt to strike the balance when more and more evidence suggests the WHO’s estimated mortality rate of 3.4% could be the lower bound. Running the numbers again with 3.4% as the death rate, we get this:

Incidentally, a new report by 18 infectious disease researchers at UM predicts only 195,000 people in the USA could die by the end of the year — but a model from Imperial College London predicts 2.2 million if actions taken are weak or futile. Split the difference? Either way, it’s not good.

I’ve heard it’s just like the flu…

You might’ve heard people say that this is no big deal because the Flu kills many more people per year. Well, the death rate from the seasonal flu in the USA is about 0.1%, killing 12,000–61,000 each year (CDC). We need a new flu shot (vaccine) each year because the virus mutates, and so we lose that number of people annually in the presence of a vaccine.

Enter COVID-19. Death rate of about 1.9%. No vaccine. No treatment. And we can expect ~500,000 deaths by the end of the year.

And it can mutate.

We have a problem.

Image for post
Image for post

How bad will this get?

In most countries, the infection rate is doubling every 4–6 days; even Singapore—which has very strict measures—is growing exponentially at 10% a day. See live updates via the Financial Times.

Countries like the USA, Canada, and Australia are on track for a serious crisis. It’s highly possible that estimates of an Italian-level experience are not overblown—just delayed given geography, the incubation period, and lack of testing. For my folks back in Australia, this is the ominous picture [Grattan].

Image for post
Image for post
Note this chart has a logarithmic scale, which results in straight lines for exponential curves.
Image for post
Image for post
Note this chart has a logarithmic scale, which results in straight lines for exponential curves.

Why do the confirmed cases rates vary so much?
There’s a couple factors that help to explain this: 1) variations in the speed and seriousness of response from country to country 2) variation in treatment regimens from country to country 3) variations in the age and health of populations 4) variations in the level of testing.

If you want to play around with some data, see this spreadsheet I created based on reported cases. Note: The ideal approach is to forecast based on the confirmed death-rate — but because we’re early in the game, and different countries report cause of death differently, those data can also be deceiving.

Why should I care?

First, our loved ones—yours, and mine.

Apart from the fact you may act as a vector and unwittingly infect someone at risk or elderly, you will want a functioning health system when you or a loved one falls ill. The reality is that hospitals usually run at about 95% capacity. Even with 70% drawdowns on elective procedures, exponential demand will not just outstrip supply, it will utterly overwhelm it.

To make this real for you, in the USA, it is estimated that 49 out of 50 people who are critical will die due to the massive shortage of ventilators – In this link, the doctor estimates this to be about 7.5 million people.

If we incorporate the data that the majority of people infected are asymptomatic (say 5:1 per the studies cited above), a back-of-the-envelope calculation suggest the shortfall in ventilators will result in ~1.5 million completely preventable deaths if we don’t flatten the curve — and institute war time directives to immediately ramp production.

In Australia, we have even less ventilators per capita than America (2,000 /23M versus 70,000/329M ). This suggests over 100,000 people may die due to a lack of ventilators if production isn’t quadrupled over the next two months.

See the experience of Italy (video below) — and the chart below, which indicates ICU capacity v forecasted demand in the USA.

When demand outstrips supply, doctors are forced to make harrowing decisions about allocation of scarce resources, e.g. ventilators — and determine who lives and who dies. If you want to know how doctors make these impossible choices, this is a wonderful article on bioethics.

Image for post
Image for post

Transmissibility and capacity issues have led to 100s of people forced to die a horrible, lonely death — and families unable to arrange a proper funeral.

Image for post
Image for post

It gets worse. There is currently a critically insufficient supply of personal protective equipment, causing hospitals to “ration” masks among clinicians at the frontline The high rate of transmissibility means that many clinicians will get infected. In Italy, some 2,629 health workers were infected as at 3/19–8.3% of all cases!! [DailyBeast] 45 physicians have so far died [CNN]. You need healthy staff to treat people.

