By Ken Evoy
Foreword page 3
Disclaimer page 3
Introduction page 4
Why Is This
Important page 5
View of the Top
Takeaway #1 page 8
Help! What Do I
Do? page 10
Takeaway #2 page 10
Takeaway #3 page 11
Solution page 14
There’s More! Page
Takeaway #4 page 22
Takeaway #5 page 23
Takeaway #6 page 27
What Are the Key
Elements to Defeat SARS-CoV-2? Page 29
The Big Six page 29
Takeaway #7 page 32
Who Puts This All
Into Place? Page35
Takeaway #8 page 39
Experiment in Exponential Growth page 41
China Blame? Page 51
So How Did China
Do It! How Should the Rest of the World Do It? Page 54
What’s the Deal About Herd Immunity? Page 57
originally wrote Ballad Of A Thin Man -
How To Ignore Your Government and Think About COVID-19 For Yourself as a
pair of forum posts out of concern for Solo Build It! members. Requests from
the SBI! community for a document that they could share with family and friends
convinced me of the need to create this PDF.
the forum posts from March 12 to March 20, when I published them. So some of
the numbers have changed.
lessons, however, remain valid today. The primary lesson is that governments
tend to misinform and mislead, sometimes deliberately.
document to protect yourself and your family from COVID-19. Use it also to
develop your critical thinking skills about what your government is telling you
and doing “for” you.
document is not intended as either medical advice or legal advice. Please
contact a medical professional if you experience any symptoms you think are
related to COVID-19.
decisions you make based on this document are your responsibility.
anyone who watches even the most mass-market NBC Nightly News knows that
“something is happening here”...
continue that lyric from Bob Dylan’s song, “Ballad of a Thin Man”...
“but you don’t know
what it is, do you, Mr. Jones.”
of this essay is to help you know and understand what “it” is...
staggering that most people still know only enough to be afraid, but don’t understand enough to “know what is” and what to do. And that’s
the goal of this piece — if you take the time to absorb it, and recognize where
your particular locale falls on the timelines and scenarios, you’ll know what to do.
important because most people will go along with the herd. At times, a herd is
smart. In times of panic, though, often not so much.
staggering that governments must understand by now, from the scientists, how to
stop this virus. But instead they treat the symptoms, not the underlying
problem of, well, you know... a pandemic!
Why Is This Important
of the SBIer community asked an interesting question a few days ago...
I wondered what your take is on the
British approach — to let the wave wash over them, as it were, in order to
build up herd immunity more quickly.
I actually have it from a serious
epidemiologist that this is the way to go — if you can stomach it.
I started to dig into the reply, I decided to widen her question to this...
approach is ideal? And what should you do if/when you realize that your leaders
aren’t on that ideal path?
I got, the more resentful I became.
“Our leaders really suck.”
like that was an epiphany or anything, but only a few have managed this world-changing
continued talking to myself...
“Time’s running out for most of us, and if there is one thing in this
world that you can’t waste when dealing with a problem that grows
It’s alllll about time.
as every good solopreneur knows, the issue to master — prioritize
optimally, right? Depending on what time it is, the macro solution varies.
Let’s see how (badly) our leaders are doing.
quick answer to that SBIer’s question...
I wondered what your take is on the
British approach — to let the wave wash over them, as it were, in order to
build up herd immunity more quickly.
I actually have it from a serious
epidemiologist that this is the way to go — if you can stomach it.
to that depends on the context. But we need to look at this from a much larger
perspective because the answer changes, all depending on the time!
words, there’s a time to think about this. That time is generally near the “out
of control” phase (way over at the far right of the power curve). Even then,
though, there should be some provisions that were left out by Boris Johnson,
Prime Minister of Great Britain.
intro over, here we go...
View of the Top
this with what I really don’t understand (or perhaps I prefer not to) ...
Why does a
government throw $$$ at a virus? What makes them think that raining “helicopter
money” from above will fix the economy when the problem is driven by a microbe
(and, just as importantly, the population’s terrorist-level fear of that
have missed that class in macro-economics (or was it microeconomics?). But I
don’t foresee most folks running out to blow that wad of free money on stuff.
Even if they do, even if the markets go up for a day or two after the big
doesn’t have a stock portfolio. It’s just happy to have more time to wreak
death, doubling in pace every few days. And that
brings worse-than-ever news that hits at a gut-fear level. So the markets go
right back down, while the virus has doubled its spread.
specifically talking about the U.S. government here. It’s not personal. It just
happens to be uniquely positioned to be the example...
the world’s largest economy and third largest population, with all the people
and resources to solve a problem like this rapidly, especially given its usual
inclination to learn from others and improve upon that.
following in Italy’s footsteps and headed toward a disaster that looks like
has had more time to avoid the fates of Italy, France, Spain, yet seems
determined to follow the same path to a massive death count.
had more time to copy the best of what Taiwan and China (after its initial
mis-step) did so well, yet hasn’t.
So, in a
nutshell, if an impending failure can happen there, it can happen anywhere,
wherever you are as you read this. The lessons here apply to you, wherever you
live. And that brings us to...
Understand your enemies — virus and ignorance. It’s the only way to
brave self-serving government misinformation and to resist the herd instinct of
depend on your government. Act on your own, based on understanding the principles laid out here. Spread the word to help
others understand and do the same.
amazed what folks don’t know, as well
as who doesn’t know it. Such is the
damage of misinformation from leaders. For example, I was floored at how
cavalier/ignorant my own sisters were...
And I’m not dissing my sissies (I’d never do
Normalcy bias is hard to overcome. It’s impossible to emerge from the fog if
you’re not being well informed. The smartest people you know may be paralyzed —
until they hear it from you in clear, clean words. https://en.wikipedia.org/wiki/Normalcy_bias
proof of that in the feedback in the SBI! Forums, how some of the sharpest
SBIers were moved to action. They had a high level of suspicion, even knew that
something big was coming, but that alone is not enough to break normalcy bias.
teach. Be part of the solution.
that I’ve put this weight on you, you may be thinking...
Help! What Do I Do?
with the second takeaway.
Assume everyone is ill. Assume you are, too.
an awful lot right if you remember just that. After all...
know just a whit about the common cold or Influenza, you know to keep your
distance (to avoid catching and
spreading), for example.
that’s more important now than ever because the extra info here is that this
virus is both sneaky-contagious (no need to feel ill to spread ill) and more likely to kill you! That’s one
distance. But make it 10 feet apart instead of 6. That gives you time to put
your hand up like a traffic cop and say, “STOP” when a friend approaches you.
It also means that you won’t go out at all, except for the necessities (and
even then, you’ll know to stock up).
around to be told what to do. We covered “social distancing” before it was a
thing. Now it’s all you hear about — after
so many have caught this nasty little surprise due to all the social events, big
and small, and including direct personal contact.
Bottom Line: You don’t need to figure out whether your
leaders are dumb or evil. Or both. Just know that, with rare exception, they’re
wasting precious time, enabling the virus to 2X and 2X again, and again, and
again, every 3-5 days (depending on local circumstances).
The silent power of exponential growth. It
creeps until it leaps.
1,000 people are sick.
“We’re going to cut interest rates by half a percent.” Result 4 days later:
2,000 people are sick.
Leaders: “OK, well
then, we’re cutting rates by 1%, down to ZERO.” Result 4 days later:
4,000 people are sick.
Leaders: “Wow, OK, maybe this is a problem. We’re going
to pump up the banking system with hundreds of billions of dollars, up to
Result 4 days later: 8,000 people are sick.
Leaders: Maybe you didn’t understand that banking
stuff. So are you ready? We’re gonna give $1,000 to you. Yes, each and every
adult, so that you can spend it right back to big business and taxes to us.”
(OK, they didn’t say that last part.)
Result 4 days later: 16,000 people are sick.
the 2020 stock market crash…
You think you see where this is going, right? Well, sort of. At the time
of this writing (March 18), there were 9,000 confirmed cases in the
Go to the
exponential growth curve that you see (it’s labeled “Total Coronavirus Cases in
the United States”). Next...
to March 6 and click on that dot. How many cases?
story doesn’t look so crazy now, does it? Especially since cases are now at
35,000+ as of the morning of March 23.
government repeatedly tried to solve a medical problem with an economic
solution. I know you know Einstein’s definition of “insanity,” so I’ll just
skip to the bottom line...
I n s a n
kicker in all this…
when Trump said there were only 15 cases, headed toward zero? He doesn’t,
either, but I promised not to make this political, so let’s just get to the
30, he said...
“We have it very well under control.
We have very little problem in this country at this moment — five. And those people
are all recuperating successfully.”
full list of all the false downplaying statements)…
somewhat math-oriented (I am, so you’ll have to bear with me, but it’s worth it
— I promise)...
times do you multiply 5 by 2 until you reach 9,000? Calculators at the ready,
times (10.8, if you want to split hairs). That’s 11 doublings in how long?
days in January
in March (up to the day I wrote this)
doubles in 49 days, or roughly one double every 4.5 days, which fits into the
3-5 day estimate above. Now here’s the most important part of all this...
government is fiddling dollars into a fire, the fire is doubling every 4.5
days. (And almost doubled twice again in just 5 days, from March 18 to 23.)
They knew this.
impossible not to have known.
the evidence around the world, it didn’t take an epidemiologist to understand.
Even a garden-variety ER doctor would have this basic knowledge and would
certainly know it’s an emergency (I
used to be an emergency room doc).
doubles, it was an emergency. All you had to do was the math.
The Easy-Magic Solution
Just stop it at 5. It’s so doable. Heck,
take a week or two to twig to it, screw up your courage, and get the right
people into place. You’re still only at 3 doubles after 2 weeks. That’s 40
people with CV19.
slammed Wuhan and other locales into the right cure at 400 cases!)
heck with the cost...
