Responding To COVID-19 And Other Pandemics

COVID-19 Poses A Grave Health Risk To The World

 

COVID-19 infections are continuing to exponentially increase outside China. Furthermore the fatality rate, and the rate of developing severe pneumonia currently seems to be about 1% and 5% respectively – and this is an optimistic estimate derived from samples that include mild cases, such as cases outside Wuhan, where there was contact tracing as well as cases outside China (where there was also contact tracing).

On the Diamond Princess, out of the 705 people initially infected, 36 (5.2%) of these are now seriously ill and 6 (0.85%) have died… so far, as of writing. Contact tracing also takes mild cases into account, and there was extensive contact tracing of individuals from Wuhan who both left for other provinces in China and for other countries. Many individuals who have been infected remain in the hospital and have not yet either died or recovered but this case study of some of the earlier cases in provinces across China suggest a 1% mortality rate and a 5% chance of developing severe pneumonia. It seems likely that, at the early stages, individuals identified through contact tracing, tested, and found to have the virus, would likely be taken to hospital, even if their condition was mild. There was also contact tracing for those who had contacted people from Wuhan outside China, and many individuals who tested positive initially showed no symptoms (though the condition of a number of them subsequently deteriorated). It’s

hard to get accurate numbers for patients in a serious condition outside China, they tend to be featured in piecemeal news articles here and there, but my impression from reading them is that, in general, roughly 5% of international cases have also developed pneumonia. So far, outside mainland China there have been 120 deaths out of 7644 cases giving a mortality rate of 1.6%. Because of contact tracing outside China, it is likely that these figures take mild cases into account and do not overestimate the mortality rate. Indeed, they may even underestimate it as the overwhelming majority of currently infected patients have not recovered – and many may yet die. Indeed, since China successfully reduced new COVID-19 cases, the mortality rate has steadily crept up from 2% to 3.4% with existing cases dying and no new cases to dilute those numbers.

Intrinsically, COVID-19 is at least 5-10 times deadlier than the flu – these estimates include contact tracing and mild cases. At this stage, believing that a vast number of mild cases will magically show up to dilute the mortality rate down further is delusional wishful thinking. Unfortunately, unless the spread of COVID-19 can be checked, in practice, it will likely be 30-100 times deadlier than seasonal flu for those who catch it. This is because the case burden from COVID-19 will likely overwhelm the ability of the world’s healthcare systems to cope. 1% of those who catch the existing seasonal flu end up hospitalized and roughly 10% of those hospitalized for seasonal flu die. It is estimated that if COVID-19 is not contained and becomes a widespread “community disease” it could infect 60-80% of the global population (at least the first time around), as no one has any immunity to this new disease – this compares to the seasonal flu, which typically infects between 5 and 20% of the population each year. Clearly, if 5% of 60-80% of the world’s population get pneumonia over the next few months, the healthcare systems of the world will be utterly overwhelmed.

Existing estimates for the case fatality rate have been made for patients that received adequate medical attention. If medical facilities are overwhelmed, then a much larger fraction of seriously ill patients will die. Indeed, an overwhelmed hospital system could easily push the mortality rate up from 1% to 3 or 4%…

…and if 60% of the world’s population are infected, then a mortality rate of 4% would mean 370 million people could die in the next few months.

It may even be somewhat worse than this as an overwhelmed medical system might not be able to treat patients with other diseases, like hospitalizations from standard seasonal flu, appendicitis, cancer patients, people living with HIV, diabetics, and many other conditions requiring urgent medical attention. So, in addition to the direct deaths from COVID-19, there could be many more indirect deaths from patients with other life threatening illnesses not getting access to the medical attention they desperately need.

Clearly COVID-19 must be contained at all costs.

 

Containing COVID-19

 

The one piece of good news is that there is evidence that China’s extreme response has been effective at curbing the outbreak. At the moment, it looks increasingly unlikely that any country will remain entirely free of COVID-19, but, through taking extreme measures, as soon as localized outbreaks arise, it may be possible to reduce the number of infected to far below the 60-80% of the world’s population that experts anticipate will contract the disease in a business-as-usual scenario.

