Although the COVID-19 pandemic and its consequences are far from over, there are a number of key lessons that must be urgently drawn upon. Whether people react responsibly is a different story. Unfortunately, early indicators point to excessive human carelessness and negligence. For instance, the behaviour of some leaders[i]has been highly questionable. During a pandemic ignorance only contributes to greater volatility and the unnecessary loss of life. Everyone, yes that includes politicians, athletes, beach goers, and party-animals alike, must listen to the advice of doctors and scientists. Simply put, people should follow the guidance of epidemiologists, immunologists, and virologists to help mitigate the risks associated with the Novel Coronavirus and COVID-19. As at 8 July 2020, we have had over 12 million confirmed cases and 550,000 deaths. These numbers only represent the recorded instances as there are many, many more, possibly multiples, that have simply not been captured. These figures will only rise unless people diligently take precautionary measures to minimize the impact of COVID-19 and a cure (i.e. vaccine) is found. On an aside, the pandemic has also caused global economic paralysis and triggered a financial crisis that is going to make the subprime (2008 – 2009) and subsequent European sovereign debt (2010 – 2013) crises look like a walk in the park.
So, what do we know so far? The Novel Coronavirus or the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) spreads when an infected person coughs, sneezes, or speaks, releasing droplets into the air. Recent studies suggest that even smaller airborne coronavirus particles can infect people and the World Health Organization was asked by experts to revise its recommendations and mitigation strategy. To limit the risk of contracting the virus and consequently the COVID-19 disease, everyone must frequently wash their hands (lather your hands and properly wash them for at least 20 seconds); cover your mouth and nose – typically with a surgical grade mask; do not touch your exposed areas (i.e. eyes, nose, and mouth); and follow social distance requirements (i.e. 2 metres, not the diluted 1 metre being propagated by some politicians). If you have been exposed to the virus or display symptoms, then please isolate yourself for no less than 2 weeks, because the incubation period is approximately 5 – 6 days and can last up to 14 days. It is during this period that infected people are contagious and can easily spread the virus. Roughly 80 percent of infected people are either asymptomatic or have very mild symptoms. This is why keeping your hands clean, wearing protective gear, effectively social distancing, and voluntary, self-isolation, when required, are critical to limiting the spread of the virus.
Globally, we have seen that there is roughly a 5 percent death rate. However, the data is questionable, as countries do not have the ability to identify and report all cases and deaths. There is also a significant range in mortality rates when comparing data from across countries as a number of factors impact death and recovery rates, including health issues (e.g. overweight, heart conditions, diabetes, asthma, etc.), access to quality and affordable health care, and socio-demographic and economic challenges (i.e. poverty). For example, the United Kingdom (UK) ranks amongst the highest with a death rate of 15.4 percent, France is at 14.6 percent, Italy is at 14.4 percent, Mexico is at 11.9 percent, Holland is at 12.1 percent, Spain is at 11.3 percent, Canada is at 8.1 percent, Germany is at 4.6 percent, the United States (US) is at 4.4 percent, India is at 2.8 percent, Turkey is at 2.5 percent, and South Africa is at 1.6 percent. Material cases result in people being admitted to Intensive Care Units (ICU) and require ventilators to help them breath. British Prime Minister Boris Johnson is among the highest profile COVID-19 cases that required ICU support and on 7 July 2020, Brazil’s President Bolsonaro also tested positive.
There is also a lot of talk about COVID-19’s second and third waves. Effectively, these are subsequent rounds of large-scale infections. Iran is the first country likely experiencing a second wave and other countries are seeing alarmingly high spikes and surges (e.g. Bangladesh, Brazil, Chile, India, Mexico, Pakistan, Peru, Russia, Saudi Arabia, and the US). In the US, a number of states (i.e. Arizona, Arkansas, California, Florida, North Carolina, South Carolina, Tennessee and Texas) that resisted strict lockdowns and eased restrictions early on are seeing frighteningly high increases and being forced to re-introduce targeted lockdowns. On 3 July 2020, the US registered more than 55,000 new cases; the highest single day figure to be recorded anywhere. In Australia, Melbourne has seen an alarming cluster which led Premier Daniel Andrews to enforce a tight lockdown to limit the risk of contagion. It may sound repetitive, but it is actually quite simple: to avoid spikes, surges, and the spread of this disease, people must maintain high levels of personal hygiene and security (i.e. wash your hands and wear masks), adhere to social distancing requirements, and self-isolate when they are exposed to the virus or show symptoms. Authorities must also implement effective identify, isolate, and contact – track – trace systems to monitor and restrict the movement of people that have been exposed to the virus. In such scenarios, we need Big Brother’s help, because it is a matter of survival.
