Covid19 - Fighting for our future

On the 26th of January this model was shared on social media which gave a hypothetical extrapolation of the early stages of Covid19 based upon the breakout in China. The growth was based upon three data points; the start date and identified initial cases, the estimated infection rate and ultimately the mortality rate.

As of the the 14th of March we are at 146 thousand recorded cases of infection and 5400 deaths. At first glance this looks like we are two to three weeks ahead of the model. However this is misleading because of the unknowns.

It is likely that we are massively under recording the number of those infected and indeed the Chief Medical Officer of the U.K., Chris Whitty, said this week that with recorded numbers of just over 500 that it was probable that close to 10,000 people were carrying the virus. Whilst this indicates that the infection rate is significantly ahead of the Wuhan model, it also hopefully indicates that the mortality rate is dramatically less. Indeed Whitty explained that their best estimate was 1%.

This perspective is important when you look at data points coming out of other parts of the World with Italy perhaps being the most dramatic and replacing China as the highest growth area of new cases, with recorded infections standing at 17600 and 1266 deaths, mortality rates appear off the charts at over 7%. In reality it is more likely that up to 170k Italians have or have had the virus.

On a global basis this could mean that we are already at 1.5m infections and this is likely to continue double every week.

Strategies for tackling this crisis

What is worrying at the moment, is the contrasting and uncoordinated approach to stem the tide and impact of Covid19. We know that if unchecked, up to 80% of the population of the planet could catch the Virus and even at a fraction of this, the death rate could ultimately eclipse the 1918 Spanish Flu where between 50-100 million lost their lives.

China, which saw exponential growth from 4 cases at the start of the year to 80k by the end of February, has seen a rapid decline in new infections due to immediate and aggressive actions. In Wuhan the epicentre for this outbreak, factories and offices were closed and individuals were effectively put under house arrest (an English teacher still under lock down confirms that for over eight weeks he has only been allowed out for three 15 minute intervals a week, with food delivered or short visits to collect food packages at supermarkets being supervised). Clearly China demonstrated absolute control to take the fuel for the virus away and whilst it would be premature to say it has emerged at the end of the battle, it has at least slowed what would have been a forest fire burning across 1.4 billion people.

By contrast, the U.K. government seems to believe that there is an inevitability of the majority of the population catching the virus and that the best option is for ‘herd immunity’ to eventually protect the British public with accumulated antibodies, these would make it difficult for future outbreaks to spread.

This epidemiology modelling rests on at least 60% of the population catching the virus and places a big bet on the immunity lasting, the 60% being an accurate ‘herd immunity’ ratio for the U.K. population (Measles requires 90%) and of course that the Virus does not mutate to make the immunity worthless.

At the moment where most of the world is betting on suppressing the spread of the Virus with various watered down versions of the China model, Britain is an outlier betting on taking an expensive hit now for longer term benefits later.

Assuming that the Chief Scientific Advisor Sir Patrick Vallance is right, with the estimate of 40m people people in Britain needing to catch the Virus to make the strategy work, this would still represent on their estimates a 1% mortality and 400k deaths. This is not an even distribution either as Sir Patrick said this week, in an ideal world, he would move all the high risk members of society to Scotland and everyone else to Kent and would have a mass infection of the young and healthy on the South Coast.

With the early evidence of Covid19 indicating that 1.3% of over 50’s would sadly die and up to 15% of the over 80’s would have the same fate, this would effectively see a culling of the elderly and vulnerable. This is going to be a highly charged and politically sensitive strategy to follow. Even with the argument of 15% at the highest level being a relatively small percentage, this will be a standard distribution curve which will mean that those with highly reduced immune systems, those frail elderly citizens in Nursing homes and even those with high blood pressure and diabetes or battling cancers would see a much sharper spike.

If the U.K. strategy is to genuinely try and cocoon the most vulnerable, then nursing homes and supported living houses should be blocking potentially infected visitors now. Those over 70 should be being given strong social isolation advice and GP’s should be guiding those on the record as having immune suppression through fighting cancer or other conditions and should also be on lock down.

Which Strategy Wins?

The World Health Organisation seems to back the strong intervention with fighting early and hard and in a press conference on Friday 13th of March, Dr Michael Ryan (Executive Director of the World Health Organisation) was adamant that with all his experience of fighting viruses from Ebola onwards, “that giving no quarter and not allowing over analysis to paralyse strong and immediate action”was the key.

It appears to be a two bet option for every health system in the World. Allow the Virus to grow, manage the consequences and aim to survive with new immunity or to fight hard and delay the outbreak and rely on vaccinations or new viral immunotherapies being developed, which counter the future inevitable outbreaks

I suspect that the elderly, immune suppressed and vulnerable would prefer the latter.