We're at War
We are at war with an invisible enemy called COVID-19, commonly referred to as the Coronavirus. This is not an enemy that marshals their forces and meets its opponents on a battlefield, eye to eye, with artillery and guns lined up with clear front lines.
COVID -19 operates more like a combination of the blitzkrieg of World War II, crossing the borders with lightning speed, breaking through front lines, with a phalanx of armies, including tanks and airplane bombers, and encircling its targets; it also uses tactics of a guerilla army, opportunistically picking its targets, spreading fear and frustrating efforts to target it. It is savage and merciless.
Source: Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
Why the danger?
We are dealing with a genuine pandemic. The word pandemic has its roots in the greek: pan-demos; pan meaning all or everything; and demos, the people. According the World Health Organization, the definition of a pandemic is: the worldwide spread of a new disease. COVID-19 is now found on all populated continents (except for Antarctica). Further to this, "An influenza pandemic occurs when a new influenza virus emerges and spreads around the world, and most people do not have immunity." I have had several conversations with family, friends, and colleagues as to why COVID-19 is dangerous:
While the epidemiological data is still being collected and analyzed, the current estimated transmission rate is between R2.3-2.6, which means that sustained transmission occurs with one sick person passing this on to an average of 2.3-2.6 people in a given cycle of illness. The cycle is not yet clear, but is believed to be contagious in the days (perhaps weeks) before, during and after someone presents symptoms.
The mortality rate for those infected with COVID-19, again based on what we know, is between 1-3.4%; compared to seasonal flu which is 0.1% this is a factor of 10-34 times higher; we do know from the early data out of China that this skews toward the elderly and those with a comorbidity, or in other words, an underlying illness, such as cancer, cardiovascular disease, or diabetes. It does not appear to impact as acutely children or those who are under 60 years of age who are in good health.
Source: NY Times
There are no vaccines and no anti-viral drugs known to treat COVID-19 at this time. Companies and governments are working on this, but it may be months or longer; estimates that I have seen are 8-18 months.
This is not just a bad seasonal flu; this is a serious contagious disease, and it is having severe impacts across the globe: social, technological, economic, ecological, political, legal, and ethical (STEEPLE). It has the capacity of tearing at the very fabric of our society. This is a systemic risk, defined by something that we cannot mitigate, cannot transfer, cannot avoid, and it is or will soon be present everywhere; it will impact us all, no matter what.
Back in 1918, the world population was 1.8 billion, with 103 million in the USA, and the Great Pandemic of 1918-19 killed an estimated 50 million people globally, 500,000 in the USA. This wiped out a whole generation of young people, as the "Spanish Flu" variant had a higher mortality among young healthy adults and tended to impact less those who were very young or old. It has never been fully understood as to why, and there are many theories about this. While this disease impact's skewing toward older people (60+), a mortality rate of 1-3% or higher is far more dangerous than seasonal flu.
We are now at 7.8 billion on the planet, with 331 million in the USA, and if figures are correct that this may infect up to 70% of people, we have a genuine global crisis on our hands, with millions of people falling ill and tens of thousands, even hundreds of thousands dying from COVID-19. They say that now when China gets a cold, we all get sick due to our global integration; the USA and Europe could not only be getting sick, but the entire globe will be contracting pneumonia.
Stop Admiring the Problem and Start Solving It
"They are in front of us, behind us, and we are flanked on both sides by an enemy that outnumbers us 29:1. They can’t get away from us now!”
– General Lewis B. “Chesty” Puller, USMC
In times of crisis it often helps to go to the marines for wisdom. I often cite General Chesty Puller as an example. As above, he was quoted when faced by an overwhelming number of enemy troops. He led his troops into battle, fighting alongside them. He put his troops' needs before his own; most of all, he did not panic or lose hope, but set to task on his plan of attack. So, again to quote the marines, we need to "stop admiring the problem and start solving it".
