As we approach 100 days of quarantine or shelter in place, I wanted to take an inventory of what we know, what we need to know, and how to live and love in the time of Corona.
Humanity is at a critical juncture, and our individual decisions will decide between life or death, recession or depression, and potential social unrest or greater harmony. It is a time for empathy. It is a time to live and love, to give and grieve.
What do we know, and how should we live and love in the time of COVID-19, are the subjects I want to explore (a tip of the hat to Gabriel Garcia Marquez for his Love in the Time of Cholera).
Before I begin, let our hearts be with our friends and colleagues that are still trapped in the COVID-19 storm, including India, Philippines, Brazil, Saudi Arabia, Russia and elsewhere. May you pass through the storm with speed, health and blessings.
We have known knowns, and unknown unknowns.
My industry is technology and the technology narrative has spanned from “digital by default” to embracing “new ways to work.” Cries of “flatten the curve” were splattered across social media, with the definition of success being not to overwhelm the medical system. We have demonstrated that we can flatten the curve, keep our healthcare systems operating, but only with the bravery of our healthcare professionals, nurses and doctors.
We are flattening the curve, one of the many milestones in defeating the virus, but it is a milestone with no celebration. Consider one of the symbols, the USNS Comfort arriving in New York City with water cannons and cheers, and quietly sailing away after servicing only 182 patients (and we are thankful—to the crew, for the preparedness and also for the lack of demand). It is a silent celebration as we flatten the curve. There has been very little time to live, love or grieve through the pandemic.
So how do we live and love between “flattening the curve” and “finding the cure” (either as a therapeutic or a vaccine)? Like any great journey or project, there should be milestones. A year is not a year; we break it into four quarters, milestones. So, let’s go back to the math and science and focus on the metrics that matter.
Math, science, and metrics that matter.
Metric 1: New cases a day is an important metric, but it is very incomplete. There will be spikes, and there will be lows. And with hope, the lows get lower. However, I believe we need to move beyond this metric as the primary metric.
Metric 2: How many people are infected? We are approaching six million reported cases, but is this number under reported by 10x or 20x, and is the true number of cases closer to 120 million? We don’t know. This is why testing is so important. We need to test, test and test more. Until we have wide scale testing that is reliable (either for the active virus or anti-bodies), the analysis from the current math and statistics will be massively incomplete—and this analysis is what is informing policy decisions.
Metric 3: How many people have died? Around 350,000, as reported on May 25, 2020. The number is surely under reported.
Metric 4: What demographics of people are dying? I think the data is clear that those over 65 are at a 70% death rate.
Metric 5: What is the pace of contagion, or the R-Naught? We know it’s high and aggressive, but we really do not know if it is ultra-high, and this matters. If the R-Naught is ultra-high, then 20% to 40% of the world’s population could already have been exposed, which would actually be encouraging, if true. But we don’t know, we need testing.
Metric 6: The infection rate from contaminated surfaces was thought to be very high. It is now thought to be very low. I heard one medical expert explain it this way. Do all the right hygienic things and take all the right precautions; wash your hands, clean surfaces, wear gloves. These things of course help, but the best thing you can do, is to not lick the bottom of your shoes.
Metric 7: Infection rates are ultra-high from aerosol spread, that is, respiratory droplets through breathing, coughing or sneezing. Stay six feet or 1.8 meters apart. Wear that mask. Masks work. You are going to be wearing a mask for the next two years—own it, make it fun.
Metric 8: What is the death rate, or mortality rate? It is division with a numerator (how many parts are being considered) and a denominator (equal parts of the whole).
What is the mortality rate (MR) of COVID-19? No one knows yet, because you need years of data and trending. But we tend to want immediate explanations and answers, so we may take whatever numbers are available to us and calculate the MR. Take 400,000 reported deaths over six million cases, you get a MR of 6%. Six out of 100 people who contract the disease will die. If you take out those over 65, you would do this math: 122,500 / 6M = MR of 2%.
This approach could end up being ALL WRONG, as this is an observed rate.
If there are 350,000 deaths, and say it is 5x under reported, you have closer to 1.75 million deaths. If in fact the number of infections is under reported by 20x, you are closer to 120 million cases: 1.75m / 120m = MR of 1.4%, an MR closer to measles. If you take out those over 65, your MR = 0.5% or closer to influenza rates.
The numerator and denominator are essential. The MR will be more sensitive to the accuracy of the denominator.
We need to get more accurate numbers on both the numerator and the denominator by testing and finding better classifications.
Metric 9: What’s in a name? Diseases where once named by location of origin, as the location of the virus is very important and instructive: Marburg, Zika, Ebola, Spanish Flu, Hanta, Dengue, Hong Kong. This disease was discovered in Wuhan, China and the official name of the disease is COVID-19 and the official name of the virus is SARS-CoV-2, as viruses are now named for their genetic structures to help facilitate research, tests, treatments and vaccines. You will note that the term novel is used both in the name of disease and in the name of the virus at times: Novel COVID-19 or Novel SARS-CoV-2.