With extreme measures, it may be possible to keep the infection rate at a low enough level that the health systems of different nations will be able to cope. If COVID-19 infections can be kept to a manageable level, this will in turn reduce the mortality rate of those infected by a factor of 3 to 4, even more if effective treatments are found – such as effective anti-viral drugs. These extreme measures will not be pleasant, and will disrupt people’s lives and impose great inconvenience upon everyone – but they are surely better than the alternative of 300 million+ people dying.

With the exception of workers who are needed to maintain vital infrastructure and services, such as healthcare, internet, electricity, water, food production, etc., etc., the biggest contribution that everyone else can make during a serious pandemic is not to contract the disease themselves and, by not contracting the disease – and by neither becoming hospitalized yourself nor infecting someone else who becomes hospitalized – individuals who remain uninfected will ease the burden on healthcare systems that will likely be almost stretched to breaking point.

The easiest steps we can take is:

1. Not to attend gatherings
2. Not to attend church
3. Limit social visits, outside immediate household
4. Take extra precautions if family members, or even neighbours, come down with respiratory illnesses such as wearing respirators, gloves, washing surfaces with bleach ( a 0.1% sodium hypochlorite solution destroys coronaviruses in about 1 minute)
5. Call a doctor immediately when someone develops a severe respiratory condition of if someone who has been in a situation that would put them at risk of infection from COVID-19 develops mild symptoms
6. If you live in a large community, develop a plan to both quarantine and treat members who fall ill and simultaneously limit the spread of further infections.
7. Avoid public transport – if you want to be environmentally-friendly…cycle!

A further measure, would be for people who live far from work, but don’t own a car, to find a regular car sharing buddy (always the same person) to commute to and from work, to enable them to avoid public transport. Employers should encourage their employees to do this as a COVID-19 outbreak in the work-place, as a result of one of their employees catching it on the bus, would obviously be a nightmare.

Everyone can take these steps. However, many people must meet other people to make money or earn educational qualifications at work or in school. It takes strict government legislation to ensure that people can stay away from work and school during an outbreak without fear of being financially penalized or jeopardizing your educational qualification. Preferrably online work and online education can replace work in-person, but COVID-19 is sufficiently severe and sufficiently contagious for it to be preferrable not to work or study at all, in a region with an serious outbreak, than to spread the disease, cause death to others and add to the strain of an overburdened healthcare system.

So long as regions with outbreaks can be isolated, we can hope that governments will be able to afford to financially compensate individuals in quarantined locations – at least partially – for lost wages, both to encourage compliance and because it’s the right thing to do.

 

Training Delivery Men: A Crucial Component Of Any Containment Strategy

 

Delivery men are key personnel during a pandemic.

Water and electricity flows effortlessly to our houses, but food, medicine and other essential supplies must be delivered by human beings during a lockdown – by delivery men.

Those delivery men will make or break any containment effort in an area under lockdown.

If they can remain uninfected, they will enable residents in an area under lockdown to procure essential supplies without risking infection in crowded shops (and – as we’ve seen in Wuhan – because many shops close during a lockdown, the ones that stay open are often filled with customers, sometimes there are even queues, even when most of the city is abandoned) and by enabling people not to travel outside to crowded shop, delivery men will play a crucial role in safely containing the outbreak and saving millions of lives in the process.

If, on the other hand, delivery men get infected, they will act as vectors and spread COVID-19 far and wide throughout the community, up and down the supply chain to both customers and suppliers, even people who stay at home.

Furthermore, if delivery men start getting ill and dying, then delivery-workers may stop delivering essential supplies to inhabitants under lockdown. In which case desperate people will break quarantine and take to the streets spreading choas and infection everywhere.

Delivery men will be in contact with a large number of people so will be at significant risk of infection unless they are given the proper equipment and training to ensure they can safely deliver essential supplies to those who need them.