$1,000,000,000,000 (a trillion!) at those first cases, and it still would be
money well spent to eradicate the
disease. The cost goes way up if you deny and keep denying the inevitable
and then pour gas on the fire.
how and why catching it early could have been so easy. We’ll see how China
could have chopped off most of the problem by starting just 2-3 weeks earlier.
deserves a partial pass because it had no idea that it was dealing with a totally
“novel” virus. Suppressing it, though, including censuring whistle-blowing
doctors, was head-scratchingly, dumb and evil. After that, though — it was a
model of how you can quarantine and-manage (not just quarantine) your way out
suffered a mixed bag. Some chose to swipe right, others left. The US had the
benefit of a ton of data and results. It coulda/ shoulda fixed it for the
bargain basement price of a few million.
people. If only what Trump said early on was the truth. Because it really
We’re not done. In the fine art of the Ginzu Knife salesman...
believe, but I have a final kicker...
person with a confirmed case spins off 50 others with the virus before being
diagnosed. Source/explanation (interesting stuff!)...
talking 450,000 people.
the wrong stuff was done. And the right stuff was right there for the using,
ride. And thanks to our leaders, it’s only just begun. We’re many months from
wrestling this to the ground, over a year if the right moves aren’t made fassst!
Would you slap me upside my head if I said
“Wait, there’s more!” just one more time?
so. That’s why I’m hiding this part in a sidebar. The other reason is that this
area is not my forte.
of the government’s inappropriate action has other negative consequences,
potentially also in the trillions.
solutions for non-economic problems beget greater economic problems and don’t
solve the original, non-economic cause. If I gave you Tylenol to reduce your
fever but no antibiotic for the pneumonia that’s causing the fever, how well do
you think you’d do?
economic expenses happen at two levels... the direct dollars that are borrowed
(increased debt) or printed (leading to inflation and possible hyperinflation)
to throw trillions at the non-cause, and
the indirect societal cost of letting things get out of hand. The latter is
hard to measure, so let’s start with interest rates as an example of
Federal Reserve in the U.S. fired 1.5%-worth of interest-rate bullets that
should have been saved to fight the next recession. Now there’s zero room to
fight the next recession with that classical go-to move of reducing interest
rates. This leaves the nation without one major weapon to fight the next
How do you
measure the cost of a recession that might be deeper than it needed to be due
to the absence of being able to cut interest rates?
Do I look like an economist?
“a lot.” LOL.
possible that economists may consider the interest rate cuts as a “prepayment”
on getting out of the recession after
the disease is cured (the pre-condition for turnaround).
people are both well and unfearful, the system will be locked and loaded with
super-low interest rates. Consumers will be ready to buy and travel, while
companies will be ready to borrow to grow again. In short...
The economy will be ready to zoom ahead faster than ever. SARS-
(COVID-19’s other name) is like a million pound weight holding back a Ferrari,
tires burning rubber and ready to take off. Remove the disease and get out of
right, there are some tremendous investment opportunities coming your way.
Bottom Line: Let’s just call the cost of lowering interest
rates a wash, but worth remembering.
is the main cause of the recession.
stock market had been overpriced, with lots of stresses in the economy ready to
pop at any second. One example is the high levels of debt that companies had
built up due to low interest rates....
It was becoming
untenable, and represented a serious risk to cause or aggravate a down-turn in
the economy (with or without CV19). Now, though...
reduction of interest rates and the pumping of tons of money into the system
reduce the chances of the scenarios in the above article causing or deepening a
government super-revved the engine and stock prices came down to more
reasonable levels (they were seriously overpriced before).
the disease = remove fear and caution. Benefit from all that futile stimulus,
still waiting to go.
interest rates, we have another direct cost to deal with...
U.S. national debt is already at the unfathomable amount of $23.3 trillion. It
will grow by roughly $2T (a rough guesstimate on the final cost of the
above-mentioned programs to save the economy and stock market, but not fight
be a prepayment, too, but right now, it’s an expense that’s going to push the
deficit up, assuming the program is executed fully.
Note: Just as impressive is how Trump has grown the
debt from $20 trillion at the time of his election to $23.3 trillion before any
of this came along to change the world...
one rack up $3.3T of new debt during boom times? In fact, he’s just getting
started. His plans are estimated to take the budget to $28.5 trillion by the
end of his second term....
Note: We all know, though, that the real numbers end up way worse than projections
that are 5 years out. Consider that Trump had promised to eliminate deficit spending...
reality is that far-into-the-future estimates are “magic-monkey numbers pulled
from their, well, you know.” And they never err on the low side. Let’s assume
that he’s equally as far off during the remaining 5 years, so add $5T to his
at $33.5 trillion.
were we? Oh yes, we’re adding $2T to that, for a total of $35.5 TRILLION.
“It’s going to be ‘HUUUUUUUGE.’”
it really is going to be much more because we have not yet calculated the cost
of the real solution to our medical-driven problems. And the
problem is now much bigger and more complex than China faced.
The real solution is draconian, but
necessary. The economy takes another hit, but this time it’s to end the horror
story. China has already gone through the slowdown of the economy that happens
when you shut everything down (the
right move that will cure the problem — more below).
much does that cost a country? Let’s take a peek at China’s experience. The
total containment (with sophisticated process) worked, but at a cost, both
financial and social...
gets the job done...
of a total shutdown is to stop the virus from spreading. We’ll cover how that
works below. You don’t just close ingress and egress of people. You have to
process, sort and treat appropriately. That
is absent in the U.S.
And that’s a shame. You know why by now...
The sooner you shut down and run a process that eliminates the virus,
the quicker and better and cheaper.
Otherwise, you have to find and deal with geometrically larger populations of… “Asymptomatic Infections” — have the
virus, but no symptoms.
“Symptomatic Infections” — treated according to how ill they
Sick, but from Influenza — or a bad cold or bacterial pneumonia.
Well — no infection, not ill.
sooner you can sort and treat, the smaller the job, the sooner the area can get
out of their homes and back to work and play. Sadly, containment is no longer
is in a much worse place than China was when they put their total shutdown in place (9,000+ cases vs
400 in Wuhan — and now 35,000+). On top of that, Americans are more mobile,
U.S. cleanup will be an order of magnitude bigger and longer than China’s. It’s
hard to say how much it would cost to shut down a country completely.
no dollar cost was included in the articles above. But let’s say that the U.S.
does introduce a total country shutdown as advocated by Bill Ackman, a
respected and sharp-thinking investor activist...
would that cost? OK, as a non-famous and rather ignorant amateur economist (as
of this moment!), I’ll take a stab… The size of the 2020 US budget is $4.8
trillion, with only $3.8 trillion of revenue, for a deficit of roughly $1T. Now
imagine a month of total shutdown,
paid for by the government.
that the government loses approximately $300 billion of income (roughly 1/12 of
revenues for the year).
spends an extra $1.2T to cover all the expenses of a country with no income.
finally, it spends $500B to fund a massive program that sorts, diagnoses and
treats every man, woman and child appropriately.
up = around $2.0 trillion. Yes, I fudged a little to keep the number nice and
round, but it seems reasonable given the amount of money the government is
willing to throw at the non-problem (economic) part of the problem already.
to the $35.5T and we’re at $37.5T total debt by the end of Trump’s second term.
still not finished on the costs of the delay of inaction...
The stock market: a roller coast that had record down days and has
erased more than $10 trillion of wealth. That does not count as a federal
expense, but it’s $10T out of investors’ pockets, and that means less
The U.S. is now in a bear market and the general consensus is that a
recession will be seen to have started in March. How long it lasts depends on
how long it takes to tackle the medical
problem at a consistent and determined national level.
already way too late, with no concrete national plan on the verge of starting,
including total shutdown and other policies (more on this below).
fair to say that the upcoming cost and pain to everyday people is going to be
enormous. We’ve factored this in above, but further delay could push that
Until then, why would someone who is not buying much now, out of fear
and shock, suddenly start spending? No, the core problem of a terrorist virus
has to be resolved first.
happens, a deepening recession continues to cost the nation an unimaginable
amount of money...
$37.5T in debt and counting by the end of Trump’s second term.
OK, if you
skipped that sidebar, you’re fresh and don’t have a headache. If you read it, I
apologize for the bilateral pain in your temples! And either way, we’re at a
total deficit of $37.5T by the end of Trump’s second term, if he’s re-elected.
See through the B.S. (It’s everywhere.)
know the principles to use with your shiny new BS-o-meter. For example,
whatever the government may say or do next, ask...
this have to do with stopping SARS-CoV-2?”
example, instead of passively swallowing “the news” (see the YouTube link below
for a sample of NBC news), I hope you will now be critical, even posting on
this government think that money is going to slow down SARS-Cov-2’s torrid
exponential growth and surging mortality rates? SC2 is delighted to see
everyone wasting time, because each
wasted day means even more unchecked exponential growth, making the solution
exponentially more difficult.
of time, let’s move on to the next takeaway...
Time is not linear when it comes to CV19.
of time. It’s critical to understand
how exponential growth works.
words, don’t count like this...
2 3 4 5
2 4 8
As time passes,
the problem gets geometrically bigger. It sneaks up on you. No one sees it
until it’s “too late.” Then everyone
sees it (and toilet paper sells out).
if mad rushes for Purell and Charmin have not occurred where you live, stock up
now. On everything.
never see that magical “supply chain” that everyone suddenly talks about
(always in the context of it breaking down). But a nasty virus is on a
collision course for it. It’s not far from exploding onto your scene, wherever
that may be.
important point about time...
government has had the benefit of time, except China. It was the first. More
subject to the normalcy bias than any other country-victim, it made mistakes
early on. And not all were of the innocent variety.
recovered just in time and set a template for others to build upon. It bought
leaders should have absorbed those real-world
lessons, in realtime. China’s
results were real proof of what
everyone else needs to do.
what constitutes wasting of time. For example, as I type this at 7AM on the
19th, the first notification of the day flashes on my tablet...
no new locally transmitted cases on March 19th, for the
first time since it started.
recorded 475 deaths on the 19th, its highest number since the
crisis began (and now closing in on 1,000 per day).
announced its first death, but few containment measures.
about each of the countries above in terms of time and how they use it. This
should now be straightforward!
containment program is working. No new cases, just a few weeks after an
with its highly social culture, started way too late. Strict countermeasures
show no sign of improving. See the first power curve (“Total Coronavirus Cases
in Italy”) at…
same path. The U.S. is still showing a clear power curve (meaning “exponential
growth”). The U.S. has done little testing anyway.
part of the reason that Italy has such a high fatality rate is that they test
people with symptoms of a coronavirus infection, while, say, South Korea has
been testing basically everyone since the outbreak became apparent.
Consequently, Italy will pick up older, sicker patients (relative to young and
important implications. For example, if the disease spreads mostly within a
younger population, there is less chance of hospitals being overwhelmed. The
inverse applies to Italy — spreading among older patients could end in
hospitals being overwhelmed.
