You are going to catch it.
Not everyone who reads this article will contract COVID-19, the novel coronavirus originating in Hubei province, China. On the current rates of transmission and expected trajectory, however, the chances are better than even that if you are reading these words, in the near future you will catch this virus.
Harvard epidemiology professor Marc Lipsitch believes that the virus has moved beyond any attempts to contain it. Whilst governments around the world, Australia included, continue to talk about containing the virus and preventing its spread, they are also mobilising their plans for responding to a global pandemic. Dr Nancy Messonnier, head of the US government’s Centre for Disease Control, said on Tuesday that COVID-19 could not be stopped and that public policy would have to switch from containment to mitigation.
“Pandemic” has a formal definition. Professor Brendan Murphy, Australia’s Chief Medical Officer, explains: “A pandemic is a label that simply says that there’s sustained community transmission in several countries. We are already preparing for the eventuality that we have further outbreaks in Australia should they happen. So that’s what the preparation is about. So, declaring a pandemic doesn’t change what we do.”
Prime Minister Scott Morrison today announced that the government is preparing its full response plan for management of the crisis. Current plans include securing the supply chains for required medical supplies and personnel, and as reported elsewhere, the repurposing of sports stadiums and other infrastructure as temporary medical facilities.
The truth is, it is likely this virus already qualifies for “pandemic” status. Whilst the majority of cases have so far been detected in China, the disease is spreading rapidly and largely uncontrolled throughout Asia. The United States has seen its first case of an apparently disconnected diagnosis – a confirmed case of coronavirus in a patient with no known contact to people from affected areas. There have been reports of people becoming symptomatic up to 28 days after exposure, which is well outside the accepted quarantine measures. In all likelihood, in several countries or many, the disease is spreading unchecked and unseen throughout populations.
They won’t know about it for some time yet. The disease is often mild, or even for some asymptomatic. This virus appears to be more contagious than influenza, and every individual affected may on average infect four others (reducing, as the virus becomes more endemic in the population). In combination, a highly contagious virus with mild effects is likely to be impossible to control. Once it gets out of control in any one place, in practical terms our globalised economic system ensures it will spread everywhere.
The most important direct response anyone can take towards this sobering thought is: Don’t panic!
The moments of greatest disruption from this virus are right now. There is much that is yet unknown, but from the cases we have so far seen, we can draw some conclusions.
COVID-19 is far more virulent than the common cold, it’s true. It’s more severe than normal strains of influenza. Typical influenza hospitalises a small percentage of sufferers, with complications and severe outcomes including death for between 0.1% and 0.5% of all infected. COVID-19 has a mortality rate between 1.5% and 4%. The wide range reflects that the severity of virus outcomes depends largely on the quality of medical care sufferers receive. Untreated, obviously more people die than those in countries with advanced medical systems, such as Australia. COVID-19 appears also to be particularly severe in the elderly and those with co-morbid conditions (pre-existing conditions such as Diabetes or Asthma). This is no different to the regular strains of annual influenza and related cold and flu viruses.
COVID-19 is not a devastating new epidemic to kill vast swathes of Australians. It’s far more akin to a particularly severe flu strain. The more pernicious effect of the virus is measured in how societies are responding to its threat.
Governments have already closed borders, and even after a few short weeks the global economy is shuddering under the strain. Australia’s universities are suffering a loss of international students, many of whom will not return. Global trade markets are at a standstill, as are many major industrial facilities in China. (As a result, China’s CO2 emissions for the quarter are hugely reduced, although if COVID-19 is contained and restrictions are lifted there is an expectation that China’s factories will roar back into life, seeking to make up for lost time.) There have been reports already of panic buying of medical and infection prevention materials in various cities. Japan is terrified about the possibility of the Olympic Games not going ahead, or (worse) being run without an influx of tourists. International art, fashion and music festivals have been postponed or cancelled for fear of spreading the virus amongst attendees. Forget making people sick, COVID-19 is having a devastating impact on modern society, in much the same way terror of terrorism used to.
