How we missed what was coming with COVID-19
It was the middle of March. I was in South Africa, exploring the Western Cape on a Vespa, debating if I would go to Uganda to trek with gorillas or stay around Cape Town for a while.
Less than a week later I was on a flight to Canada, on a hectic dash to beat the border closures that were imminent.
My good friend was trapped in Panama, unable to leave — and unable to go to the beaches or buy alcohol, both of which were shut countrywide. Other friends were stuck in Peru and Spain on total lockdown. It all happened so quickly that we had a hard time believing it.
But we should have seen it coming.
Precedence over data
Early on, there was a familiar refrain: “Every year they say there’s a new virus that’s going to kill us all.” I must admit, I thought this would be another epidemic that was stemmed before it reached the rest of the world. Before it became a pandemic.
As an average citizen, with little insight into what was happening on the ground at the epicenter of the outbreak, you could be forgiven for thinking it would abate. After all, SARS, MERS, swine flu, avian flu, and Ebola were all defused before they shut down everyday life around the world. Why would this virus be any different?
But that’s the problem with looking at precedence over data. Just because it hasn’t happened before doesn’t mean it can’t happen now. This is especially true if the data says that, yes, this is most likely going to occur. And for the record, most of those other viruses didn’t spread to the rest of the world because of the brave people who worked tirelessly on the front lines. I saw this first hand with Ebola in 2014 when I was in West Africa. I, and the rest of the world, should be grateful that they risked their lives to stop one of the most vicious illnesses from spreading worldwide.
Another big issue with fixating on precedence is that it doesn’t take into consideration a lot of the nuances that helped shape past events. Ebola, for instance, is a very different virus than SARS-CoV-2. Comparing the two has little value, both in terms of epidemiology and for mapping outbreaks. Ebola kills roughly 50% of people that contract it, but it is only contagious through bodily fluids of an infected person. The novel coronavirus has a mortality rate that is much lower than Ebola but it is very contagious. It is easily transmissible, spreading through droplets expelled during a cough, a sneeze, or even speaking. This means that, on top of killing an exponentially higher percentage of patients than the flu, it will infect considerably more people if proper measures are not taken, especially since influenza currently has a vaccine available and COVID-19 does not.
To put in perspective how much more contagious SARS-CoV-2 is than Influenza A, consider what Professor Hugh Montgomery laid out: if you have the flu you are likely to infect, on average, 1.4 other people. If each of the people you infect passes the virus to the same average of 1.4 people, after 10 iterations of infection you will be responsible for 14 total cases of influenza. Now, if you have COVID-19 you are likely to infect 3 other people. This doesn’t seem like a huge difference; it’s roughly double the number associated with the flu. You might think this would mean you would be responsible for around 30 cases after 10 iterations of contagion. However, if you were to infect 3 people, and each of those people infected 3 other people, and this went on for 10 iterations, the number of cases would not be 30. It would be 59,000.
You would be responsible for 59,000 cases of COVID-19.
Let that sink in.
Heeding the advice of medical experts, the World Health Organization declared the outbreak of COVID-19 a public health event of international concern in late January. Still, most countries didn’t seem to be taking the threat of infection very seriously. And most people seemed to think this faraway virus would only impact their life if they travelled to central China.
Even at this point, you could be forgiven for not understanding the scope of the novel coronavirus. But as more information became available, as we learned the incubation period could be up to 14-days, as we saw China shut down its own economy, as we saw it spread to Europe, we should have seen that this would be different.
We should have seen that this is not just a “bad flu” with a slightly higher mortality rate.
Still, it was difficult to understand in the moment.
China’s lockdown
When China locked down entire cities, shuttering manufacturing and essentially shutting down a significant portion of its economy, that should have been a warning.
However, to many people, it still didn’t drive home the severity of this virus.
When an autocratic, communist state restricts travel and locks down entire cities, it doesn’t alarm the rest of the world as much as if, say, Germany did the same thing. Even though the economy was taking a massive hit, and millions of people were essentially locked inside their homes, it still didn’t prompt other countries to do much except screen travellers that had recently visited Hubei province.
Many people thought lockdowns of this sort could never happen in the West; they could only happen in China.
That’s why it was hard to see it coming in Italy, and then Spain, and then a whole slew of countries from South Africa to Panama. Even while looking at and understanding the data it was hard to see it coming. Unparalleled moves are hard to believe, regardless of how much evidence exists that it will unfold. It’s still hard to believe, even after experiencing it firsthand.