This is an
excellent example not only of the importance of testing, of the information
that you can get from it, but also better knowledge of CV19’s impact on a
Bottom line: Trying to manage CV19 without much testing is
like driving a car without vision. Thankfully, the U.S. is about to roll out
are closing their borders like mad. Almost 220,000 infections have been
confirmed worldwide, with the death toll over 8,800. That’s 20,000 and 800 more
than the day before. (Those numbers are now 359,000 and 15,433 globally, with
mounting numbers, still growing exponentially in most countries, say it all.
The fact that all European nations are doing the same thing is a handicap. And
Europe is kicking in a trillion euro or so, too.
it’s good enough for the U.S. to not affect the viral spread, it’s good enough
for the EU.
(and the sick) don’t seem to care about free money. So...
focusing on pushing the stock market back up, instead of trying to fix the
economy with free money, attack the actual problem, the virus and its
accelerating rate of spread. That can only lead us to one conclusion...
out of time.
SHUT EVERYTHING (AND EVERYONE) DOWN AND
LEGISLATE A NATIONAL DISTANCING AND SELF-ISOLATION PROGRAM.
all the YELLING, but this is so obvious...
only basic economics, it’s basic medicine.
late to use this and expect to contain CV19, but a vigorous and disciplined
program can still slow it down, easing the hospital overloads that we’re
already seeing in some locales.
program must include fast, free and intelligent testing, rapid sorting out (flu
vs a cold vs pneumonia vs CV19). Quarantine the ill, together, not at home
(where they’ll infect loved ones). In short, and for the first time, aim a
massive, motivated program at the disease itself.
shorter: Fix the disease, not the symptoms.
way to get on top of this problem, as I talked about when I began, is to
institute draconian measures that would normally not be considered in the free
that China was only able to do what it did because it’s a dictatorial state.
That’s true, but only to a certain extent, because it also got good buy-in.
People were scared and wanted to be safe.
buy-in, it’s not enough to try to
force people to stay at home. Nor can you force people to maintain a safe
distance from everyone else. Clear, transparent communication goes a long way
to getting that trust.
to manage that reduced mobility with a smart, disciplined program, which we’ll
see shortly. It’s not necessary to replicate successful programs to a tee, but
it is necessary to understand that
this is the most significant threat
of the century to the world (OK, the Spanish flu was worse, but it had 2
If you missed
Bill Ackman’s case for shutting it all down, the whole country, watch it now.
His passion and arguments are compelling...
the big picture right. Certain parts can be improved (e.g., you don’t keep sick
people at home with well people). Whatever, it’s critical to just get
What Are the Key Elements to Defeat SARS-CoV-2?
key to success is fast and sneaky doublings. So leaders must check their egos
and focus on finding it, slowing doublings down, and leaving it with no place
jump right past denial and partisanship, etc., to act fast to nip exponential
growth in the bud. Successful countries do that and mix in a blend of the following key components in varying
1) Fast, cheap or free testing.
spend many paragraphs on how and why testing is so important. Instead, this
article says it all...
tested every person in a town, and learned that asymptomatic carriers are the big problem. Once they were isolated,
they eradicated the disease from the town. Period.
that work large-scale would require a total shutdown of a region or country. No
one in or out while you find all the no-symptom spreaders and isolate them.
A solid action-plan for what to do
with the ill.
someone with a positive test. This part of the program ranges from meticulous
contact tracing to gathering them all together where they can’t infect the healthy,
and where medical staff don’t have to constantly de-gown and re-gown (all they
see is patients with the same disease), and they develop expertise in
assessing, triaging and treatment.
Clear, transparent, no-BS, yet
reassuring is nice, it can’t sustain when it’s based on falsehoods. Simply knowing
that your premier or president really does
have things under control and that you’ll be hearing the truth is reassuring
did calculable harm by denying CV’s existence, disciplining doctors who went
public, etc. Without defending him, it takes time to connect dots and conclude
committed, the full program rolled out with mind-boggling success. But if he
had skipped the early nonsense, it’s estimated that he could have reduced this
coronavirus to “disaster averted.”
incalculable harm by telling us all that there were only 15 cases, heading to
zero, by saying it was like the flu, etc. For a while, it was clear that even
Canadian friends of mine had believed his various inaccuracies.
no excuse for this, since he had loads of data. Scientists knew where this was
also off-topic with bizarre messaging, for example about his genius uncle. He
claimed, therefore, that he had a knack for this, too. Sheesh, that’s hard to
listen to when the stakes are low.
critical time-losing communiques instill false confidence in people (who
therefore act far more loosely, becoming early fodder for a virus looking to
establish a foothold).
deliver frequent, open, evidence-based (i.e., scientific data) messaging about
what’s going on and why it’s a danger, even in the earliest of days (when you
might look silly if wrong, although you should know enough to know that’s not
who communicates well and honestly leads citizens with reasonable order through
tough times. The rest ultimately go from “false calm” to “panicked reality.”
What do you do?
messaging and believe the principles outlined here. We were stocked up with
months’ worth of supplies well before anyone we knew, both in Panama and
Anguilla. There’s nothing “smart” about it — we just used the principles here.
The next three must be legislated and
enforced. There’s no partway or some-of here. This Chinese expert made no bones
(Scroll down to the headline, “Chinese coronavirus experts warn northern
Italy’s lockdown measures are not enough.”)
He says in
no uncertain terms that Italy was “not strict enough,” adding..
"Here in Milan, the hardest hit
area by COVID-19, there isn’t a very strict lockdown: public transportation is
still working and people are still moving around, you’re still having dinners
and parties in the hotels and you’re not wearing masks. We need every citizen
to be involved in the fight of COVID-19 and follow this policy.”
showcases the importance of no-compromise, putting the blame for ongoing poor
performance in the face of “shutdown” into the right perspective. He also
advised Italians to stop all “economic activities and cut the mobility of
people. Everyone should just stay at home.”
You’re either in all the way
or out. There’s no “part pregnant”
takeaway for countries doing battle. The takeaway for you?
Beware the media.
Trust only those you know provide reliable
lot of solid work being done. And big tech is joining forces to eliminate false
info, at a level and cooperation never seen before. Get your news only from the
also, unfortunately, quite a bit of poor journalism, not to mention biased
reporters with an agenda (Democrat or Republican, Chinese vs America, etc.).
And many (doomed to hell, I hope) remain dedicated to flooding social media
with false and potentially harmful information.
So yes, be careful. Subject what you read to
the model and principles laid out here. In other words, turn your BS Detector up to maximum
We’re making good progress.
The next 3 of The Big Six are the all-important must do’s that have to be enforced by each country —
these take commitment, physically enforced if/where needed, but ideally with
voluntary “us vs. virus” enthusiasm.
Aggressive quarantines, both
external and internal.
terminology is generally saved for those who are known to be ill with the
disease, or expected to have it if testing is not available or if a test is
You simply can’t have this virus seeding all over the world, or back to
your family. The Chinese did quarantine brilliantly, aggregating those who were
ill into large areas — stadiums, warehouses, dedicated hospitals, etc. More
on that elsewhere.
yourself off from the rest of the world. Stock
up and hunker down. It can be
voluntary or regulated.
This is generally used if your status is
unknown but worrisome (e.g., arriving
from a country with widespread CV19, or close contact with same).
6) Social distancing.
Stop unnecessary contact with others, including
no travel. Hooray for introverts — we can avoid people to our hearts’ content. OK, back in “serious mode”...
generally used by well people, ideal for everyone in the country, especially if
everyone does it at the same time, i.e., see the video of investor Bill
Ackman’s passionate plea, referred to earlier...
Bottom Line of the Last 3 of The Big Six...
virus by depriving it of new hosts.
repeat that for extra emphasis...
Starve the virus by depriving it of
new predator on this planet. We’re the prey. It can’t chase us, but we can’t
see it. The obvious solution...
yourself, friends and family out of its way.
daunting task, but it’s doable. We learn more and more about the virus every
day. The entire science community is working together. It will further improve
on how we manage.
Stop” is the next step. Antivirals and vaccines will stop it, but we’re many
months/a year+ away. The antiviral medication will cut death rates down, not to
mention the morbidity. The vaccine will eradicate it, or at least this version
of it (no available hosts to infect).
that’s a forever fix, or done on an annual basis (along with a flu shot),
remains to be seen. On the flip side, we remain in danger from a possible
second mutation wave such as the Spanish Flu (most deaths were on its second
again, it’s all about time.
Who Puts This All Into Place?
should be doing the first three and imposing and enforcing the latter three with strict commitment. There should be
one, optimal program for all countries to put into place.
we see a hodge-podge of countries with many different programs, enforced to
varying degrees. Ditto for the states and cities in the U.S. The only way to
rigorously rid ourselves of this danger is to “franchise” the approach.
it’s simply taking too many countries too long to get there. Even programs at
the national level take too long. Debates and votes in the U.S. Congress and
Senate take a week, at least. I know that’s fast (relative to a snail’s pace).
is of the essence. In a week, the extent of the viral spread quadruples (or octuples). We’re out of time!
how China rolled with this in a bit. Suffice it to say (again) that it takes
draconian measures (by our free world standards) to do this. As the U.S. starts
doubling its way beyond ICU bed and ventilator capacity, however, we’ll see it
in more and more spots (e.g., Washington state, San Francisco, New York state).
All of this must
not be done piecemeal, here and there by local authorities. I cringe when I hear what the city of New York is planning, or
what was just done in the state of
Washington. It takes a nationwide
shutdown and relentless execution of The Big Six.
written this essay over a period of several days. Some has already come to
pass. “Espresso,” a daily update of top stories, tellsme it’s a story of every
country for itself, outlining that this country is doing this, that one doing
that. Elsewhere, I read much the same about what’s going on in the U.S.
the numbers are going up, up, up, many weeks after the time when China
quarantined like crazy, shutting down a huge part of the country.
week’s issue of the Economist has the answer on its front page... a Closed sign over the planet. It should
not mean what’s happening region by region, city by city. It must mean “Planet Closed.”
be ideal, but would take impossibly long, given the rising tide of contentious
nationalism, a tsunami that would swamp any attempts at a world-level solution. We must accept the “possible-butstill-bloody-difficult”...
against SARS-CoV-2 must be started and run nationally,
and now — without option for states or cities to do their own thing (aside,
maybe, from legislating even more stringent “add-ons” or locale-specific
supplementation). That policy must exclude access to the country implementing
the total shutdown.
action across an entire nation has
all the advantages of excellent franchised restaurants. Regardless of where
people live, they’d get consistent quality with flawless execution of one program throughout.