And they are terrified. This quote is from a text sent to me today by a nationally recognized full professor at a nearby AMC:

We are all getting exposed to high risk everyday in the ORs — I think it is the feeling that people don’t care. Instead of saying [ the hospital administration] know they aren’t doing enough and they wish they could do better they are literally gaslighting us saying surgical masks are fine protection from SARS-CoV-2 and we don’t need N95.

For my Australian friends, if anyone tells you “we’re better equipped… that’ll never happen here,” the only scenario in which our health system doesn’t crater requires urgent and drastic action to slash the growth rate from doubling every 3.5 days, to 7 days [Grattan]:

Image for post
Image for post

Is there any hope? Yes! First, China, Singapore, Japan, and South Korea have all shown that the measures below—if taken, are highly effective for stemming the tide.

Second, the economy—your livelihood and mine.

Brace for impact. This is an unprecedented crises affecting both the supply and demand-side of the economy. If everyone froze for one month, this would all be over. But that simply will not happen. This report by Oliver Wyman contains an excellent, short, and easy to read summary of three potential scenarios.

What is almost certain is that this crisis will be much worse than 2008. Per Greg Daco, chief U.S. economist at Oxford Economics, we are assured of at least two consecutive quarters of recession — with the largest quarterly contraction on record. The White House is expecting 20-30% unemployment [NYT].

Why is the impact so severe? Our economies are dominated by services. Customers drive demand—whereas in the past, manufacturing generated a greater share of GDP. About three-quarters of economic activity derives from consumer spending, and half of that is at risk [NYT].

Mythbusters

If you need ’em.

Are we overreacting?

Is all this overblown? A few truths:

From my former life as a risk strategist: we know that for every future outcome, there are a range of probabilities. Our job is to do our best to characterize those probabilities and place mitigation measures in place for outcomes beyond those we can tolerate, e.g. insurance—or a rainy fund.

Allowing ~1% of the most vulnerable to needlessly die from this disease negates the human project.

Of course, we are relying on incomplete data, but that’s why we use the information we have to generate information we don’t.

A question that is genuinely hard to grapple with is whether the costs of pragmatic or moderate suppression measures will result in larger loss of life in the long-term. We can run the risk models—but we don’t have good language or mechanisms for grappling with real-life Trolly Problems on a global scale—especially with the erosion of deference and investment in our common institutions, e.g. the UN.

So, what should we do?

“If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.” [NYT] *

*In fact, it has to be two full incubation periods. 28 days; halting now will still generate new cases.

What action should we demand of our governments?

The short answer is, pull out all of the stops and flatten the curve! Get on the front foot, trust the science, embrace the pain. This appears to be the paper that many governments have used as the basis of their response.

Image for post
Image for post

This article (and cf. its predecessor — viewed 40+ million times!) by Tomas Pueyo discusses the implications of three strategies: 1. doing nothing, 2. mitigation — i.e. half-measures, and 3. the Hammer.

Image for post
Image for post

Quotable:

“Strong coronavirus measures today should only last a few weeks, there shouldn’t be a big peak of infections afterwards, and it can all be done for a reasonable cost to society, saving millions of lives along the way. If we don’t take these measures, tens of millions will be infected, many will die, along with anybody else that requires intensive care, because the healthcare system will have collapsed.”

The Chinese, Singaporean, and South Korean experiences suggest that the virus can be suppressed through the following measures:

And indeed, a recent paper suggests that if 80 per cent of Australians follow the advice to stay at home, there’s still a chance coronavirus could be brought under control in 13 weeks [USyd].

Image for post
Image for post

With the truly massive potentials for loss of life and economic devastation, flattening the curve is not enough. There needs to be a truly gargantuan build up in health capacity.

Okay, okay. What can I do?

It’s time to go, go, go — and stay put.

Practice extreme social distancing. This means staying at home and go out only when absolutely necessary. The Washington Post has a really intuitive set of simulators that explain why social distancing and staying home matters.

But I feel fine.

That’s great. Except that 48% and 62% of people in Singaporean and Chinese clusters (respectively), caught the virus from someone that was pre-symptomatic [ECDC]. In all likelihood, you will contract the virus. The goal is to delay onset so that if you are infected:

The CDC offers the following guidance:

What about a cure?