This was something incredibly unprecedented in modern free democracies.
It quickly became the norm.
Viewing cases in the moment rather than the future
Back in Africa, I was with some friends who work remotely. As cases started soaring in Iran and Italy, we were looking at the infection count in each country to base where to go. We were looking at where the lowest numbers of infections were in that moment and planning to travel to those places next.
We clearly didn’t understand the situation.
It quickly became apparent that our strategy was deeply flawed. Selecting which countries were better to go to based off static infection numbers wouldn’t work. The virus was spreading, and no country was immune to it. A location that only had 20 cases would register 200 cases in a matter of days, and on and so forth. We were not forward-thinking.
And so, we planned to hang out in South Africa a little longer. We were going to go kloofing in the gorge and spend a couple of nights at a winery. After all, South Africa had far fewer infections in that moment than anywhere in the Americas or Europe. It seemed like a smarter idea to stay where the numbers were lower.
Soon after, we saw the problems with our thought process.
It started when the United States banned flights from Europe. A couple of my friends packed up and went directly to the airport upon hearing this news, including a Dutch friend that was only going back to the Netherlands. In quick succession, more closures and bans were enacted. South Africa closed its borders to non-citizens, right after Canada did the same. It was all moving incredibly quickly; statements were changing by the hour. Being in the farthest country from home — literally — when borders start closing is not a good feeling, believe me.
I realized through this experience what matters most: Which country is taking the best precautions, has the best capacity to deal with healthcare, does the most testing, and is the most stable? South Africa, to its credit, got on board rather quickly, enacting border closures, non-essential business closures, and other preventative measures at a point where they had much fewer infections relative to other countries on lockdown. They had the benefit of looking at the experiences of other nations and they acted swiftly, which is critical for a country with a high incidence of HIV and tuberculosis infections that could spell disaster if COVID-19 were to spread uncontrolled.
The government of South Africa did a much better job of understanding the situation than I did. In the end, I made it home, but I feel confident that, based on their response, if I had been stuck in Cape Town everything would be all right. Time will tell if I’m right.
Public misunderstanding about why we shouldn’t gather
Even with all the border closures, the shuttering of economies, and the stories of overwhelmed hospitals in Italy, a lot of people didn’t understand the point of social distancing. For me, before all the stringent measures were taken, I didn’t fully realize the importance of staying away from others to stop the spread. Even when the first flight bans were announced, I saw several of my friends carrying on travelling to countries that were still open. Largely because of this, I grappled with the idea of heading home. If other people were still travelling, I wanted to travel with them! But after some extended reflection and a lot of reading, I realized the biggest problem wasn’t if I get sick — it was if I got sick and spread it to other people around me. This was before I heard Professor Montgomery’s bone-jarring explanation of exponential infection.
At this point, I began sharing the importance of hunkering down to my travelling friends. I received a lot of replies along the lines of “I’m not afraid of the virus, I’m not letting it stop my life,” and “we’re stubborn, even if we’re told not to go out we’re still going to. You can’t stop us.” It dawned on me then that we were going to be in for a long, long fight against this pandemic.
The reasons for these reactions were fed partially by conspiracy theories, self-centeredness, and a general misunderstanding of what was and is at stake. If this pandemic has illuminated one thing, besides the unpreparedness for a challenge of this magnitude, it’s that media and government distrust is prevalent around the world. A lot of people refuse, or simply don’t know how, to listen to experts. It’s understandable,then, that many people did not and still do not accept social distancing.
I’m happy to say that all my friends that had earlier shunned social distancing are now faithfully, if not begrudgingly, self-isolating. This gives me hope for the future. In the end, I think most people get it’s about protecting others, especially the vulnerable, and trying to buy time so the healthcare system isn’t overwhelmed while capacity improves. Damage that could have been avoided, however, has already been done.
American-centric conspiracy theories
The only thing more maddening than farfetched, dangerous conspiracy theories were the ones that framed the pandemic as a blight solely on the United States. Countless “theories” propagated online claimed that all of this was because of the upcoming election, like the entire world suffering is only for the American narrative. A sign on a doctor’s office read: “This is a viral pneumonia being hyped as the Black Plague during an election year.” That one really upset me, the audacity to claim that thousands of people dying in Europe and Asia was nothing more than “hype.” The sign went on to list, incorrectly, the dates of all the past epidemics that threatened America and how they all took place in an election year.