Our modern economy cannot operate if people are reluctant to go out in public, if they avoid sporting events and art galleries, beaches and rock concerts, if they avoid Chinatown and restaurants and shopping centres, the whole edifice that is our carefully constructed and tended economy may crumble.
Already stock markets are tottering, and the worst effects have not yet begun to bite. Investors have been so far reluctant to admit the worst possibilities of this pandemic, assuming that the effects of the virus will be to depress the stock market for a short while – perhaps one fiscal quarter – before the inevitable rebound. It seems hugely optimistic to assume that COVID-19 will be under control in a single quarter. This crisis has, almost certainly, a lot longer yet to run. Some analysts fear that the results of COVID-19 will be worse than the GFC. Compared to the damage this could do to modern societies and nations, the physical effects of this virus seem positively benign.
In reality COVID-19 is not too dissimilar, in many ways, to the existing strains of flu. If it becomes endemic in world populations, to the extent that governments cease attempting to contain and eliminate it, we will treat it much as any other flu-like illness: with symptomatic treatment. It is important to note also that there are vaccines currently being developed for this disease. Contrary to some breathless reporting elsewhere, such efforts will not be providing an immunisation against COVID-19 any time soon. The best-case scenario is for a working, mass-produced vaccine to be available 22-24 months from now. This timeline is unprecedentedly swift: most vaccines take up to a decade to bring to market. Two years from now, COVID-19 will either be eliminated in practical terms, or it will be everywhere, sweeping across the globe in annual waves with the weather.
So what would a world with COVID-19 look like? Largely this depends on a couple of factors, which are currently not known.
One of the most important questions is whether COVID-19 might, like existing influenza strains, be highly mutable, changing form every year such that the touted vaccine for this year will be less effective next year. If this proves the case, COVID-19 might be here to stay. The good news is that the severity of COVID-19 might be due in part to its novelty – it is a new virus not previously found in human populations, so it’s feasible to suppose that this virus is proving harder for the human immune system to beat. Unlike the flu, nobody has immunity to COVID-19 from either immunisation or having experienced an earlier strain. After we’ve all experienced COVID-19 once, the likelihood is that many will resist any future strains, should they come. Once you’ve recovered from this year’s strain, your body might more easily fight off the next iteration.
Our most probable future is one where COVID-19 has swept through most global populations and most, at least in western, advanced societies, are now either immune or vaccinated against it. Perhaps the virus will be mutable, each year seeing a new strain, with the medical fraternity encouraging us all to get our Flu-and-COVID shots as each flu season rolls around. Or it will be a one-and-done. In either case, we will no longer be afraid to step outside our doors, to interact with our fellow humans, to socialise and share company and food and experiences. In truth, we shouldn’t be afraid of these things now. Either the authorities will prevail, against the odds, and COVID-19 will go the way of Polio and Ebola, eliminated in most human populations with only a rare outbreak occurring from time to time. Under this scenario the chances of a typical Australian contracting the virus are slim. We are protected by our strong biosecurity and the tyranny of distance. If any country can retain control of such a disease it is Australia. Or else the virus will slip past our defenses anyway and run amok through our cities. Your chances of avoiding the disease then, due to your own vigilance, become unfeasibly small. You are likely to catch it. And that shouldn’t bother you. Most of us will catch it, and for the vast majority of us the result will be a case of coughs-and-sniffles.
At 2% morbidity, COVID-19 would be a substantial killer of the old, the sick, the vulnerable, but as always this cost will be borne most heavily in third world countries, rural areas or those with undeveloped medical systems. Here in affluent Australia it will be a mere sub-component of the list of diseases which can kill us, and we will give no more thought to it than we do to Measles. So, don’t panic. If COVID-19 becomes a pandemic, the likelihood is we’ll just have to live with it. So we shouldn’t let it stop us living now.