Urgent Actions We Need to Take
Just like in the movies, and this is not a movie folks- this is an emergency, we need to take urgent countermeasures including all non-pharmaceutical countermeasures (see below). We need to flatten the growth curve of COVID-19, in essence reduce the burden that would overwhelm our healthcare system. See the chart below from the CDC. We need to move from the purple curve to the smaller, blue/purple lined curve.
We need to adopt strict personal hygiene and social distancing measures; wash hands regularly and apply hand-sanitizer; no hand shakes, use the elbow bump, hand wave (even the Vulcan "live long and prosper sign") will do. No hugs for friends and distant family that we do not live with, lest we spread a hidden virus among asymptomatic children and give it to our elderly family or immunocompromised individuals.
Self-quarantine when you are sick, even if you think it is just a cold or regular flu. If you can keep a distance of 6 ft. then do so. Avoid large gatherings of people (over 10). Consider cancelling large events, gatherings, unnecessary travel etc. South by Southwest cancelled this year as a result of COVID-19; this was a smart move. The NBA is starting the prepare for no fans at live games (sorry folks); this is wise. The healthcare system can become easily overloaded by additional visits of the worried well or healthy ill.
Protect our first-responders: healthcare workers. EMS (including fire fighters), police as necessary with appropriate personal protective equipment (PPE) and healthcare protocols. Make sure we manage adequate staffing patterns to avoid burnout, provide for psycho-social needs, and ensure that we support the families of care-givers and first line responders that are reliant on them. Again, this is a community effort (see above).
Read my earlier post "Don't Waste a Crisis", and get cracking if you have not already done so, preparing your household, community, and at the business level. I know people are getting ready, but a number of people I speak to act as if they are in a haze. It is time to wake up (snap out of it) and realize that this is an existential crisis for our communities, especially the most vulnerable. Businesses may go under, and not just small start-ups or out-dated mature industries, but severe impacts to what we call our critical infrastructures: food supply chain, energy and fuel, telecom., transportation, etc. Business continuity, continuity of government, and crisis management are not an afterthought; they are vital to organizational and community survival.
Start implementing non-pharmaceutical countermeasures (more below): surgical quarantines of impacted households and communities (if you think this does not work, then look to Singapore; they have blunted the impacts by implementing this through Smart Government and social adherence). If you are still wondering why, then just look at the potential implications.
Ration acute medical care for only critical care; all elective procedures that can wait, should be put on hold. Unless you get very sick or have an urgent medical procedure (urgent= life threatening in the immediate future), then put it on hold.
Open up the government coffers to cover medical costs, tests and acute care, for COVID-19 for those who cannot pay (not covered by private insurance through work, ACA, or medicare/medicaid) hospitals and other healthcare providers. If people are afraid of the debt burden for seeing a doctor for COVID-19, then they will not see someone if they are seriously ill and are another vector for spreading it if they report to work.
All medical doctors and healthcare professionals of all types, including recently retired professionals, need to be pressed into public service. This is a call to arms, my friends.COVID-19 will impact, the rich and poor, so doctors performing cosmetic surgery or procedures need to think about what role they will play.
We need an all of government and industry response as the situation starts to worsen and impact critical infrastructures.
We may need to support those who are impacted at the lower end of the socio-economic ladder: people who live paycheck to paycheck and have no savings to support themselves. This means economic support for expanded sick leave and, consideration of funds to cover them in the near term until we can bring life back to a new normal.
A Call to Arms
There's much more to add, but leaders at all levels, local, county, state, tribal, territorial, and Federal, as well as the private and non-profit sectors, need to turn their full attention to the impacts of COVID-19 and figure out their role, what they need to do, and get started implementing it today.
In the past when our great nation has come under threat, whether the two world wars or 911, we muster our collective efforts, intelligence, innovation, and come together to defeat a common enemy. As the Marines say when confronted with an obstacle, "we improvise, adapt, and overcome that obstacle"; this time is no different, so we must all now rise to the occasion, take heed, and answer the call to arms and fight COVID-19.
It may seem alarmist at this point to make the recommendations above, but an ounce of prevention is worth a pound of cure.