But the worst idea I came across was from an anonymous person commenting on a YouTube video about how we are all being lied to — about how the SARS-CoV-2 virus is less dangerous than the common flu, complete with abysmal mathematics and severely flawed reasoning. The comment read: “They want us to look at coronavirus while they invade somewhere. Somewhere they’re invading and people are getting killed.” Yes, people are indeed getting killed. By this virus. And every ill-informed comment, blog article, and video that downplays its severity will ultimately help contribute to the death toll.
This, too, we should have seen coming. In an era of unprecedented access to information, a growing number of people refuse to accept such basic truths as the irrefutable evidence for a round earth. One woman in Ontario, perpetuating an American-centric conspiracy from Canada, claimed that she knows germs don’t cause disease, and she invited everyone with flu-like symptoms to come to her store so she could cure them with magic.
Like most conspiracies, these all lack actual data and are full of wild speculation — people have to fit selective and blatantly false data to support their conclusion. This is because their conclusion is not based on data, it’s based on a decision they made about the way something is without any evidence or proof. It is little wonder, then, that so many of these “theories” are so easy to debunk with basic factual evidence.
But it seems a growing subset of people have zero use for evidence in their life. Except for when it comes to treatment for a deadly virus — though even then, some people will die from placing their trust in treatments that have no basis in reality.
U.S.A. downplay at the beginning
It came as no surprise when the President denied reality, then blamed China, then patted himself on the back for an awful response to the pandemic. During this terrible display of leadership, it allowed the virus to spread largely unchecked and made the situation a lot worse than it needed to be. Then, abruptly, strict measures were put in place and changed without warning over and over, adding a sense of panic and uncertainty on top of the general anxiety that everybody was experiencing.
The travel ban was something I definitely didn’t see coming, even from the troubled Administration. It created chaos as other nations condemned the move as a unilateral act — and then followed by enacting their own bans just days later.
This was one of the worst areas causing fears and uncertainty, especially for citizens abroad. Would they be able to get home? Would movement be impeded? Nobody knew what was going to happen in a few hours, let alone a few days.
I gave the President the benefit of the doubt and honestly rooted for him to succeed, for failure would lead to a lot of suffering for a lot of people. I wanted this to be the event that would unite us and bring us closer together, a silver lining in all the mayhem. But I should have seen this coming. The Administration’s response was consistent with everything else they have done since the 2016 election, so it should have come as no surprise that Trump would look out for himself first, the stock market second, and the people last.
Mexico’s blatant denial
Trump’s actions — as problematic and harmful as they’ve been — pale in comparison to his counterpart south of the border.
Mexico’s president held fast in his denial about the severity of the SARS-CoV-2 virus even as borders were shut around the world and citizens in his own country were beginning to take precautions on their own. He actually encouraged hugging others to show you’re not afraid of the disease — and he was pictured biting a random baby’s cheek at a rally he held, which would be problematic even during normal times.
A concert with 100,000 attendees over a two-day period was allowed to proceed as other countries prohibited gatherings of more than five people. Football matches continued as all major sports worldwide, including the United States, suspended their seasons. People showing symptoms that wanted to get tested were told it was probably just the flu as testing was in even shorter supply than in the U.S. This led to low numbers of infections and public assurances that everything would be fine based on these false pretences.
The situation in Mexico is going to become very problematic. I can see that coming.
What’s Next?
Looking at the data it seems a few things are certain:
1. It’s going to get worse before it gets better
2. It’s going to be better than if no measures were in place thanks to the unprecedented moves that governments around the world have made, and citizens sharing good information to combat all the misinformation and downright harmful content on the internet
3. We are far away from a vaccine, but we are understanding more about the virus every day
4. Flattening the curve will only work if healthcare infrastructure — including antiviral therapies — is upgraded while everybody is quarantined
5. Mexico is in trouble
Other than that, there are still so many unknowns. Will herd immunity work? How long will we have to stay on lockdown? Will this become a yearly issue? Will the virus mutate like influenza and force us to fight a different strain every year, looking for new vaccines and trying to re-develop herd immunity? Why are some people asymptomatic, and why are some seemingly healthy people affected when the vast majority are not?
These answers will surely come. In the meantime, we need to look at the data and not the precedence.