It is also important that those working to deliver goods to quarantined areas be assured that they will receive the best medical care, should they themselves become infected, and also be assured that they will be covered for lost wages should they develop symptoms and require quarantining. Otherwise, delivery men who are strapped for cash, and have families to support, may be inclined not to report it when they get a snuffle, for fear of losing their wages.

Despite the constant moaning that “Amazon is shutting down the high street” Amazon may prove to be indispensable in containing COVID-19 outbreaks provided they proactively undertake stringent measures to simultaneously protect their contractors from infection and ensure that those under quarantine receive essential supplies in a timely manner.

Doctors, nurses and healthcare workers have a certain glamour to them, especially during pandemics, and obviously are most at risk of infection and should be front of the list in terms of equipping and protecting them. But those planning the nation’s response to this COVID-19 epidemic must not neglect delivery men and must mindfully and prominently consider their protection when discussing containment strategies.

In the long-run, fully automated delivery will be a key strategic technology that should be developed to facilitate the robust containment of future pandemics.

 

The Best Case Scenario

 

Realistically, the idea that the COVID-19 outbreak can be limited to Wuhan, or even China, with contact tracing and quarantining sufficing to keep the caseload in other countries down to tens or hundreds of cases, is completely delusional at this stage. As is hoping to completely wipe out COVID-19 in the way that MERS and SARS were wiped out.

In all honesty, the best plausible scenario is pretty grim – but not catastrophic. 100’s of millions of people’s lives will need to be disrupted, but it might be possible to keep COVID-19 fatalities below 1 million.

 

In the best plausible scenario, localized outbreaks of COVID-19 will keep erupting in random towns and cities, here and there, all over the world and will be contained with Wuhan-style mass quarantines and lockdowns followed by frenetic contact tracing for those who flee from the outbreaks for the next two years, until an effective vaccine has been developed, tested and mass-produced.

There won’t be shortages of food, as the system will be mobilised to ensure people who are locked down can continue to order things on delivery and the number of people dying during each lockdown will be relatively low, perhaps 1,000 per outbreak, as the outbreaks will be detected early and the response will be swift. Because of this, the medical system will not be overloaded and those who do get seriously ill will get the best of treatment and 90% of them will recover. Healthcare professionals will instutite procedures that enable them to safely treat infected individuals in isolated rooms without spreading the infection to the rest of the hospital. Special trailers, that can be hooked to the back of lorries, are designed to carry up to ten infected individuals in quarantine zones to distant hospitals scattered throughout the country. These trailers are equipped with ICU and there are special cubicles disinfecting areas, airlocks and clean-zones in the trailers to enable staff to look after patients without risking infection and also to safely get out of their hazmat suit and relax from time to time.

 

Building shipping containers equipped with ICU is probably a better use of resources than building fixed hospitals. Shipping containers are also more appropriate for isolating suspected cases (who may not have the virus) compared to massive open field hospitals, with rows of beds all next to each other, which will be breeding grounds for infection and reinfection. And once an outbreak is over in one location, shipping containers can be redeployed to the next location with the next outbreak – including to countries in the developing world.

Epidemiologists are intensely busy for the next 2 years and there is a massive recruitment drive for more of them. They constantly test people for COVID-19 at the slightest hint of there being an outbreak of respiratory illness anywhere. Sometimes, if they catch the disease early, they can avoid a lock down, through contact tracing. But other times it is necessary to lock down whole cities. All in all, over the next two years, 40 population centres have to be locked down for 2 months each. With many more precautionary lockdowns, for a week or so, of streets and neighbourhoods.

Mask and other PPE shortages probably won’t last beyond 2 or 3 months. Masks and even respirators are not that resource intensive to make. If the U.S. managed to increase the total number of military aircraft they produced 12-fold between 1940 and 1942, it should be possible to ramp up PPE manufacturing to ensure there is adequate equipment for everyone over the next few months. As we speak, Chinese car manufacturers and other large manufacturers, like Foxconn, are shifting their production away from their usual products to manufacture face masks instead.

