The Iconoclast
Published in

The Iconoclast

The Four Horsemen of the Apocalypse

by Patrick H. Ruane and Ravi Pamnani, May 21, 2020

We are 4 months in, and the global Covid-19 case trajectory is fairly ominous (Figure 1).

Figure 1. Number of Covid-19 cases reported worldwide over time.

It is impossible to tell when this curve will bend over. The best case scenario is of course, the curve wil bend over today, and that would mean we will be done with Covid-19 around September (explained further below).

However, given what we are seeing in countries with lower resource healthcare systems and/or poor policies and leadership (Africa, Latin America, Indian subcontinent, Brazil, Russia, and the USA), this upward trend is likely to continue, and Covid-19 may be with us well into 2021.

Spanish Flu 2.0?

Many, many comparisons are made between Covid-19 and the Spanish Flu.

The first known case of the Spanish Flu occurred Mar 11, 1918, at a military base in Kansas and spread from there in 3 waves as hundreds of thousands of US troops traveled across the Atlantic during World War I.

The 1st Wave in Spring/Summer 1918 was relatively benign. It was the 2nd and 3rd Waves in the Fall of 1918 and early 1919 that contributed to upwards of 65+ million deaths worldwide (Figure 2).

Figure 2. The Three Waves of Spanish Flu in England and Wales. While we normally don’t like graphs without numbers on the y-axis, this graph is illustrative of the difference in magnitude of the three waves. The virus was thought to have mutated and become much deadlier in the second and third waves. Those that were ill and recovered in the first wave had immunity to this later virus. (Source: CDC, originally adapted from this England and Wales Registrar-Generals’ Report)

So why is it called the Spanish Flu (and not the American Flu)? Well, that is because Spain wasn’t involved in World War I and was one of the only countries without a media blackout (History.com). They reported accurately on the pandemic, and everyone else assumed it was specific to Spain (it wasn’t).

In 1918, 65 million deaths were roughly equivalent to 3.6% of the world’s population (1.8 billion). In comparison, Covid-19 has killed approximately 325,000 people to date — equivalent to just 0.004% of the global population.

Let that sink in for a minute.

This means the Spanish Flu was responsible for 720 times more global deaths on a percent basis. Today we have much higher population density and ease of global travel — Covid-19 is but a mere breeze sent by Mother Nature compared to the F5 Tornado that was the Spanish Flu.

Today we live in a society where people piss and moan about having to wear a mask in public, not being able to socialize with their BFF, or partially closing an economy in order to contain this gentle breeze. The scientific community understands what a 2nd Wave could mean, and if it hits like the Spanish Flu, your worries in 12 months will be about survival, and no one will care about the economy (sorry JC, it’s not the economy, stupid).

First Wave vs. Second Wave

So you’re probably saying — “Guys, you’re blowing things out of proportion. Back then, they didn’t have ICUs, ventilators, antibiotics, and all of the modern marvels of medicine.”

There are two problems with this thinking.

  1. As we have seen in Italy, Spain, and New York City, even modern, technologically advanced societies will run out of things like ICU beds, ventilators, medicine, or PPE, nasal swabs, etc., if the system is overwhelmed and we are underprepared.
  2. The people experiencing the 1st Wave of the Spanish Flu probably thought the same thing, right before they were smacked with subsequent Waves.

For Point 2, let’s look at some numbers to see how bad it might get. While there is limited data on the exact differences between the 1st and 2nd Waves of the Spanish Flu globally, some cities were already keeping detailed records. In Figure 3 below, we get an idea of the magnitude of the difference in deaths between the 1st Wave and the 2nd Wave in 4 Scandinavian cities (Andreasan et al, 2009).

Figure 3. Scandinavian 1918 Spanish Flu waves— weekly incidence of influenza and respiratory deaths in 4 Scandinavian cities during 1918–1919. Their 1st Wave came in mid-summer, because of the time it took for US troops to carry the virus when they came to Europe. “P&I deaths” refers to deaths from Pneumonia & Influenza, as cases were lumped together in those early reports.