So, here is the question: Is COVID-19 novel? The experts use this term, but they actually do not know, and this matters. If it is new—truly new, never been exposed to humans before—and this is the first zoonosis from animal to human, then we may have no antibodies. If it is not novel, that is humans may have been exposed to it, humans may have had reservoirs of antibodies, through time, and we may be more prepared for SARS-CoV-2.
Metric 10: Structural and systemic racism and poverty. Marginalized communities are the hardest hit in this pandemic as well as the poor in India, Brazil, Bangladesh and elsewhere. It is a combination of general health conditions, education, density of population, and the structural and systemic aspects of racism and poverty. In some city clusters, as many as 70% of COVID-19 deaths are from the brown and black communities.
COVID-19 most likely began in November 2019, with global awareness occurring in February of 2020. With a tsunami of information, assumptions, hypothesis, and analysis that is only four months old—it is an impossible problem to solve. We are living what is called the “fog of war,” our scientists and politicians need to make decisions with incomplete information.
Criticism is the backbone of the scientific method, and through this method, we gain knowledge and develop science. Scientists are trained not to make assumptions.
Based on the metrics over the last four to six months, two main narratives are emerging:
- Narrative 1: Virus is Novel, High Mortality Rate, Medium R-Naught.
- Narrative 2: Virus is not Novel, Low Mortality Rate, Ultra-high R-Naught.
- Aspects common to each narrative: it disproportionally affects those over 65 and those in poor health or who are immunocompromised.
Is COVID-19 a deadly pandemic that only a small fraction of the population has been exposed to, or, is it a milder pandemic that a large percentage of the population has already encountered, and is on its way out? The truth will present itself with time.
Consider the movie JAWS. If Narrative 1 is closer to the truth, you would close the beaches on Amity Island. If Narrative 2 is closer to the truth, you would keep the beaches open. There is a potential third Narrative that may emerge, more like a “shark net”: smaller beaches, protect the beach, but keep the beach open with managed risk.
The collective wisdom is currently narrative 1, except for Sweden, which is on track to become one of the highest per capita mortality rates.
Where do we go from here?
We are all experiencing the “great lockdown” in our own ways. Some of us are beginning to experience the “great unfreezing” as we begin to return to our workplaces, stores, shops, places of worship, and playing fields. This past weekend, I visited an open space preserve in the Santa Cruz mountains near my home, went for a nice hike, and wore a mask when I encountered people.
Here are some thoughts on how to live and love between flattening the curve and finding the cure.
1…. Wear a mask. Embrace it, own it, love it. I heard a person on the news talk about “If god decides it is my time to go, then I go, it has nothing to do with a mask.” Dear sir, the mask is for you, but what’s more, it is for all the people around you. We must have the courage to change our behaviors.
2… Test. And test. And test. And test more. The new serology tests are important, as they test for anti-bodies. We need to know the “denominator.” Without it, we are guessing, and that is no way to run our lives or our economy for the long term.
3… Hygiene. We need to continue to have a healthy dose of paranoia regarding hygienic practices. Wash your hands, clean your surfaces, use sanitizer.
4… Physical distancing. I know this is hard, but it works. Isolation is not social insulation.
5… Time to reconfigure. We are social by nature, I want to be around my friends, family, colleagues, customers, partners. We can reconfigure our physical spaces with great safety and enjoyment. Our parents and grandparents lived in foxholes during wars. We can flourish in the short term with glass partitions and 6 feet / 2 meters of distance.
6… We need a new playbook for those who are disproportionally impacted, such as those 65 and older. It is not too late. Sending the sick back into healthy communities was the wrong answer.
7… We also need a new playbook for structural and systemic racism and poverty, to create an equitable society, providing healthcare and education for all. We need to make ourselves more unselfish every day.
8… Intervention. Governments have a role to play when a system is failing. Governments should pool key resources and coordinate, intervene now, and allocate billions of dollars to develop a vaccine or therapeutics. Twenty-five countries going after a vaccine in an uncoordinated way with hundreds of rival corporations, is counter to solving a global crisis and pandemic of this unprecedented scale and nature.
9… Second spikes. They are going to happen. Be physically and emotionally prepared. When they happen, we should turn the dial back in those affected areas, and not overreact to a second global lock down. We need to understand the specific spike and its data and analysis.
10… Love and grieving. Kahlil Gibran’s “On Love” has stayed with me through time. With love, I also need time to grieve. To grieve for the dead, to grieve for the poor, to grieve for those affected, to process what is happening, and to turn our energy and resources to supreme action.
To wake at dawn with a winged heart and give thanks for another day of loving;
To rest at the noon hour and meditate love’s ecstasy;
To return home at eventide with gratitude;
And then to sleep with a prayer for the beloved in your heart and a song of praise upon your lips.
Let us strive on.
Let us strive on with our mission and work, let us press forward on living and loving, giving and grieving. Let us find answers to the questions we need to answer, to make informed decisions between flattening the curve and finding a cure.
We will live and love in the time of Corona.
Mark J. Barrenechea
OpenText CEO & CTO