Furthermore, in the months that follow, better, more accurate, more sensitive, more rapid test kits are developed and mass-produced and within 3 months meaningful screening of individuals can be conducted in a relatively watertight way on roads leading out of infected towns, borders, ports, airports etc., This increased testing capability greatly shortens the quarantining process and enables global trade to somewhat recover over the next 2 months (from June to August). It also enables lockdowns to be targetted on streets and neighbourhoods rather than whole cities.

Nevertheless, a few cases keep slipping through, and outbreaks keep happening, but with better testing and a more rapid response, their rate and severity starts to decline by June. All in all, between March and June, it was necessary to lockdown 35 population centres outside China to halt the spread of COVID-19, while, due to more efficient testing equiptment, from June until the vaccine was deployed in December 2022, only 5 subsequent population centres needed to be locked down, although across the entire period there was a flurry of quarantines and contact tracing all across the world.

Although conspiracy theories that are out-right false, get flagged, in the best-case scenario the WHO and national health authorities recognise that COVID-19 is an alarming illness as a matter of fact. As such, they do not suppress or censor messages and reports that draw attention to aspects of the disease, or its spread, that are alarming but factual.

Across the world, most people keep working but avoid unnecessary socializing, especially in large groups and work from home, if possible. Many pastors conduct chuch services remotely via Skype as an additional option for people who have cold and flu symptoms, in addition to the physical church services. While those under lockdown simply stay at home and order food on delivery (the government pays them a special lockdown living allowance so that they can afford to do this). 95% of the world is not under lockdown and life goes on at a muted pace. Furthermore, the combination of the avoidance of socializing and the careful observation of good hygiene standards, slowed the R0 of the virus and ensured that when outbreaks did emerge and people developed symptoms, the number of overall cases was kept to manageable levels.

Thanks to the efforts of epidemiologists, doctors, healthcare workers, engineers, researchers and delivery men, the disease does not exponentialy increase until the whole world is infected. Rather, the next two years are categorized by numerous localized exponential explosions of infections that, with great effort, are rapidly stabilized within weeks. All in all, 10 million people end up getting infected, 1 million people are hospitalized, 100,000 people die and 200 million people outside China are locked down in cities under martial law for periods exceeding a month.

The effort involved to contain the spread is massive, and the cost are astronomical, but the alternative is far worse…

 

The Worst Case Scenario

 

If we preassume the disease is largely mild, then there will be selection bias where only a fraction of infected individuals with severe symptoms appear in hospital which would result in an inflated overall case fatality rate due to milder cases not being detected.

Conversely, if we preassume the disease causes pretty bad symptoms in most people, and that asymptomatic carriers are a minority, then most people who come down with it, will end up in hospital. In which case the hospital case fatality rates for the overall disease may accurately reflect the overall fatality rate for infections.

So the fatality rate of hospitalized cases does not necessarily greatly overestimate the fatality rate (although it might).

There are many credible articles that quote the figure 20% as the number of patients infected that go on to develop a severe condition “including pneumonia, respiratory failure, and, in some cases, even death.” Even more worryingly, in aggregate, 7 out of the 90 confirmed cases in Singapore became severely ill (8%), and Singapore did aggressive contact tracing and testing, so the confirmed cases are a representative sample which include mild and asymptomatic cases.

Since a full global outbreak will completely overwhelm the healthcare systems of the world, the mortality rate during an uncontrolled outbreak will be close to the rate that patients develop severe conditions. Add to this, that there are plausible reasons to believe that not everyone develops lasting immunity and there are some tentative indications that the second infection may sometimes be even more deadly than the first through stimulating a cytokine storm like the Spanish flu, and possibly like SARS and an overall mortality rate of 10%, while pessimistic, is nevertheless plausible. If we then apply that to the higher end of the 60-80% range that some experts predict will be the attack rate of COVID-19, then 1 person in 10 out the 80% of the world who contracts it will die during a pessimistic scenario where the outbreak gets completely out of control.

