5 Things for Friday | Coronavirus Issue
In early January I spotted an article, fairly far down the Guardian front page, about a virus that had jumped from animals to humans in a market in China. I remember making a fairly offhand comment to my wife about “whenever I see one of these stories I wonder whether this is ‘the one.’” A couple of weeks later things were spiralling in China just as it geared up for Lunar New Year — the world’s greatest migration of people. Hollywood couldn’t have scripted a more perfect set of circumstances. A member of my team was back in Shanghai for the new year and things suddenly got a little stressful. But then it seemed fine, and it was a long way away.
For another couple of months those outside of China, or even outside of Wuhan, have continued with little more than morbid curiosity. There was a cruise ship from hell near Japan and some cult members in South Korea that had it. Seems like everything was under control.
No longer. We are in full on exponential growth phase. Exponential growth is easy to say, I find it quite hard to spell, and very difficult to grasp for those of us who are not statisticians.
I had been feeling quite sanguine and relaxed until Thursday. Grateful to live in a country that puts its faith in professionals and institutions. Working in a job I can do from home — which I was told to do on Wednesday last week — or a well run, well capitalised global company. Confident that, in the world’s most developed city, I will have access to world-leading healthcare if I need it. Hopeful that I won’t. Not particularly swayed by arguments that I should be stocking up on essentials.
But that faith has been shaken. In issue #44 I asked, in a slightly over-engineered attempt at a pun, Is it time to pan(dem)ic?. I think we have our answer.
This long blog is the main reason why. It is the most instructive 20 minute read I can remember. You could save yourself the rest of this email and read it.
I don’t know who Tomas Pueyo is but he has a talent for telling stories with charts. 12 million have read his post in the first 48 hours. That number is now 28 million. It would say it’s gone viral but that seems insensitive.
The piece methodically goes through what we know so far and what this might imply about how things will unfold. It draws heavily on the experience in China and Wuhan in particular. It is full of graphs that go up very steeply on the right. As the author says at the outset there are a few things that will stick with you:
“The coronavirus is coming to you.
It’s coming at an exponential speed: gradually, and then suddenly.
It’s a matter of days. Maybe a week or two.
When it does, your healthcare system will be overwhelmed.
Your fellow citizens will be treated in the hallways.
Exhausted healthcare workers will break down. Some will die.
They will have to decide which patient gets the oxygen and which one dies.
The only way to prevent this is social distancing today. Not tomorrow. Today.
That means keeping as many people home as possible, starting now.”
It is worth remembering that this guy is not an epidemiologist. This is his opinion. But it is stark and the data he presents make the recommendations very hard to ignore.
I won’t be able to do justice to the whole argument here, but there were three things that have really stuck with me.
The first is this chart of cases in Wuhan.
It is very detailed and therefore a little hard to read. But the key thing is this: because it’s historical data you can draw two bars — true cases (grey bar) and confirmed cases (orange bar). Confirmed cases are those which were diagnosed on that day. True cases are people who had the virus but didn’t know yet. The critical point is the time lag. On the day that Wuhan went into lockdown there were c.400 confirmed cases. On this same day there were (probably) 2,500 true cases. That is 7x bigger. That matters because exponential growth is fed by the number of true cases not just those that have been officially diagnosed.
So when there were 400 cases in Wuhan they went into lockdown. Lockdown is not just working from home a bit and cancelling a bit of football. Lockdown is a complete change to the way you live your life. Lockdown is one person leaving the house every other day if at all. Lockdown is no bars, pubs, restaurants, gyms, schools, nurseries, being open. Lockdown is what is happening in Lombardy right now. Lockdown is what happened in France yesterday when Macron said people would be arrested if they went outside. It’s profoundly different to anything experienced in living memory. People will miss weddings, and funerals, and birthdays, and their grandchildren, nieces, nephews and, in some cases children, growing up. Lives will be put on hold in every imaginable way.
Wuhan is in Hubei province. There are 60 million people in Hubei. It is comparable to the UK. The Chinese government, with all its authoritarian muscle, locked it down when they had 400 cases. As of Thursday night the UK had 590 and we weren’t in anything like lockdown. Yesterday we were at 1,500. The number is unquestionably a low estimate given that testing is being restricted to only those who really need it.
The second thing that stood out was this chart of daily growth rate:
The red line is the critical point. When your daily growth goes above 40% that means your cases double every two days. In his excellent book Factfulness, Hans Rosling, a public health professor, describes the moment that he saw the data from the 2014 Ebola outbreak. It was exponential. He described it as “the most frightening graph he ever saw”. He was so afraid that he stopped everything he was doing and sent his whole team to go and try to help. What he saw was that the chart he thought was a straight line was actually an exponential. That was an outbreak of a disease we’d seen before confined to three relatively isolated countries. I shudder to think what Rosling would be thinking now.
Something similar happened in the UK yesterday. Scientists from Imperial and the London School of Hygiene and Tropical Medicine looked at the data in Lombardy and estimated that on its current trajectory the UK could expect 260,000 people to die. That is an unimaginably large number.
The reason that most of those people would suffer is that an already creaking, underfunded health service would collapse under the strain. That is the third thing that stuck out in this article. Pueyo links to this thread on the inside account of life as a doctor in Lombardy. It is horrifying.
Graphs are powerful but they are nothing compared to the realisation that there are people dying in tents in one of the most developed parts of the EU without access to the equipment they need to breathe.
I wrote most of that on Friday. At that point the reaction in most places was still fairly lukewarm. The last four days have seen a huge escalation. I hope it isn’t too late and the curve can be flattened in some meaningful way. It is incredibly hard to consider the true magnitude of what is happening. In my lifetime there have only been two events that I think are in any way comparable. The first was 9/11 and the second was the Financial Crisis in 2008. Both of these sudden shocks defined the decades that followed them. This feels deeper, more far reaching, more all-consuming than either of those.
Unprecedented is a word that has become anodyne from overuse but this is the textbook example. We have no model for how to respond and there is no exit strategy. A globalised economy fuelled by 10 years worth of cheap money, structurally inflated equities, an obsession with quarterly earnings and unsustainable consumerism is in free fall and nobody knows where the bottom is. Whatever the other side looks like it might not be much like this.
I, like everyone else, has no idea what happens next. But I do think, as difficult as it is to avoid, panicking can’t be the right answer. Neither is the retreat to mudslinging, partisan suspicion, misinformation and jingoism on display from the less savoury corners of the global political firmament. Surely in light of such seismic shifts the only answer is to look after those close to you, support those who need it most, take medical advice very seriously, and be kind. And as far as possible, stay at home. However painful it will be, business, economies, countries can be rebuilt. Lives lost cannot.
Also, wash your hands. 🧼 🤚