That’s what wins!
hope that at one point, and soon, the government of the U.S. takes over the
reins of variable local practices and institutes a nationwide plan. There
simply isn’t time to lose, not anymore. But, you ask...
“Isn’t that a risky move for the government? Hey, it could be really
unpopular and backfire.”
was spoken like a true politician, at least today’s version of what passes for
politicians. Follow (polls), don’t lead, right? Wrong...
Yup, that just may be risky politically, but
it’s rock solid medically. Why do you really think politicos took (and are
still taking in most cases) so long? Politics — their career — wins out over our
while it’s all something that every country should be doing, it’s already too
late, unless rolled out with incredibly disciplined efficiency. If the above national shutdown program were executed
nationwide in the U.S. tomorrow, it would take a fierce determination and a
megantic budget, including strong “us vs the virus” buy-in from the
of the cost, that “megantic budget”...
up, up, up when everything shuts down
(there’s no GDP, basically) because the Federal Government still covers all
costs, including the salaries of everyone staying at home.
doable in the short-term, where the virus is beaten, but it will deliver a
major blow over a much longer period to the budget, shooting the deficit way
up, while crushing the economy into a severe recession or (at the other end of
the spectrum) hyperinflation.
news is that this final “expense” would take the calculated value of $37.5T and
push that final deficit number to over $40T! The good news is that the extra
money will no longer be wasted on symptoms (stock market and economy).
the virus of hosts, and the numbers will drop in the coming months. The
shutdown must then be slowly and carefully unfolded, with massive testing to
watch for recurrence.
that the “wasted money” turns out to be the stimulation needed to jump-start
the economy, which will help deal with that stratospheric debt (which is
finally looked at with gravity by government).
SARS-CoV-2 is brought down to near-zero levels (China has had zero no new
internal cases over the past several days, so that’s a realistic goal, yay!),
the work is not done.
It’s time now to start this generation’s “Project
Manhattan,” ideally a worldwide program. Rather than fragmented labs around the
globe, “Project V&V” is a joint effort of the best and brightest, with but
a single goal...
the vaccine and antivirals that will bring us the rest of the way home.
the virus within a year with antivirals (for those who get ill, and there would
still be some who do) and vaccines (for those who have yet to get it, this is
the final blow against it), as well as to vaccinate against the next outbreak,
much like the yearly Influenza shot, assuming it behaves similarly).
That is the ultimate global destination. But right
now, total national shutdown (including sealing all borders) is a program whose
time is almost past. No time to lose, we can still beat it back.
no other way.
Be hard. Be strong. Be
ready to make hard decisions. Do not
trust communications from government. Re-read this document if need be. Its
principles have already served my family well. May it do the same for yours.
that you now have the tools you need to deal with the news and find the optimal
route to safety for you and your loved ones. I used the concepts here to bring
my daughter Nori to Panama, despite having accumulated a massive inventory of
food and supplies in Anguilla months before this. However...
is a small island. What happens when the supply chain breaks down? There may
not be a boat for months. People do anything
when that happens. There’s no strong leadership. The island was only closed after it was clear that tourism was
dead, when there was nothing to lose.
been no reported cases, but there have been no test kits either. This will
prove to be a convenient excuse. Having talked to doctors and a pharmacist on
the island, there are many people with “colds” and sicker (with a fever). It
has been convenient not to be able to
tourists are gone and not returning, the first case will be announced, then a
second. The real issue, though, is that there are likely hundreds of people with
the virus, infecting others over the past weeks due to a lack of any real information (except for “wash your
hands” type of info). There’s no strong policy/program.
I say this
only to show how you can use the concepts here to decide your own best route,
regardless of what politicians say. They “work” whether you live in the most
advanced, large nations of the world or the smallest island.
As I type
this, Panama has just imposed a total shutdown. It’s happening. It will happen
wherever you are. Please, if you have any doubts about what’s written here, end
them. I know it’s hard...
to normalcy bias with intensity. All I can say is…
changed, almost surely forever, and in some ways for the good. But it’s the
next 6 months to a year that will be most different — we all have to get
through it, together. Get prepared if you have not yet done so.
A Thought Experiment in Exponential Growth
along with this should make you comfortable with the important concept of
exponential growth. Not just what it is, but how it explains much of what we’ve
seen so far...
leave Earth for “Planet Thawt,” a thought-experiment planet with
1,000,000,000 (1 billion) people (“Thawtians, I
suppose ). No borders. Each person is merely 1 of 1,000,000,000
comes a virus that makes 1 of them sick. Then another. And another.
Let’s assume that it takes 1 week for the number of cases to double.
keeping this simple with nice, round numbers, so I’m not using Earth numbers — it’s the concepts that matter.)
At the end
of Week 2, there are 2 cases, 4 at the end of Week 3, then 8, 16, etc. at the
end of each successive week.
therefore, take 10 weeks after “Patient Zero” (2 and a half months) to go from
1 to 1,000 people. What does that mean to most people on Thawt? Nada. Here’s
That’s still “only” 1,000 people out of the
1,000,000,000 on Thawt. That’s only 1 person per million. And heck, it’s
happening somewhere in Thawt that’s far, far away for most, a place called
Wuhan (what a coincidence!
“It’s never going to reach me!”
Wuhan, a city with 5,000,000 people, it’s hardly noticeable. Given the time of
year, it would be attributed to “a bug going around.” And then...
takes notice of one person dying. Nor a second. But when a few people die, a
clinician or pathologist or nurse is bound to have crossed paths with 2 or 3
patients. They ask the critical question that’s about to start a massive
undertaking (not having the least inkling of that — yet)...
those deaths different?”
notice the negative Influenza test, the appearance of the lungs on CT, etc.
This is no longer “a fluke” — it’s like nothing they’ve seen before.
Now it’s a
story. It makes the local newspapers and maybe a brief article on page 12 of
the “Planet Daily” about some curious disease that has killed a few
Not a big
deal from a planetary perspective. Things come and go — that’s “normal.” And
normalcy bias is a powerful thing.
starting to worry, though. And so are some sharp local doctors who start
working together, reviewing charts of the recently deceased and being on
special alert for more cases going forward.
finally report it, once they’re sure....
is killing people. It’s going to cause more deaths.” They petition local
“This is the time to contain it, while it’s still local. If we don’t, it will spread and
indeed... That is the time to get it
geographically tight, and those few who have flown to other parts of the planet
can still be tracked down and tested, along with their contacts (if they’re positive). It can be contained pretty easily — the earlier, the (geometrically)
story is so bizarre, so outside the norm, that the few politicians who know?
They’re partly “new-reality-stunned” and
partly afraid of going into action over something they can’t even see.
put yourself into their shoes — are you willing to look like “Chicken Little?”
Jones” kicks it up the ladder. By the time it reaches all the way to the top
“Mr. Jones,” then gets discussed, more info requested, etc., etc we’re at Week
5 — only 32 people, lots of time to decide what to do...
even real? Let’s not panic over 30 people. Form a committee.”
I’m not defending them. At this early
stage, you need a champion willing to make the tough call to early action. That
person would be a combination of one part super-smart, one part hero and one part visionary-moral leader — a
maverick ready to tell “the system” this...
“We have a
major problem, one that needs serious
of person does not grow on trees, let alone get into politics. What are the
odds of finding an early stage champion who is in power, someone who makes the
call to strong action now?
have two heroes who saw the future, a young doctor-andnurse team, but they got
blamed for scare-mongering. All pleas are scanned-and-canned if/when they
finally reach the highest levels.
those in the upper echelons come to understand, they then decide to stifle it
because their system would look weak, perhaps even blamed. We cross the line
into people with evil intent.
and self-interest are strong stoppers to early action. So... inaction. You
don’t have to be evil or merely lack vision to get it wrong at this point.
Normalcy bias is powerful.
virus doesn’t care about why, it’s
just glad to have time. It loves
Tick. Double. Tock. Double.
Tick. Double. Tock...
real (our) world, Chinese leaders suppressed its existence, denied it, even as
leaks sprung. They even disciplined the young doctor who first blew the whistle
(and later died of the disease, as have so many in the medical community — they are the heroes of Earth’s
“stiflers” — that is a whole other type of wrong — unforgivable on many levels.
Let’s get back to Planet Thawt Any delay in action, whatever the
motivation, is a critical loss of time. It’s amazing how inertia sets in,
despite urgency. It’s now Week 10, 1,024 active cases and 12 dead.
close to losing control, where containment
is no longer going to eliminate this problem.
Inaction can still last for a while longer without much harm seeming to happen. In week 11, we’re at
2,000, then 4,000 in week 12 on Thawt.
The local medical community is alarmed, while the Planetary
of Medicine is pressuring government at the highest levels. Worst of all (for
politicians), the press is hot on the story and pumping out hard headlines.
longer work. They’re “looking into it,” while some in progovernment media
belittle it with jokes...
people died this week from auto crashes, but you don’t get upset about that.
Why don’t you worry about that this week?”
Thawtians, excluding a growing minority, have a (false) sense of calm — “surely
our government would not lie about that.” Most Thawtians don’t think and
respond critically. So, for example, when they hear the “auto crash” answer, no
but the number of deaths from car crashes isn’t doubling each week.”
we know what their cause of death is
— do you know why these new deaths
are happening? How to avoid it?“
of ThawtBlog did. But Thawt does not seem to encourage independent thought,
especially if it’s critical...
playbook for politicos...
doubt, appear relaxed and distract with noise. It has always been a “go-to” in
the past, a successful way to play for time, time that no one has because,
here’s the biggie...
inaction persists, it only takes the same amount of time to go from 1,000 to
1,000,000 cases as it did to go from 1 to 1,000!!!
more people will get it in the same amount of time as it took for the first
1,000 people to become sick. How?
growing number of people with the virus met, shook hands, kissed, and hugged
their way through networks of friends, family, colleagues, who in turn do the
same. Kids brought it home from school, with nary a symptom.
jump to 1,000,000 from 500,000 was just as easy as going from 512 to 1024 because
the actions that spread it multiply to the same degree.