Estimates suggest the soonest any vaccines will be available is Q1 2021. [Wired] However, it is possible a treatment will be available in months — megatrials on various drugs are underway [ScienceMag].

Okay. It’s coming. How should I prepare?

This part is a wonderful contribution from a nurse—which has been making the rounds.

~~

As your friendly neighborhood Nurse let me make some suggestions. You basically just want to prepare as though you know you’re going to get a nasty respiratory bug, like bronchitis or pneumonia. You just have the foresight to know it might come your way!

Things you should actually buy ahead of time (not sure what the obsession with toilet paper is? :)

Oh boy. I don’t feel so good. What do I do now?

For symptom management and a fever over 38°c:

If you are worried or in distress or feel your symptoms are getting worse, call your local provider. They will advise if you need to go to hospital. The hospital beds will be used for people who actively need oxygen/breathing treatments/IV fluids.

If you have a pre-existing lung condition (COPD, emphysema, lung cancer) or are on immunosuppressants, now is a great time to talk to your Doctor or specialist about what they would like you to do if you get sick.

One major relief to you parents is that kids do VERY well with coronavirus — they usually bounce back in a few days (but they will still be infectious). Just use pediatric dosing .

Be calm, prepare rationally, and it’s most likely everything will be fine.

~~~

Should I wear a mask?

The CDC recommends to wear at least an N95 face mask if you are sick to help prevent infecting others. If you’re not sick, don’t wear one unless you are caring for someone who is sick.

FYI, the virus is .05-.2 microns [Lancet]. Respirators filter out most airborne particles from the surrounding air, preventing wearers from breathing in particles down to 0.3 microns in diameter [CDC]. This means that a mask is not fool-proof, but masks rated:

95 is generally the standard. However, N95 masks are only effective if you are wearing one in which you have been properly fit tested and wear it in a proper way. This is not easy and requires training. This is therefore a waste of money and resources since it won’t be helpful.

In terms of effective use, masks are usually single-use and have a useful life (outside of an infectious disease setting) of 4–8 hours. Guidelines for use are here.

Can I donate masks to hospitals?

More and more hospitals are officially accepting donations (see this roundup)—if they do, the practices of rationing supply do not guarantee masks will make it to the frontline—at least to the satisfaction of health professionals in hospital and primary care settings.

For that reason, many people are donating masks directly into the hands of frontline doctors and nurses. See for instance getusppe.org or mask-match.com — there are many others!

If you do donate a mask, even if the box is unopened, you may unwittingly contaminate it. Recommendations from several experts (Stanford, UHN) are to quarantine donations for 3 days (i.e. beyond COVID-19 survivability [NEJM]), or consider UWisconsin, Duke, Stanford’s sterilization protocols.

What’s the advice for at-risk people, or anyone 60 years old or more? E.g. my 108 year old Grandpa.

In fact, getting my Grandpa out of Sydney was the primary motivator for this article. P.S. He is a legend. Check out this 2 min vid by Jetstar.

Unfortunately, it is likely your elderly loved one will get infected (which is terrifying), but the hope is that when this happens:

In the meantime avoid infection at all costs.

How will we know social distancing is working?

Because of the incubation period, not for at very least two weeks. By that time, we’re all going to be stir crazy and frustrated and tempted to have a few wine nights with friends who aren’t symptomatic, etc. So let’s say just one of our friends (say an extravert) starts getting lax with the rules (you know who, right?) … and conservatively say that’s 1 in 20 people. That’s 1.15 Million Australians…or 16M Americans!

…and then we just start this whole thing again. Remember, the South Korean epidemic started with a single person: Patient 31.

But does social distancing work?

Yes. Yes, yes, yes. See above. And if you need to understand the consequences of mild cheating, check out this awesome video simulating various scenarios.

Image for post
Image for post

@jpsmithalt said it best:

We are in the very infancy of this epidemic’s trajectory. That means that even with these measures in place, we will see cases and deaths continue to rise globally, nationally, and in our own communities.

This may lead some to think that the social distancing measures are not working. They are.

They may feel futile. They aren’t.

You will feel discouraged. You should.

This is normal in chaos. This is the normal epidemic trajectory.

Stay calm.

This meme has been making the rounds—but it’s sage exhortation!