Furthermore, in a recent press conference , Dr. Bruce Aylward, a member of WHO that went to observe the pandemic situation and response in China stated that, on investigation, it appears that mild and asymptomatic cases only account for a moderate fraction of the overall caseload and that cases with serious complications account for 13% of all infections. Also, the uncanny similarity in the curves showing the growth of confirmed cases in China, South Korea, Italy and Iran (starting from 50 cases) suggests that the number of confirms cases reflects the intrinsic growth rate of the virus as opposed to an increase in the efficiency of detection (which you would think would vary from country to country). So, unfortunately, the more pessimistic estimates of the lethality of COVID-19 increasingly seem to be the most probably ones.

This would produce 624 million direct deaths from COVID-19 before the start of next year.

But it may be even worse than this.

Plagues that kill huge numbers of people have occurred throughout history. The Black death killed 45-50% of the population of Europe, while between 1862-1864 smallpox wiped out 90% of the Haida population. The most recent plague was the Spanish flu (January 1918 – december 1920) which is believed to have killed 1-2% of the world’s population. But however horrifying these plagues were, in their aftermath, people returned to their farms and workshops and life went on.

For most of history, people have managed to rebound from plagues, however for most of history people have not relied on complex, interconnected infrastructure that requires constant maintenance by highly-specialised skilled personnel (many of whom may die from COVID-19) along with a vast assortment of parts which are manufactured by extended global supply chains.

Examples of networks we depend on today that require constant maintenance are the water network, the sewerage network, the electricity grid, financial systems, the internet. These system depend on infrastructure that requires constant maintenance in order to remain functional and to avoid cascading failures – where one network failure causes failures in others.

The people who lived in 1918 were less dependent on networks and the networks that they used were less sophisticated and required far less maintenance. The sophistacation, inter-connectedness and interdependence of the economy today would be scarcely recognisable to someone living in 1918.

We’ve had a pretty good run of luck since World War 2. No major wars, no major plagues, no worldwide famines (although localised disasters obviously continued to happen) – and in that time we’ve built a technological civilization unlike anything that has ever existed in any previous period in history.

Modern post-world-war-2 civilization has never been stress-tested by a lethal global pandemic – in other words, by a plague – and there is no guarantee that our current civilization will be able to ensure that all the high-maintenance infrastructure, which we have now become utterly dependent on, will continue to function tolerably in a situation where a large fraction of the population either dies, or is afraid to show up to work.

Even more concerning is the fact that COVID-19 is far deadlier to older people. The largest case study on COVID-19 conducted so far found the case fatality rate for those over 60 was 9 times higher than those who are under 50. And most of the patients involved in the case study have not yet recovered, so absolute mortality rates could be higher.

In a worst case scenario, where hospitals are overwhelmed and those who contract it get no medical attention, would it be unreasonable to assume that 33% of those over the age of 55 would die?

The problem with a third of all the old people suddenly dying is that most people in senior management roles – who coordinate the vast, incredibly complex mosaic of institutions which all interact together to form modern civilization – are old. Consider every conceivable institution from governments, to charities, to banks and financial institutions, to hospitals, to every conceivable type manufacturing company, to the heads of logistics firms, grid maintenance firms, municipal water companies, oil and mining companies etc., all over the world. Now imaging if one in three of the heads of all these institutions, along with one in three senior managers, all suddenly kicked the bucket in the next few months with the other two spending a month or so covalescing at home (as hospitals are all maxxed out). It is quite conceivable that, under such conditions, modern technological civilization as we know it, would simply collapse.

The average age of farmers in the U.S. is 57.5 years.

38 percent of people who work in nuclear power generation are set to retire in the next few years.

If civilization does collapse, the fatalities in the wealthier developed countries will be enormous. Very few people today know how to grow food to feed themselves and even modern farmers depend heavily on farming machinery, fertilizers, pesticides and many other products from long, complex supply chains.