To use a
tech term, this disease scales.
is way more than “s/he gave it to 2, who gave it to 4, who gave it to 8, etc.),
all proceeding in a nice mathematical, local progression. It’s “network-exponential,”
which is incredibly hard for epidemiologists to backtrack and find
have networks of people we know. They break into clusters — family, friends,
colleagues in a different city and random intersections. For those who have it,
the virus rips through every person’s network.
locally and to faraway places
(business meetings, vacations, etc.). Even the busboy — you kindly pressed a
few dollars into his palm to help with university (who takes it back to the
At the end of 5 months (another 2.5 months — only 10 more doubles after
the first 1,000), 1 million people have it. That’s 1/10th of 1% of
population. As a fraction, it doesn’t sound like much, does it?
to most, it’s way too late for a containment policy to work. They’re at the end
of the hockey stick, only 2.5 more months until the entire planet has it (yup,
that same 10 week period will add 999,000,000 (999 million) with the same ease
as when it added 999).
can’t happen in real life. The straight-doubling will slow down when more
people have it than don’t. You can’t pass it to someone who already has
the dumbest, most corrupt government has to do something at some point, or face
a mob ready to storm the gates. Martial law is a convenient way to slow the
virus and the mob.
But let’s not worry about that on Thawt — it’s
a Thought Experiment, so we can suspend certain laws.
on Thawt will have it after just 7.5 months.
we? Oh yes, 1,000,000 have it...
just no way to track down 1,000,000 cases and every contact at these levels.
The problem is too big and the “sneaky-contagious” spread is too messy.
oops... I got ahead of myself — we’re not even there yet.
2,000 cases and a few deaths. Deaths seem to occur in about 1 of 100 cases, a
week or two after symptoms start, which is a week or two after being exposed
(again, I’m not trying to match the real world’s data, just establish
principles to help us think this through). And it’s mostly the older people who
seen the “power curve” of exponential growth. At first, the line is almost
horizontal as it goes from left to right (with Time as the Xaxis and the number
of sick (or dead) as the Y axis). It looks like this back on Earth...
down and see all the hockey sticks — cases, deaths, new cases vs recoveries,
etc. See how it’s flat at first, then starts its swing upward? That’s the hockey stick.)
“hockey sticks” upwards — I’ll call that the “inflection point” but it’s not a
single point. It’s the series of points that Thawt has entered, somewhere along
a curve that grows increasingly vertical until it’s almost straight up (as we
double from 125 million to the full Thawt population of 1 billion people).
there (yet), though. We’re early in the hockey stick (let’s say Day 12 or so).
are screaming, the media blaring... “Do something!” What the politicians do depends on when they’re ready to move past “newreality-stunned,” then past
“denial” (don’t want to admit they were wrong, fear of being punished by their
political boss, or whatever, and later it’s due to the top leaders’
lots of blame right here, as the alarm moved up the Chinese leadership
of bad motives and the disadvantage of being “first” led to time being lost.
Part of this is natural... the rest, as it got closer to the top, is evil.
stick to the story on Thawt.
the Wuhandles who have the virus will soon be overwhelming local medical
resources. Right now, though, they have already unwittingly started new
clusters all over Wuhan, and some all over Thawt (there are great beaches in
“my” Thawt, by the way — sadly, tourists bring it to those who work at every
resort, too, who then go out and spread it even more).
Each of those near and far-flung clusters start with their own doubling
clocks. They will be lucky because
they are weeks behind Wuhan’s clock. They
will be able to act fast and decisively — no risk of being wrong, with lots of
good data available. Oops, correction...
they should be “lucky.”
it should work.
Thawt, it’s “just” going to be a loss of time, every day of which lets the
disease grow exponentially, everywhere, making it harder to track down and
contain in Wuhan, while it sneakily spreads all around the planet (whose
initial reaction is/was “we’re OK”).
authorities do get to “action.” What works? No half-way measures, that’s for
sure. An example...
Early (Pre-inflection or Very Early Into Inflection)
point, containment is the way to go. The virus can be eradicated.
an Earth example to illustrate...
twigged to it very early on. If this was Thawt, there would be, say, a hundred
or so people who are sick. In the real Taiwan, it didn’t take that many. Here’s
what they did...
scientists to China to study it (kudos to China for permitting that). They did
not have access to all the data (I take back my kudos). Still, it was easy
enough to “read the room” and realize that something big was happening.
Now here’s the key...
Having recognized reality, they dealt with it. That should not be a heroic act. Taiwan gets lots
of praise (and I join that). But really, once you know what you have, how hard should it be to say...
we have to save our population!”???
countries who got it and acted fassst
— it’s almost sad that we heap praise on them. It’s depressing, though — it
should have been the reflex action everywhere
outside of China.
look up the story of Taiwan for yourself — but simple and smart action, at a time when the Taiwanese
people must have been wondering WTH, got it under control.
smart action steps, big and small, won the day.
about far enough. You should write your own ending on how things end on Thawt.
After all, it’s your Thought
growth of any type (from the worst pandemic to hit us ever to compounding
interest) is hard for many to grasp.
it’s critical to understand. It’s not hard to ask you to take good care of
yourself and loved ones. Now it’s easy to understand why you must protect others, too. Every contact
starts his/her own cluster of 50 people or so before showing the disease. So
one final time...
“Assume you have it too” — even if you feel
perfect. Don’t infect others.
finish the China story of SARS-CoV-2 (it’s obnoxious of Trump and his zombie
followers to use the term “Chinese Flu.”)
Yes, I know that China is now trying to spread a story that it was the
planted the virus. It’s despicable. But I heard the term “China Flu” (and
variants) well before I read this. Trump always calls out others as being
divisive while he is the one who
starts the nonsense.
And yes, if
China had acted instead of stalled when it
knew, I probably would not be writing about this at all. However, it did do a
180 just in time. And that makes China an example of the far-end of containment
as a plausible solution.
most countries’ fault that they did not model on that solution fast enough, and
still, even as far along as today with not enough commitment. Illinois just
announced (as I write this on the 20th) a lockdown — with apologies! (“I don’t
come to this decision easily.”) Worse, there’s no boots-on-the-ground policy to
take advantage of freezing folks in place in their homes. But let’s get back to
who did it right...
virus in China had doubled a couple more times, the rest of the world would
have been much worse off. They clamped down hard, giving us all a model to use
and a lighter viral load.
purpose, I agree. But it’s up to us to use something that works. (Chinese scientists were literally begging their confreres
from around the world to use what they learned.)
had not covered up at the start, we’d all be much better off. It paid the
price, so let’s model on its success — total containment is now impossible for
most places, but the strategies and execution can still slow it down enough to keep
our hospitals under control (or less out of control).
China’s delay was incredibly costly, both in terms of human life and its
economy. It cost them the most...
the largest quarantine in the history of the world for China to defeat it (no
cases of Chinese nationals for several days now). But they worked together and
got it done, just before it would have become impossible.
their economy is in tatters. It will recover, but they’ve paid enough and don’t
deserve to be stigmatized.
blame China for having this in Panama or any other country. I do blame both the
governments of Anguilla and Panama where I have inside knowledge of despicable
behavior that will result in more people getting it, some of whom will die.
this first-hand, I assume similar unknown stories are happening everywhere,
except in those handful of countries that simply understood it and fixed it.
Countries that failed to act immediately?
Take a look at this...
down to the first graph (“Total Cases (worldwide)”). See how it breaks into 2
curves? The first is China, showing the exponential curve. The second is “Rest
of World” — showing an even more pronounced curve.
finally, who are the heroes in all
doctors and nurses and EMTs and other medical personnel who work 20 hours every
day, at great personal loss. Here...
Here’s to those fighting on the front lines.
So How Did China Do It! How Should the Rest of
the World Do It?
doing a quarantine would have doomed those in that part of Wuhan and other
quarantined spots. The reason for a geographic quarantine is much more than
keeping anyone from coming in (making the fix more complicated) and from
leaving (which keeps the Rest of the World (ROW) from getting it).
have a population stuck within a geographic boundary, you can go to work...
They had a
system where you did not keep the
sick at home (thereby giving it to everyone). Here’s the step by step to
finding and dealing with the sick...
temperature was taken everywhere — bus, entering a building, taking a cab,
If you had
a fever, you did not go to your
doctor (and give it to him/ her). You went to a fever clinic (mothballed SARS
clinics that were reopened for this).
You got a
CBC (looking for white counts), CXR, simple 2-cut CT, etc. If you had Influenza
or pneumonia, with a negative test for CV19, you went home (or to the hospital
if you were really sick, as usual). If you were found to have CV19...
to a stadium with thousands of others. You were close to others with it, you
could socialize, etc. Old ladies were encouraged to do Tai Chi or to dance —
great for the lungs.
triage decisions had to be made at times. Treatment was topnotch, delivered by
medical pros who knew what they were doing and were totally garbed. No need to
de-garb and re-garb — because everyone has the same illness.
If you got
sick enough, you went to the hospital. Some old folks who got super-sick were
allowed to die (they were likely to die anyway, so it made no sense to tie up
limited ICU bed space when young moms could be saved). That sounds bad, and
some with political agendas attacked it, but China had no choice.
Brilliant. It scales. And...
great description of what China did, in more detail...
Bottom line: Enforced self-isolation and social distancing
within a geographic quarantine are useless unless you take advantage of reduced
mobility with smart practices! I don’t know of any state or country that’s
doing anything near what China did to do that.
I pray I’m
wrong, that they implement aggressive management protocols. Otherwise all they
end up doing is presiding over the virus rampaging through the local
You want more
proof of how well it works early on? Think on this...
other area of China where it started later was stamped out with ease. Same
system, just applied earlier.
Every country had the same opportunity. Only a
handful took advantage...
Once the governments of Taiwan, Norway, South Korea and Italy came to
understand this math, they reacted accordingly and shut everything down. And many more countries have locked down since
it in place, but is not enforcing it hard enough. The practice does not come
easily to the free world. But our sensitivities to freedom must be put aside if
we hope to save hundreds of thousands.
social distancing, combined with management protocols, is the only response
available to stop the virus today.