Image for post
Image for post

How long will this last?

A huge concern is what happens when governments relax social distancing measures. As you can see from the Imperial Collage London paper, it’s quite possible that cases will surge — just like they are now.

Image for post
Image for post
Ferguson et al.

The most likely policy will be may be what’s called “adaptive triggering,” where suppression strategies such as social distancing and shelter-in-place orders are turned on and off in order to manage the tide. This graph projects the impact of suppression measures when in place 2/3 of the time.

Image for post
Image for post
Ferguson et al.

So the short answer is; unless the virus miraculously disappears — or epidemiological assessments prove wildly conservative — this will be our new normal for quite some time.

I’m worried about my job.

While economics is not the focus of this article (and I’m not an economist either!), it’s worth pointing out that with so many people about to lose their jobs, social determinants such as financial stress are a primary driver of health outcomes. Now is the time to support local businesses, and find creative ways of assuring at-risk workers have an income. Introduce them to Upwork, do virtual gym sessions, etc.

In the face of mass layoffs—which are already here—businesses (and employees) should assume this is the new normal. Oliver Wyman suggest the following immediate actions:

Image for post
Image for post

I also found this article from Deloitte especially helpful in providing a blueprint almost any organization to follow.

Where should I place my focus?

This brilliant article on non-linearity (worth your time) explains,

“most companies focus on identifying customers who are most likely to defect and then target them …. However, it’s usually more profitable to focus on customers who are more likely to stay.”

Indeed, an older Bain analysis calculated it’s ~5x more expensive to gain a new customer than to keep one you already have, and moreover, a 5% reduction in churn can increase profits by 25% on average. So focus on retention and customer loyalty.

For folks in the innovation space, McKinsey’s study on what happened after 2008 was that 1/3 of company R&D budgets were reduced, but for most, portfolios rebalanced from long-term to short-term ventures. Interestingly, top-quartile companies doubled-down on innovation, creating outsized competitive advantages for themselves in the years to follow…cf Bain .

Given projections, I’d assume an EV of ½ of your customers will experience budget cuts — so consider a 1000% focus on retention. Make salient the value you have captured for your stakeholders thus far — and demonstrate the value you are going to create for them in the short-term. Talk to them about their needs and wants. Scratch where they are itching.

How do I convince my family member or friend who went to Bondi Beach last weekend? Or my boss who thinks this is all going to blow over?

“It’s not about trying to convince the other… what you really want is understanding; what you can do to make it easy for them to move your way? … It’s very non-intuitive — which is also very surprising.” — Daniel Kahneman

In the present moment, it’s been helpful for me to remember that it’s very hard for humans to change our minds. In Thinking Fast and Slow (one of the greatest books of all time), the eminent Daniel Kahneman explains that we form strong emotional attachments to our beliefs, which incentivize us to stay a present course — even in the face of new information. We find it really hard to act on data we have no mental images to connect them with. And neurochemically, we’re almost incapable of changing our minds when we feel confronted.

…And despite knowing this, we (and I!) often default to avoidance and conflict. It’s helpful to know that the human-centered way is effortful and nonintuitive. So when encouraging others on social distancing or otherwise, remember: be mindful, you are relating to a human.

Daniel Kahneman encourages us to ask: How might we make it easy for others to shift their point of view?

Here’s a helpful guide:

  1. Learn and validate what they care about, ie. What does their belief do for them?
  2. Work hard to enable the other person to feel that you are on their team.
  3. In a spirit of openness, offer an alternative from a trustworthy source they trust, e.g. “I saw [abc] said [xyz], so I wonder if [the alternative might be true]?”
  4. [Maybe on the 2nd or 3rd conversation], shift in to collaboration mode with them: i.e. “How might we achieve [what they care about] in a better way?”

Okay! That’s all for now. If you have any comments or suggestions about this article, please let me know! I’ll continue to update it.

Best wishes to you and yours,
—Simon

Written by

strategy + design | innovation manager at Plug and Play

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store