Jaswinder Singh looks solemn as he scrubs his cab in between his shifts of ferrying passengers in NYC Metro area; Hossain Patwary is avoiding eye contact as his customers strain to understand what he’s saying behind his face mask in his tiny kiosk at Port Authority Bus Terminal. Elsewhere in New York, where Gov. Cuomo declared statewide emergency, life has already adjusted – Dana Cohen and Adam Quinn preponed their wedding by months so both can be under his health insurance, UJA-New York distributed meals instead of a planned gala, companies are rationing hand-sanitizers after spending a bundle buying them in bulk, even the characters hustling on Times Square are wearing gloves. There are glimmers of famous New York nonchalance though, “People up here aren’t really paranoid, not yet”, says Sharon John, “It’s going to take a little more than that to get Harlem going”. All of these in the pages of The New York Times this morning.
As the world hunkers down in a staring contest with COVID-19, it beggars the question – how deadly it really is? What price are we going to pay for a presumed absolute immunity? For how long? What about the vested interests that are out to exploit our panic response?
Case fatality rate (CFR) of Covid-19 proves it is far more benign than it is made out to be. In an editorial at New England Journal of Medicine, Dr. Anthony Fauci, Director of National Institute of Allergy and Infectious Diseases and the premier US authority in these subjects, along with colleagues, writes “overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.” It is critical that we first deal with data, and not hysteria.
There is a huge age disparity in vulnerability. In a very well-designed study out of the University of Bern, Switzerland, four authors posit that 36% of individuals over 80, with symptoms, have died, or will likely die, in China. This compares with 3.3% estimate for the overall population. A vast majority of people exposed to the virus will never be infected, and at least 80% of infected people will never show any symptom, thereby reconciling their analyses with Fauci’s. Children are proving resistant to the virus, or mortality, though we do not know why that is the case.
“Here we have a disease for which there is no vaccine”, says Michael Ryan of WHO, and vaccines are at least two years away, “no treatment, we do not fully understand transmission”, and, “we do not fully understand case mortality”. It is inevitable that paranoia sets in, as it has, globally. Fear mongering, or vanilla racism, is rampant – a pattern we have seen time and again when faced with uncharted. Hype is being used against migrants – gleeful finger-pointing by some can barely conceal their racist moorings. Disease crosses borders through air travel and cruise ships, that did not stop Italy’s Matteo Salvini from heaping it on African refugees who could barely afford a sandal; he is hardly alone. The first thing we can, and must, do is to silence xenophobic voices arising out of too-convenient hysteria-by-design.
As Dr. Fauci told various media outlets, the real choice now is between containment and mitigation. Containment, with an unrealistic goal of zero new cases, is onerous and unrealistic. “Containment means quickly tracing the contacts of sick people and encouraging them to quarantine themselves, as well as closing schools, workplaces and public events”. In Italy that meant locking 17 million people this morning; China essentially locked down 150 million people in their homes, most of them perfectly healthy, Japan closed schools, and so on. In the US, large companies are already canceling travel, even domestic, SXSW stands nixed, Stanford just canceled all in-person classes, the list goes on.
Unless you indulge in forcible home imprisonment of millions of healthy people against their will, as China has done, containment will not be effective. Containment has costs for the well-being, China probably saw 30% of its economic activity shut down for more than two months; we may never know as accurate data has never been on the menu behind that Iron Curtain. Elsewhere under freer skies, containment proved unrealistic. The Wall Street Journal chronicled how life goes on unaffected in the northern regions of Italy, officially under quarantine. It is highly unlikely that internment camps will prop up inside the US one more time, if not for a specific ethnic minority.
We need to think beyond containment. We need to think about mitigation. And societal choices.
Mitigation means accepting that Covid-19 will run flu-like through society, presumably exposing millions. Most of them will have nothing more than mild flu or cold-like symptoms and life will go on. As a society, and as individuals, rekindled consciousness about personal hygiene will be a blessing. Only a minuscule will have a severe impact like acute respiratory illnesses that are fatal and need intervention.
Hundreds die each day from similar symptoms with no one batting an eyelid. Flu affects the old disproportionately harder, upwards of 300,000 dies each year worldwide; CDC estimates flu caused 9-16 million illnesses and 12,000 – 61,000 deaths every year in the US since 2010. Even today there is no real cure.
Yet, nobody calls for containment of flu simply because economic costs are untenable; as a society, we have learned to internalize the disease – we simply live with it, or die. If it sounds like cold calculation around the value of life, it really is. Describing the debate inside the British government, The Times of London said this week “Ministers and officials are considering the trade-off between allowing an acute outbreak, from which the economy would rebound more quickly, or trying to save more lives by imposing restrictions on mass gatherings and transport”. Put simply, are we to accept large-scale slowdown of the economy, with all its fallouts, or are we to accept that COVID-19 doubles mortality old and infected? Does it call for better access to ameliorating treatments for the terminally ill, instead of extending lives at all costs? Does that mean we all enforce better hygiene because various studies have suggested the big economic benefits of washing hands even before COVID-19?
I hope our response is rational, not reactive. Let us curtail non-essential (repeat, not essential) travel for all we want. Let us work more from home with benefits/challenges it brings. Let us rationalize Cruise vacations, which have proved, repeatedly, to be floating petri-dishes. Let us wipe, rinse and repeat, cough on our coattails – all of that are warranted no matter what. These are rational responses. Irrational would be spreading hysteria about the origin of the outbreak, letting our ugly sides show through over racism, quarantining large swath of the population with no recourse, cutting down on normal economic and social activities. A rational response might even improve the well-being of the already vulnerable, a reactive response will bring us all down with consequences, some unintended but nefarious all the same, later on.
Keep Calm and Carry On. Wiser words have rarely ever been spoken – and that’s the word of the day.
[Partha Chakraborty, Ph.D., CFA is an entrepreneur in Water technologies, Blockchain and Wealth Management in US and India. All opinions are of the Author alone, and do not necessarily represent that of any organization he may be part of. The author alone is responsible for any error or omission]