States is not responding correctly (a hodge-podge of city and state responses,
none of which are adequate for them), nor are other countries like the UK.
Countries that do not bite the bullet and respond well now will pay a much larger, catastrophic price later.
is on the exact same curve as Italy! Time to get it done, now or never!
What’s the Deal About Herd Immunity?
Prime Minister Boris Johnson in the UK took a lot of heat for his “herd
immunity” pitch. Whether it’s appropriate or not depends on his data and
assumptions and where the UK government felt they are along that exponential
curve (“inflection point”). Herd immunity has a long and accepted history...
foundation of vaccination. You don’t have to vaccinate everyone to get its
benefits, just most. That leaves so few to get the disease that it has nowhere
to turn even if it manages to fluke-find someone who has not been vaccinated.
letting everyone get immune by getting the full, active disease at that time,
without knowing all that we need to know about the virus, without sharing data
and assumptions with rigorous transparency, was irresponsibility at its worst.
It shows that Boris, too, could not care less about the people.
point, you may get “herd immunity” whether you like it or not. A “controlled
burn” (one where the weak are protected by the strong majority) is better than
a rampant, uncontrolled forest fire. And many countries are approaching that
stage — they’ll use the same draconian policies if they hope to do more than
just let the disease roar through each country.
Boris felt that they were too far along (they were not), he had a duty to
protect the vulnerable, and to
release data and assumptions for his conclusion.
frankly, if he simply closed the country down and instituted the Chinese
process early on, there’d be no need to sacrifice 1% of all the healthy people in the UK.
this on March 12 to the SBIer community...
already has more than 4 times this number of known infected cases as Wuhan did
when it was shut down, and our citizens are far more mobile and therefore
spreading the virus more broadly when compared to Wuhan. Yet our response is
tepid at best.
20th at the time of writing this part of this document. That means roughly 3
doublings since the 12th. The U.S. now has 32 times the number of Wuhan!
— now they must simply try to keep the numbers as low as possible. Put the
proven protocol into place!
Trump, Boris showed a dramatic inability to think and come to the right
conclusions, along with a terrifying callousness...
both out of their depth.
The John Hopkins Center for Health Security
reputable media that has no political agenda will also do.
Worldometer lets you track any country. As of this writing, here’s what you’ll
entering the scariest part of this journey. Most of the west is somewhere along
the very tricky inflection part of the exponential curve. Europe is farther
along than North America.
This is where the numbers really grow (in absolute
numbers). So it’s where the media gets even louder. Hopefully, once you know
this, you can avoid reading all the nonsense.
If you have a strong cache of food and supplies, if you don’t go out unless
absolutely necessary, you should be fine. Protect the vulnerable in your family
(that may mean you — if so, don’t be shy to explain that to your loved ones).
cases, it’s almost surely too late for containment to eradicate (as China has
done — several days of zero new cases — China has had new cases, but they’re
all from people visiting China for some reason). That does not mean that they should let herd immunity be the answer.
they do is close their country or state or city (meaning no one in or out),
they turn their country into a killing field, that’s all. They must turn to the
totally draconian and uniform policy
of China, across all of Europe and North America.
And put the Chinese program into place. We’re
getting closer to that, as we see more states in the U.S. getting partway
there, Italy trying (but blasted by a Chinese observer that they’re still too
to be a long and hard battle, because all of the large western countries are
much further along than China was when they locked down and put the system into
result, the worst countries will end up with some amount of herd immunity. But
that is a very small consolation prize, especially since vaccines and
antivirals are in the works.
line is: do what we know works, until Project V&V yields results and turns
SARS-CoV-2 into just another virus for which we’ll need a vaccine, possibly
annually with our flu shot.
careful, folks. It’s dangerous out there. Your safety is in your hands and no one else’s.
you’re wondering about the Bob Dylan reference...
scientific advances we need to stop COVID-19
2020 24 minute read
coronavirus pandemic pits all of humanity against the virus. The damage to
health, wealth, and well-being has already been enormous. This is like a world
war, except in this case, we’re all on the same side. Everyone can work
together to learn about the disease and develop tools to fight it. I see global
innovation as the key to limiting the damage. This includes innovations in
testing, treatments, vaccines, and policies to limit the spread while
minimizing the damage to economies and well-being.
shares my view of the situation and how we can accelerate these innovations.
(Because this post is long, it is also available as a PDF.) The situation changes every day, there is a
lot of information available—much of it contradictory—and it can be hard to
make sense of all the proposals and ideas you may hear about. It can also sound
like we have all the scientific advances needed to re-open the economy, but in
fact we do not. Although some of what’s below gets fairly technical, I hope it
helps people make sense of what is happening, understand the innovations we
still need, and make informed decisions about dealing with the pandemic.
growth and decline
first phase of the pandemic, we saw an exponential spread in a number of
countries, starting with China and then throughout Asia, Europe, and the United
States. The number of infections was doubling many times every month. If
people’s behavior had not changed, then most of the population would have been
infected. By changing behavior, many countries have gotten the infection rate
to plateau and start to come down.
growth is not intuitive. If you say that 2 percent of the population is
infected and this will double every eight days, most people won’t immediately
figure out that in 40 days, the majority of the population will be infected.
The big benefit of the behavior change is to reduce the infection rate
dramatically so that, instead of doubling every eight days, it goes down every
something called the reproduction rate, or R0 (pronounced “are-nought”), to
calculate how many new infections are caused by an earlier infection. R0 is
hard to measure, but we know it’s below 1.0 wherever the number of cases is
going down and above 1.0 wherever the number of cases is going up. And what may
appear to be a small difference in R0 can lead to very large changes.
infection goes from causing 2.0 cases to only causing 0.7 infections, then
after 40 days you have one-sixth as many infections instead of 32 times as
many. That’s 192 times fewer cases. Here’s another way to think about it: If
you started with 100 infections in a community, after 40 days you would end up
with 17 infections at the lower R0 and 3,200 at the higher one. Experts are
debating now just how long to keep R0 very low to drive down the number of
cases before opening up begins.
decline is even less intuitive. A lot of people will be stunned that in many
places we will go from hospitals being overloaded in April to having lots of
empty beds in July. The whiplash will be confusing, but it is inevitable from
the exponential nature of infection.
As we get
into the summer, some locations that maintain behavior change will experience
exponential decline. However, as behavior goes back to normal, some locations
will stutter along with persistent clusters of infections and some will go back
into exponential growth. The picture will be more complex than it is today,
with a lot of heterogeneity.
reasonable for people to ask whether the behavior change was necessary.
Overwhelmingly, the answer is yes. There might be a few areas where the number
of cases would never have gotten large numbers of infections and deaths, but
there was no way to know in advance which areas those would be. The change
allowed us to avoid many millions of deaths and extreme overload of the
hospitals, which would also have increased deaths from other causes.
economic cost that has been paid to reduce the infection rate is unprecedented.
The drop in employment is faster than anything we have ever experienced. Entire
sectors of the economy are shut down. It is important to realize that this is not
just the result of government policies restricting activities. When people hear
that an infectious disease is spreading widely, they change their behavior.
There was never a choice to have the strong economy of 2019 in 2020.
would have chosen not to go to work or restaurants or take trips, to avoid
getting infected or infecting older people in their household. The government
requirements made sure that enough people changed their behavior to get the
reproduction rate below 1.0, which is necessary to then have the opportunity to
resume some activities.
wealthier countries are seeing reduced infections and starting to think about
how to open up. Even as a government relaxes restrictions on behavior, not
everyone will immediately resume the activities that are allowed. It will take
a lot of good communication so that people understand what the risks are and
feel comfortable going back to work or school. This will be a gradual process,
with some people immediately doing everything that is allowed and others taking
it more slowly. Some employers will take a number of months before they require
workers to come back. Some people will want the restrictions lifted more
rapidly and may choose to break the rules, which will put everyone at risk. Leaders
should encourage compliance.
pandemic has not affected all countries equally. China was where the first
infection took place. They were able to use stringent isolation and extensive
testing to stop most of the spread. The wealthier countries, which have more
people coming in from all over the world, were the next to be affected. The
countries that reacted quickly to do lots of testing and isolation avoided
large-scale infection. The benefits of early action also meant that these
countries didn’t have to shut down their economies as much as others.
to do testing well explains a lot of the variation. It is impossible to defeat
an enemy we cannot see. So testing is critical to getting the disease under
control and beginning to re-open the economy.
developing countries like India and Nigeria account for a small portion of the
reported global infections. One of the priorities for our foundation has been
to help ramp up the testing in these countries so they know their situation.
With luck, some factors that we don’t understand yet, like how weather might
affect the virus’s spread, will prevent large-scale infection in these
our assumption should be that the disease dynamics are the same as in other
countries. Even though their populations are disproportionately young—which
would tend to mean fewer deaths from COVID-19—this advantage is almost
certainly offset by the fact that many low-income people’s immune systems are
weakened by conditions like malnutrition or HIV. And the less developed a
country’s economy is, the harder it is to make the behavior changes that reduce
the the virus's reproduction rate. If you live in an urban slum and do informal
work to earn enough to feed your family every day, you won’t find it easy to
avoid contact with other people. Also, the health systems in these countries
have far less capacity, so even providing oxygen treatment to everyone who
needs it will be difficult.
it is possible that the total deaths in developing countries will be far higher
than in developed countries.
need to learn
knowledge of the disease will help us with tools and policies. There are a
number of key things we still don’t understand. A number of studies are
being done to answer these questions, including one in Seattle done with the University of Washington. The
global collaboration on these issues is impressive and we should know a lot
more by the summer.
disease seasonal or weather dependent? Almost all respiratory viruses (a group
that includes COVID-19) are seasonal. This would mean there are fewer
infections in the summer, which might lull us into complacency when the fall
comes. This is a matter of degree. Because we see the novel coronavirus
spreading in Australia and other places in the Southern hemisphere, where the
seasons are the opposite of ours, we already know the virus is not as seasonal
as influenza is.
people who never get symptoms have enough of the virus to infect others? What
about people who are recovered and have some residual virus—how infectious are
they? Computer models show that if there are a lot of people who are
asymptomatic but infectious, it is much harder to open up without a resurgence
in cases. There is a lot of disagreement about how much infection comes from
these sources, but we do know that many people with the virus don’t report
symptoms, and some portion of those might end up transmitting it.
young people have a lower risk of becoming seriously ill when they get
infected? Understanding the dynamics here will help us weigh the risks of
opening schools. It is a complicated subject because even if young people don’t
get sick as often, they might still spread the disease to others.
symptoms indicate you should get tested? Some countries are taking the
temperature of lots of people as an initial screening tool. If doing this helps
us find more potential cases, we could use it at airports and large gatherings.