COVID-19 demonstrated that traditional crisis management systems are inadequate to mitigate global pandemics. While outbreaks of SARS (2003), Bird Flu (2005), Swine Flu (2009 – 2010), MERS (2012 – 2014), and Ebola (2014 – 2016) were contained, leaders ignored experts’ warnings in how to prepare for pandemics. For example, following World War I, the Spanish Flu claimed up to 100 million lives. Considering that the world’s population was only 1.8 billion at that time, and travel was significantly less than today’s levels, we should have been better prepared. Experts have consistently said that pandemics will recur and may even increase with frequency due to climate change. To limit the human and economic costs, we need to be prepared and take personal accountability for our behaviour. Do not put yourself or the public at risk.
It appears that our future will be quite volatile and prone to risks. As the polar ice caps melt, diseases that have long been frozen will re-enter our ecosystem and create more challenges for us to deal with – that’s not even considering how we are expected to deal with the harder hitting consequences of climate change. On the other hand, we do not need to wait for the melting of our polar ice caps and the catastrophic damage climate change will wreak on our world to be alarmed. As experts have advised, there are several real and present dangers that are knocking at our door today. On 30 June 2020, Chinese scientists identified a new influenza strand (G4 EA H1N1) in pigs that can infect people and possesses the potential to trigger another global pandemic. Does misery love company? Apparently so, because on 7 July 2020, the Bubonic plague broke out in Bayan, China, and authorities issued a level three warning for epidemic control. In November 2019, this region also witnessed the outbreak of the Pneumonic plague; a deadlier version of the Bubonic plague. With everyone trying to deal with COVID-19’s fall-out, this could be a perfect storm that takes us for an even more tumultuous ride.
These instances underscore the importance of being prepared for future pandemics. Experts advise that we need to have:
1) Surveillance systems to monitor, identify, and trigger rapid responses to outbreaks;
2) Restrict travel and isolate people that are exposed to the virus;
3) Adhere to mitigating strategies (i.e. social distancing, wearing masks, and personal hygiene);
4) Effectively identify, track, and trace incidents to monitor and restrict the spread of an outbreak;
5) Adequately equipped, supplied (i.e. PPE), and accessible, strong health care systems;
6) Medical dispatch teams to rapidly respond to hot spots and outbreak locations;
7) Security structures to support logistical needs, e.g. securing defined boundaries and restricting access to contaminated areas;
8) Simulation exercises to test response strategies; and
9) Appropriate R&D infrastructures to develop and distribute vaccines.
As countries did not follow the advice of experts, everyone was caught off guard when the Novel Coronavirus broke-out in late 2019 and initially rocked China in January 2020. The US, Brazil, and Russia were even in denial. These culprits presently represent 3 of the top 5 most infected jurisdictions; India just replaced Russia as number 3 and Peru rounds-up the top 5, as Latin America has been hit extremely hard in the past two months. With 8.5 percent of the world’s population, Latin America now accounts for approximately 20 percent of COVID-19 cases.
Throughout the world, densely populated areas with systemic economic challenges (i.e. poverty) that cannot or do not provide access to affordable, quality health care are being disproportionately challenged by the pandemic. This statement applies to Africa, Latin America, and South Asia, but also to the US, because America’s population has a very large disparity of wealth and the US does not provide its whole population with affordable and accessible quality healthcare. Statistically, COVID-19 has affected the US’s underprivileged Black and Latino communities more than any other, indicating that the US has some serious systemic problems. We should, however, not forget to mention that Europe’s leading countries, including France, Germany, Italy, Spain, and the UK, experienced pandemic paralysis throughout March, April, and May, and only started to recover in early June. With the easing of restrictions across Europe and the US, some people’s disregard to social distancing caused spikes and surges and may lead to the anticipated second and third waves of this pandemic.
In contrast to the world’s troubled locations, Hong Kong, New Zealand, South Korea, Taiwan, and Turkish Cyprus, took prompt action to mitigate the spread of the virus and limit COVID-19’s human casualties. The economies of these countries, like all others, suffered, but from a health perspective, they fared much better than others. For example, Turkish Cyprus, a small Eastern Mediterranean micro island-state was clear of COVID-19 on 11 May 2020. Approximately half a dozen cases have been identified since travel resumed in late June, but all new cases and exposed people have been consistently quarantined and the locally operationalized contact – track – trace system has helped authorities manage the situation. Hong Kong, New Zealand, South Korea, and particularly Taiwan, are also exemplary models to follow. For instance, Taiwan avoided a lockdown, because its authorities systematically executed an extensive pre-emptive strategy (before Christmas, 2019); enforced regular temperature checks; rigidly monitored self-quarantine obligations for new arrivals and exposed persons; sanctioned the extensive use of masks; rigorously implemented social distance requirements; and legislated heavy penalties, including fines, for those who do not adhere to the requirements. To-date, Taiwan has only had a total of 449 cases and 7 deaths. Similarly, New Zealand has had 1,533 cases and 22 deaths, but New Zealand executed a tight lockdown between March and June 2020 and has been carefully opening back up its economy since June.