The Spanish Flu 1st Wave mortality rate in these 4 cities ranged from 0.015% to 0.056%. In the 2nd Wave, the number of deaths jumped significantly — with a mortality rate ranging from 0.188% to 0.342%. The biggest jump was in Copenhagen — which saw a 15X increase in deaths between 1st and 2nd Wave.

As mentioned above, Covid-19 currently has a global mortality rate of 0.004%. Seems like a far cry from even the Spanish Flu 1st Wave (3.75–14X fewer deaths per capita). But that’s just because big chunks of the world haven’t been hit yet. Let’s look at the US — we are currently reporting 95,166 deaths as of this writing (Worldometers). That’s 0.029% — eerily right in the middle of the range of the Spanish Flu 1st Wave.

Putting ourselves in the shoes of a citizen of Copenhagen during the 1st Wave, we also might not be taking the Spanish Flu that seriously.

And if we saw a similar 2nd Wave for Covid-19 in the US as they did for Spanish Flu in Copenhagen — we would be looking at the sobering potential of 1.4 million Americans dead by New Year’s Eve.

Global Reported Cases (log scale)

Another way to visualize the global number of cases is on a log scale (Figure 4). We started this plot on Jan 22, 2020, 3 days after the first case was reported in the US. We can clearly see that the world was very close to containing Covid-19 just 40 days after that date (early March). Unfortunately we choose to ignore the science and let the proverbial cat out of the bag.

Figure 4. Number of Covid-1 cases reported worldwide over time (log scale)

The argument that China is at fault is as specious as Spain is at fault for the Spanish Flu, and such rhetoric needs to stop so we can focus on the real problem. Every country knew about Covid-19 well in advance of Jan 22, 2020, China officially reported to the World on Dec 31, 2019 (approximately 30 days after Patient Zero).

So where is this curve headed? As we pointed out above, no one really knows and it depends on how under resourced countries mentioned above deal with the crisis.

Global Actual Data vs. Model

The model as drawn assumes that we will bend the global curve today (highly unlikely) and simply shows that the best case scenario to an end (plateau) is at least 3 months out (Figure 5).

Figure 5. Global actual reported cases vs. best fit model, assuming that curve starts bending today. Highly unlikely.

New Confirmed Cases (in past week) vs. Total Confirmed

Our favored way to look at the data shows that the global curve has not turned over yet, for the past 5 weeks we have seen between 500,000 and 600,000 cases each week, what we do collectively will determine whether this heads south or north (Figure 6).

Figure 6. New Confirmed Cases vs. Total Confirmed Cases of Covid-19 (semilog scale to highlight linear growth). Interestingly Covid-19 cases are increasing globally in a linear fashion, as opposed to exponential, which is the silver lining.

The Four Horsemen of the Apocalypse

Brazil, Russia, USA and the DUQ comprise 9.6% of the global population, yet have 47.2% of Covid-19 reported cases.

How can this be? We think a recent quote from Trump sums it up:

If you’re testing 14 million people, you’re going to find many more cases. Many of these people aren’t very sick but they still go down as a case, so, actually, the number of cases — and we’re also a much bigger country than most. So when we have a lot of cases, I don’t look at that as a bad thing, I look at that as, in a certain respect, as being a good thing because it means our testing is much better. (Time)

This of course is absurd and it tantamount to saying if you give more people pregnancy tests you will have more babies.

But we can’t blame Trump, Bolsonaro, Putin and Boris for this debacle . These 4 leaders do have something in common though — they are all populist demagogues who are too macho to wear a mask in public. Certainly, their early responses to Covid-19 have been from the same playbook, but this is because they are pandering to their base. And this is where the problem lies.

Their populist base around the world is anti-science, anti-evolution, climate change deniers, and the majority of them believe they have an invisible friend who lives in the sky. It is impossible to have a rational argument with them — the only thing to do is ostracize them, let them know publicly that their ideas have no place in modern society, and that their ideas are dangerous.

There are 2 possible futures for humanity. Mother Nature has sent us a gentle breeze in the form of Covid-19, and we ignore it at our peril.

--

--

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