Poorer developing countries, ironically, might suffer less from an all-out COVID-19 outbreak, both because they have younger populations, and because a larger portion of them are skilled at traditional farming and crafts and, as such, will be equipped with the right know-how to survive the collapse of our technical economy. But even developing countries benefit from increased crop yields produced by fertilizers and pesticides, so there will be many secondary casualties there as well.

It’s possible that the elite heads of state, and other large institutions, might manage to secure scarce high-quality medical care, even during an outbreak, so that “only” one-in-six or one-in-nine of them die. But the general masses might be so outraged that the very people whose job it was to contain the outbreak messed up, and are now sheltering themselves from the consequences – that mass-revolts could ensue. And even if they don’t, there will still be many in senior management positions, people who run small businesses, charities or highly experienced elderly specialists with indispensable skills who will not be able to access quality healthcare during a full-scale COVID-19 outbreak, and yet this large segment of elderly middle men and small business owners may still be indispensable to the smooth running of society.

 

Avoiding The Worst Case Scenario is Straightforward – But Not Easy

 

A final word as to the circumstances that allowed the uncontained exponential spread of COVID-19 in the worst case scenario when compared to the semi-successful containment in the best case scenario, which, while unable to extinguish the virus, successfully managed to curb its exponential spread and greatly reduced the caseload as a result:

The main reason why the worst case scenario of exponential contagious spread ensued was because health officials only imagined solutions within their organization’s existing resources. Instead, they should have considered how to contain it using all the collective resources and effort possessed by all of civilization – as COVID-19 may pose an existential threat to modern civilization itself.

This lack of imagination, and the lack of urgency to summon the country, and the world, to fully mobilize in order to contain it, caused some health officials to fatalistically warn that the ubiquitous spread of COVID-19 throughout the community is “inevitable“. Such fatalism is utterly irresponsible and false, given that, as Dr. Bruce Aylward has confirmed, China already has successfully curbed the exponentially spread of infections – albeit a great cost to its economy – so the ubiquitous spread of COVID-19 is therefore clearly not inevitable, at least not at this stage. What saying, “the spread of COVID-19 throughout the community is inevitable” really means is: “We choose not to pay the enormous economic price and undertake the enormous inconvenience that is required to mobilize the war-time-like effort that is needed to curb the exponential spread of this terrible disease in a timely manner.” Choosing to allow this deadly plague to spread, because “it costs too much to contain it” is irrational and unbecoming of those who possess a high degree expertise in matters of health. There is already enough data, on cruise ships and cases confirmed through testing and contact tracing (which includes mild cases), to clearly show that COVID-19 is both far more lethal and far more contagious than the flu and – if it is allowed to spread everywhere – then hospitals everywhere will end up looking like hospitals in Wuhan. This possibility is, quite simply, unacceptable, and it is worth paying any price to contain and curb the exponential spread of this virulent microbe.

Conversely other officials, in the worst case scenario, insisted they had everything under control with the existing resources at their disposal and focused instead on doing what they could with the resources their organizations had to hand, putting on a brave face, managing the communication of information to avoid a public panic, and minimize the negative effects of COVID-19 on global trade and stock market prices. In the worst case scenario, in addition to working with search engines and social media to de-rank and shadow-ban individuals that spread false information about the disease, the WHO also works to reduce the exposure of content that draws public attention to alarming, yet factually accurate, aspects of the COVID-19 pandemic or reasonable logical, yet alarming, projections of the outbreak’s future development.

Although the WHO’s aim in suppressing such alarming content in the worst case scenario was to avoid things like panic-buying, looting and public hysteria, the overall effect was counterproductive to controlling COVID-19’s spread. People NEEDED to be alarmed in order to take extreme measures to reduce the R0 of the disease like hand-washing, wearing masks, goggles and gloves, cancelling enjoyable public events, cancelling holidays abroad. Additionally, this suppression of accurate, though alarming, information, in the worst case scenario, ultimately eroded the public’s trust in the WHO, reduced compliance and undermined their ability to coordinate the response through advising the public to take action. Furthermore, because of the incubation period, widespread alarm, is better than targetted alarm, as although at any given period, there may be a limited number of regions where the disease is incubating, if everyone, everywhere, is constantly super-careful, then when it does breakout in areas, the size of the outbreak will be less severe due to a lower R0 during the incubation period.