We need to target the tests we have at the people at greatest risk since we
don’t have enough tests for everyone.
activities cause the most risk of infection? People ask me questions about
avoiding prepared food or door knobs or public toilets so they can minimize
their risk. I wish I knew what to tell them. Judgements will have to be made
about different kinds of gatherings like classes or church going and whether
some kind of spacing should be required. In places without good sanitation,
there may be spread from fecal contamination since people who are infected shed
Who is most
susceptible to the disease? We know that older people are at much greater risk
of both severe illness and death. Understanding how gender, race, and
co-morbidities affect this is a work in progress.
times, the Gates Foundation puts more than half of its resources into reducing
deaths from infectious diseases. These diseases are the reason why a child in a
poor country is 20 times more likely to die before the age of five than one in
a rich country. We invest in inventing new treatments and vaccines for these
diseases and making sure they get delivered to everyone who needs them. The
diseases include HIV, malaria, tuberculosis, polio, and pneumonia. Whenever
there is an epidemic like Ebola, SARS, or Zika we work with governments and the
private sector to help model the risks and to help galvanize resources to
create new tools to stop the epidemic. It was because of these experiences that
I spoke out about the world not being ready for a respiratory epidemic in my 2015
TED talk. Although not enough was done, a few steps were taken to prepare,
including the creation of the Coalition for Epidemic Preparedness Innovation,
which I will discuss below, in the vaccine section.
the epidemic has hit, we are applying our expertise to finding the best ideas
in each area and making sure they move ahead at full speed. There are many
efforts going on. More than 100 groups are doing work on treatments and another
100 on vaccines. We are funding a subset of these but tracking all of them
closely. It is key to look at each project to see not only its chance of
working but also the odds that it can be scaled up to help the entire world.
activity is to raise money for developing new tools. I think of this as
the billions we need to spend so we can save trillions. Every additional month
that it takes to get the vaccine is a month when the economy cannot return to
normal. However, it isn’t clear how countries will come together to coordinate
the funding. Some could go directly to the private sector but demand that their
citizens get priority. There is a lot of discussion among governments, the
World Health Organization, the private sector, and our foundation about how to
organize these efforts.
to beat the enemy
World War II, an amazing amount of innovation, including radar, reliable
torpedoes, and code-breaking, helped end the war faster. This will be the same
with the pandemic. I break the innovation into five categories: treatments,
vaccines, testing, contact tracing, and policies for opening up.Without some
advances in each of these areas, we cannot return to the business as usual or
stop the virus. Below, I go through each area in some detail.
you will be reading about new treatment ideas that are being tried out, but
most of them will fail. Still, I am optimistic that some of these treatments
will meaningfully reduce the disease burden. Some will be easier to deliver in
rich countries than developing countries, and some will take time to scale. A
number of these could be available by the summer or fall.
If in the
spring of 2021 people are going to big public events—like a game or concert in
a stadium—it will be because we have a miraculous treatment that made people
feel confident about going out again. It’s hard to know precisely what the
threshold is, but I suspect it is something like 95 percent; that is, we need a
treatment that is 95 percent effective in order for people to feel safe in big
public gatherings. Although it is possible that a combination of treatments
will have over 95 percent effectiveness, it’s not likely, so we can’t count on
it. If our best treatments reduce the deaths by less than 95 percent, then we
will still need a vaccine before we can go back to normal.
potential treatment that doesn’t fit the normal definition of a drug involves
collecting blood from patients who have recovered from COVID-19, making sure
it’s free of the coronavirus and other infections, and giving the plasma to
people who are sick. The leading companies in this area are working together to
get a standard protocol to see if this works. They will have to measure each
patient to see how strong their antibodies are. A variant of this approach is
to take the plasma and concentrate it into a compound called hyperimmune
globulin, which is much easier and faster to give a patient than unconcentrated
plasma. The foundation is supporting a consortium of most of the leading
companies that work in this area to accelerate the evaluation and, if the
procedure works, be ready to scale it up. These companies have developed a Plasma Bot to help recovered COVID-19 patients donate
plasma for this effort.
of potential treatment involves identifying the antibodies produced by the
human immune system that are most effective against the novel coronavirus. Once
those antibodies have been found, they can be manufactured and used as a
treatment or as a way to prevent the disease (in which case it is known as
passive immunization). This antibody approach also has a good chance of
working, although it’s unclear how many doses can be made. It depends on how
much antibody material is needed per dose; in 2021, manufacturers may be able
to make as few as 100,000 treatments or many millions. The lead times for
manufacturing are about seven months in the best case. Our grantees are working
to compare the different antibodies and make sure the best ones get access to the
limited manufacturing capacity.
There is a
class of drugs called antivirals, which keep the virus from functioning or
reproducing. The drug industry has created amazing antivirals to help people
with HIV, although it took decades to build up the large library of very
effective triple drug therapies. For the novel coronavirus, the leading drug
candidate in this category is Remdesivir from Gilead, which is in trials now.
It was created for Ebola. If it proves to have benefits, then the manufacturing
will have to be scaled up dramatically.
foundation recently asked drug companies to provide access to their pipeline of
developed antiviral drugs so researchers funded by the Therapeutics Accelerator can run a screen to see which
should go into human trials first. The drug companies all responded very
quickly, so there is a long list of antivirals being screened.
class of drugs works by changing how the human body reacts to the virus.
Hydroxychloroquine is in this group. The foundation is funding a trial that
will give an indication of whether it works on COVID-19 by the end of May. It
appears the benefits will be modest at best. Another type of drug that changes
the way a human reacts to a virus is called an immune system modulator. These
drugs would be most helpful for late-stage serious disease. All of the
companies that work in this area are doing everything they can to help with trials.
have saved more lives than any other tool in history. Smallpox, which used to
kill millions of people every year, was eradicated with a vaccine. New vaccines
have played a key role in reducing childhood deaths from 10 million per year in
2000 to fewer than 5 million per year today.
Short of a
miracle treatment, which we can't count on, the only way to return the world to
where it was before COVID-19 showed up is a highly effective vaccine that
prevents the disease.
the typical development time for a vaccine against a new disease is over five
years. This is broken down into: a) making the candidate vaccine; b)
testing it in animals; c) safety testing in small numbers of people (this is
known as phase 1); d) safety and efficacy testing in medium numbers
(phase 2); e) safety and efficacy testing in large numbers (phase 3); and f)
final regulatory approval and building manufacturing while registering the
vaccine in every country.
can save time by compressing the clinical safety/efficacy phases while
conducting animal tests and building manufacturing capacity in parallel. Even
so, no one knows in advance which vaccine approach will work, so a number of
them need to be funded so they can advance at full speed. Many of the vaccine
approaches will fail because they won’t generate a strong enough immune
response to provide protection. Scientists will get a sense of this within
three months of testing a given vaccine in humans by looking at the antibody
generation. Of particular interest is whether the vaccine will protect older
people, whose immune systems don’t respond as well to vaccines.
of safety is obviously very important. Regulators are very stringent about
safety, to avoid side effects and also to protect the reputation of vaccines
broadly, since if one has significant problems, people will become more
hesitant to take any vaccines. Regulators worldwide will have to work together
to decide how large the safety database needs to be to approve a COVID-19
that was taken after the foundation and others called for investments in
pandemic preparedness in 2015 was the creation of the Coalition for Epidemic
Preparedness Innovations (CEPI). Although the resources were quite modest, they
have helped advance new approaches to making vaccines that could be used for
this pandemic. CEPI added resources to work on an approach called RNA vaccines,
which our foundation had been supporting for some time. Three companies are
pursuing this approach. The first vaccine to start human trials is an RNA
vaccine from Moderna, which started a phase 1 clinical safety evaluation in
vaccine is significantly different from a conventional vaccine. A flu shot, for
example, contains bits of the flu virus that your body’s immune system learns
to attack. This is what gives you immunity. With an RNA vaccine, rather than
injecting fragments of the virus, you give the body the genetic code needed to
produce lots of copies of these fragments. When the immune system sees the
viral fragments, it learns how to attack them. An RNA vaccine essentially turns
your body into its own vaccine manufacturing unit.
also at least five leading efforts that look promising and that use other
approaches to teach the immune system to recognize and attack a viral
infection. CEPI and our foundation will be tracking efforts from all over the
world to make sure the most promising ones get resources. Once a vaccine is
ready, our partner GAVI will make sure it is available even in low-income
challenge for vaccine trials is that the time required for the trials depends
on finding trial locations where the rate of infection is fairly high. While
you are setting up the trial site and getting regulatory approval, the
infection rate in that location could go down. And trials have to involve a
surprisingly large number of people. For example, suppose the expected rate of
infection is 1 percent per year and you want to run a trial where you would
expect 50 people to be infected without the vaccine. To get a result in six
months the trial would need 10,000 people in it.
The goal is
to pick the one or two best vaccine constructs and vaccinate the entire
world—that’s 7 billion doses if it is a single-dose vaccine, and 14 billion if
it is a two-dose vaccine. The world will be in a rush to get them, so the scale
of the manufacturing will be unprecedented and will probably have to involve
I am often
asked when large-scale vaccination will start. Like American’s top public
health officials, I say that it is likely to be 18 months, even though it could
be as short as nine months or closer to two years. A key piece will be the
length of the phase 3 trial, which is where the full safety and efficacy are determined.
vaccine is first being manufactured, there will be a question of who should be
vaccinated first. Ideally, there would be global agreement about who should get
the vaccine first, but given how many competing interests there are, this is unlikely
to happen. The governments that provide the funding, the countries where the
trials are run, and the places where the pandemic is the worst will all make a
case that they should get priority.
All of the
tests to date for the novel coronavirus involve taking a nasal swab and
processing it in a Polymerase Chain Reaction (PCR) machine. Our foundation
invested in research showing that having patients do the swab themselves, at
the tip of the nose, is as accurate as having a doctor push the swab further
down to the back of your throat. Our grantees are also working to design swabs
that are cheap and able to be manufactured at large scale but work as well as
ones that are in short supply. This self-swab approach is faster, protects
health care workers from the risk of exposure, and should let regulators
approve swabbing in virtually any location instead of only at a medical center.