Wuhan, China, was the pandemic’s initial epicentre, and although China’s early response saw a lot of criticism from abroad, Chinese authorities took extensive measures to mobilize resources to address the crisis’s needs. China has tight control over tracing and isolating COVID-19 cases, it built make-shift emergency hospitals, and firmly locked-down impacted areas. Critics can challenge China’s initial response to Wuhan’s outbreak, but nobody can deny the success of China’s recovery and return to the “new normal” way of life. Beijing subsequently had a new cluster of approximately 150 COVID-19 cases, but the government took immediate action to contain the outbreak. Beijing was not locked-down and continues to function, while unnecessary travel and gatherings are restricted, and people are encouraged to work from home. China has also rolled-out a smart-phone based contact – track – trace system with strict monitoring and enforcement. Before entering public places, locals are checked to make sure they are not at-risk cases.
As a result of China’s approach, its economic recovery is expected to be amongst the most expedient in the world. China watchers are bullish, whereas most Western nations, be they leading European states or the US, will likely struggle with a sustainable recovery, because they will have difficulties limiting the risk of subsequent spikes, surges, and waves. A proportion of Westerners appear to resist adhering to the behavioural requirements (e.g. social distancing, wearing masks, drinking irresponsibly in large gatherings, etc.) to mitigate COVID-19’s risks. Recent experiences in Melbourne, Australia, Leicester and London in the UK, and states across the America’s West and South, confirm these misgivings. Since an effective cure is not available, everyone must be very cautious and adhere to behavioural expectations: stay at home if you have been exposed to the virus or have symptoms, adhere to social distancing requirements, and maintain a high level of hygiene (i.e. wash your hands, use personal protective gear).
Amongst key indicators that help gage experts and policy makers’ recommendations is the reproductivevalue. The reproductive value (aka R0, R nought or R zero), tracks how many people, on average, are infected for every person who has the disease. Social distancing and isolation are fundamental to control the spread, because keeping people away from one another limits the infection rate. Keeping the rate below 1 is critical as this means that that each case will pass on the disease to less than one person, reducing the number of new instances with the aim of bringing down the new cases to zero. This indicator is used by scientists and governments to recommend the enforcement and reduction of restrictions and lockdowns, and is monitored to guide their approach to develop and execute COVID-19 mitigation strategies.
A cure is genuinely the only way to control and effectively eliminate COVID-19 risks. As such, major pharmaceutical companies and leading research universities are busily researching, developing, and testing potential vaccines with the support of major governments and foundations. However, there is no guarantee that a vaccine will be found, but there is hope. Some trial scenarios have moved into their second and third round of testing. If vaccines are developed, then the focus will be on manufacturing, producing, and globally distributing the cure. With a population of approximately 7.8 billion, logistical challenges with producing and distributing the vaccines, and the added complexity of the virus likely mutating in the horizon, the task that lies ahead will be difficult, and if feasible, take a few years to roll-out globally.
Success will not come easy. COVID-19 is here for the foreseeable future and will not be eliminated for some time. Like most predators, as soon as this virus sees an opportunity to go on the offensive, it will, especially when people become complacent. New cases will reappear and will cause surges, spikes, and potentially new waves, particularly in regions where people are careless and irresponsible. Until a vaccine is found, people must diligently go-on with their routine activities, while adhering to risk mitigating practices, and engage with our “new normal” so our economies can begin to recover. We are still relatively early on in this process and cannot appreciate the economic and financial consequences of this crisis. Watch this space, that will be my next contribution
[i] Presidents Bolsonaro (Brazil), Putin (Russia), and Trump (United States) were initially in denial and did not effectively lock down their respective countries. Trump took things to a different level, as he’s had one gaff after another said some very un-presidential things that were not scientifically sound and were against expert opinions. While not in denial, Prime Minister Johnson was a late to respond with the initial lockdown requirements and was hypocritical when his senior aid Dominic Cummings breached the government’s lockdown requirements; Cummings should have been fired without hesitation to demonstrate the British government does not have double standards and sets the right behavioural example. Brazil’s Bolsonaro tried to halt reporting COVID-19 deaths and new cases, but was overruled by a Supreme Court judge. Censorship won’t help Brazil or any other country deal with this crisis; it only damages the country’s integrity.