Furthermore, the measured “Don’t panic, although COVID-19 is a moderate global health threat, we can handle it” message that the WHO delivered to governents in the worst case scenario, resulted in many governments not diverting sufficient resources to contain the outbreak, and delayed the extent that the governments of the world shifted to a fully-mobilized emergency footing and, by the time they did… it was too late.

Conversely, in the best case scenario, the WHO sounded the alarm early and announced to the world, if COVID-19 is not contained the results WILL BE DIRE! We MUST contain this virus AT ALL COSTS!!! However, although we must contain it, this virus is of a type that is INCREDIBLY DIFFICULT to contain, and its successful containment will require tremendous amounts of resources and the full mobilization of all the countries. WE NEED EVERYONE’S FULL COOPERATION AND EFFORT TO AVERT COMPLETE CATASTROPHE!!!

In the best case scenario, stark, frank messages like the one which Dr. Bruce Aylward delivered in a recent press conference are echoed by all WHO spokespeople:

“This is not flu, this is more like a SARS like physiology it looks like… are we ready to manage that?… one of the big things I really want to come back to is that message: go after the transmission of this thing, don’t – you know – accept this inevitable sense of inevitability that we cannot contain this virus.”

– Dr. Bruce Aylward 

COVID-19 is a truly terrifying virus, but at the end of the day it is still a virus, and like any virus, it can only transmit between people who are in relatively close proximity to each other, and like any other virus it can be washed away, killed with bleach, and must find an initial point of physical entry into the body in order to infect an individual.

Thus by…

1. Enforcing hard borders to prevent large masses of people from regions where levels of infection are uncontrollable from leaving and mixing with regions with low levels of infections (where the economy can continue to function), a tight enough bottleneck can be created to protect regions with few infections from crossing the threshold where contact tracing and individual quarantine is no longer sufficient to keep these infections in check.
2. Enforcing total lockdowns in highly infected regions where the physical mixing of people from differet households is prohibited (only practical with an influx of resources food, drinking water, etc. from uninfected regions with still-functioning economies). This enables the disease to “burn out” even in highly infected regions at far lower final infection rates than if lockdowns were not carried out.
3. Arranging an influx of food, medical resources (possibly using mobile treatment and isolation rooms in the form of modified shipping containers) and PPE for workers who maintain critical infrastructure (water, electricity, food delivery, etc.,) supported through aid offered by uninfected areas who’s economies continue to function.
4. Arrangements to financially support those who comply with regional lockdowns, again in the form of aid from surrounding regions
5. Continuously testing random samples of people for COVID-19 in areas with low infection rates combined with vigorous contact tracing (hopefully to an initial carrier who emerged from a locked down area) conducted by armies of epidemiologists.
6. Practicising of good hygiene habits and general social distancing (to the extent that productive economic activity allows) by everyone in the entire world all the time so that, when a localized outbreak is detected after an incubation time, the R0 of the community will be low enough for it to be relatively easy to contain without having to lock down yet another city.

…it should be possible to contain the outbreak.

This is possible.

This is straightforward – but extremely difficult and costly.

But it can be done.

Furthermore, it MUST be done, as the alternative is too horrible to contemplate.

Seasonal COVID-19 infections, with community spread, would more closely resemble the Black Death, which came and went and came back again between the dates of 1347 and 1351, killing 50% of the population of Europe in the process, than the flu. It would NOT be, as some claim, “just another seasonal illness” like swine flu. And the complacency emerging from many officials and academics – especially in the U.S. – is terrifying.

It’s time to mobilize and launch a full scale global response to this emerging pandemic.

John McCone