The PCR test is quite sensitive—it will generally show whether you have the
virus even before you have symptoms or are infecting other people.
been a lot of focus on the number of tests being performed in each country.
Some, like South Korea, did a great job of ramping up the testing capacity. But
the number of tests alone doesn’t show whether they are being used effectively.
You also have to make sure you are prioritizing the testing on the right
people. For example, health care workers should be able to get an immediate
indication of whether they are infected so they know whether to keep working.
People without symptoms should not be tested until we have enough tests for
everyone with symptoms. Additionally, the results from the test should come
back in less than 24 hours so you quickly know whether to continue isolating
yourself and quarantining the people who live with you. In the United States,
it was taking over seven days in some locations to get test results, which
reduces their value dramatically. This kind of delay is unacceptable.
two types of PCR machines: high-volume batch processing machines and low-volume
machines. Both have a role to play. The high-volume machines provide most of
the capacity. The low volume machines are better when getting a result in less
than an hour is beneficial. Everyone who makes these machines, and some new
entrants, are making as many machines as they can. Adding this capacity and
making full use of the machines that are already available will increase the
testing capacity. The foundation is talking to the manufacturers about
different ways to run the big machines that could make them more than twice as
type of test being developed is called a Rapid Diagnostic Test (RDT). This
would be like an in-home pregnancy test. You would swab your nose the same way
as for the PCR test, but instead of sending it into a processing center, you
would put it in a liquid container and then pour that liquid onto a strip of
paper that would change color if it detects the virus. This form of test may be
available in a few months. Even though it won’t be as sensitive as a PCR test,
for someone who has symptoms it should be quite accurate. You would still need
to report your test result to your government since they need visibility into
the disease trends.
A lot of
people talk about the serology test, where you give blood and it detects
whether you have antibodies against the virus. If you do, it means you have
been exposed. These tests only show positive results late in your disease, so
they do not help you decide whether to quarantine. Also, all the tests done so
far have problems with false positives. Until we understand what level of
antibodies is protective and have a test with almost no false positives, it is
a mistake to tell people not to worry about their exposure to infection based
on the serology tests that are available today. In the meantime, serology tests
will be used to see who can donate blood and to understand the disease
A lot of
countries did a good job focusing the PCR capacity on the priority patients.
Most countries had their government play a central role in this process. In the
United States, there is no system for making sure the testing is allocated
rationally. Some states have stepped in, but even in the best states, the
access isn’t fully controlled.
becomes extremely important as a country considers opening up. You want to have
so much testing going on that you see hot spots and are able to intervene by
changing policy before the numbers get large. You don’t want to wait until the
hospitals start to fill up and the number of deaths goes up.
there are two critical cases: anyone who is symptomatic, and anyone who has
been in contact with someone who tested positive. Ideally both groups would be
sent a test they can do at home without going into a medical center. Tests would
still be available in medical centers, but the simplest is to have the majority
done at home. To make this work, a government would have to have a website that
you go to and enter your circumstances, including your symptoms. You would get
a priority ranking, and all of the test providers would be required to make
sure they are providing quick results to the highest priority levels. Depending
on how accurately symptoms predict infections, how many people test positive,
and how many contacts a person typically has, you can figure out how much
capacity is needed to handle these critical cases. For now, most countries will
use all of their testing capacity for these cases.
be a temptation for companies to buy testing machines for their employees or
customers. A hotel or cruise ship operator would like to be able to test
everyone even if they don’t have symptoms. They will want to get PCR machines
that give quick results or the rapid diagnostic test. These companies will be
able to bid very high prices—well above what the public health system would
bid—so governments will have to determine when there is enough capacity to
assumption is that people who need to get tested will isolate themselves and
quarantine those in their household. Some governments police this carefully,
whereas others simply assume people will follow the recommendation. Another
issue is whether a government provides a place for someone to isolate
themselves if they can’t do it at their home. This is particularly important if
you have older people in close quarters at your house.
in the testing section that one of the key priorities for testing is anyone who
has been in close contact with someone who has tested positive. If you can get
a list of these people quickly and make sure they are prioritized for a test
like the PCR test (which is sensitive enough to detect a recent infection),
then these people can isolate themselves before they infect other people. This
is the ideal way of stopping the spread of the virus.
countries, including China and South Korea, required patients to turn over
information about where they have been in the last 14 days by looking at GPS
information on their phone or their spending records. It is unlikely that
Western countries will require this. There are applications you can download
that will help you remember where you have been; if you ever test positive,
then you can voluntarily review the history or choose to share it with whoever
interviews you about your contacts.
A number of
digital approaches are being proposed where phones detect what other phones are
near them. (It would involve using Bluetooth plus sending a sound out that
humans can’t hear but that verifies that the two phones are reasonably close to
each other.) The idea is that if someone tests positive then their phone can
send a message to the other phones and their owners can get tested. If most
people voluntarily installed this kind of application, it would probably help
some. One limitation is that you don’t necessarily have to be in the same place
at the same time to infect someone—you can leave the virus behind on a surface.
This system would miss this kind of transmission.
most countries will use the approach that Germany is using, which requires
interviewing everyone who tests positive and using a database to make sure
there is follow-up with all the contacts. The pattern of infections is studied
to see where the risk is highest and policy might need to change.
if someone is tested and confirmed positive, the doctor is legally required to
inform the local government health office. The doctor must provide all personal
data—name, address, phone number—so that the health office can contact the
person and ensure they isolate themselves.
local health office begins the process of contact tracing. They interview the
infected person, find out how to contact all the people he or she has met in
the past couple of weeks, and contact those people to ask them to self-isolate
and get a test.
approach relies on the infected person to report their contacts accurately, and
also depends on the ability of the health authorities to follow up with
everyone. The normal health service staff can’t possibly do all this work even
if the case numbers are fairly low. Every health system will have to figure out
how to staff up so that this work is done in a timely fashion. Everyone who
does the work would have to be properly trained and required to keep all the information
private. Researchers would be asked to study the database to find patterns of
infection, again with privacy safeguards in place.
developed countries will be moving into the second phase of the epidemic in the
next two months. In one sense, it is easy to describe this next phase. It is
semi-normal. People can go out, but not as often, and not to crowded places.
Picture restaurants that only seat people at every other table, and airplanes
where every middle seat is empty. Schools are open, but you can’t fill a
stadium with 70,000 people. People are working some and spending some of their
earnings, but not as much as they were before the pandemic. In short, times are
abnormal but not as abnormal as during the first phase.
about what is allowed should change gradually so that we can see if the contact
level is starting to increase the number of infections. Countries will be able
to learn from other countries that have strong testing systems in place to
inform them when problems come up.
of gradual reopening is Microsoft China, which has roughly 6,200 employees. So
far about half are now coming in to work. They are continuing to provide
support to employees who want to work at home. They insist people with symptoms
stay home. They require masks and provide hand sanitizer and do more intensive
cleaning. Even at work, they apply distancing rules and only allow travel for
exceptional reasons. China has been conservative about opening up and has so
far avoided any significant rebound.
principle should be to allow activities that have a large benefit to the
economy or human welfare but pose a small risk of infection. But as you dig
into the details and look across the economy, the picture quickly gets complicated.
It is not as simple as saying “you can do X, but not Y.” The modern economy is
far too complex and interconnected for that.
example, restaurants can keep diners six feet apart, but will they have a
working supply chain for their ingredients? Will they be profitable with this
reduced capacity? The manufacturing industry will need to change factories to
keep workers farther apart. Most factories will be able to adapt to new rules
without a large productivity loss. But how do the people employed in these
restaurants and factories get to work? Are they taking a bus or train? What
about the suppliers who provide and ship parts to the factory? And when should
companies start insisting their employees show up at work?
no easy answers to these questions. Ultimately, leaders at the national, state,
and local levels will need to make trade-offs based on the risks and benefits
of opening various parts of the economy. In the United States it will be tricky
if one state opens up too fast and starts to see lots of infections. Should
other states try to stop people moving across state boundaries?
offer a big benefit and should be a priority. Large sporting and entertainment
events probably will not make the cut for a long time; the economic benefit of
the live audience doesn’t measure up to the risk of spreading the infection.
Other activities fall into a gray area, such as church services or a high
school soccer game with a few dozen people on the sidelines.
one other factor that is hard to account for: human nature. Some people will be
naturally reluctant to go out even once the government says it is okay. Others
will take the opposite view—they will assume that the government is being
overly cautious and start bucking the rules. Leaders will need to think
carefully about how to strike the right balance here.
I grew up learning that World War II was the defining moment of our parents’
generation. In a similar way, the COVID-19 pandemic—the first modern pandemic—will
define this era. No one who lives through Pandemic I will ever forget it. And
it is impossible to overstate the pain that people are feeling now and will
continue to feel for years to come.
cost of the pandemic for lower-paid and poor people is a special concern for
Melinda and me. The disease is disproportionately hurting poorer communities
and racial minorities. Likewise, the economic impact of the shutdown is hitting
low-income, minority workers the hardest. Policymakers will need to make sure
that, as the country opens up, the recovery doesn’t make inequality even worse
than it already is.
At the same
time, we are impressed with how the world is coming together to fight this
fight. Every day, we talk to scientists at universities and small companies,
CEOs of pharmaceutical companies, or heads of government to make sure that the
new tools I’ve discussed become available as soon as possible. And there are so
many heroes to admire right now, including the health workers on the front line.
When the world eventually declares Pandemic I over, we will have all of them to
thank for it.
Read this next
leaders can do now
decisions will affect the course of COVID-19.
and answers about COVID-19
on what to do now and other topics.
epidemic is coming. Here’s how we can make sure we’re ready.
I was honored
to be asked to give this year’s Shattuck Lecture.
The vaccine race, explained
What you need to know about the COVID-19 vaccine
has never had a more urgent task than creating broad immunity for coronavirus.
2020 10 minute read
One of the
questions I get asked the most these days is when the world will be able to go
back to the way things were in December before the coronavirus pandemic. My
answer is always the same: when we have an almost perfect drug to treat
COVID-19, or when almost every person on the planet has been vaccinated against
is unlikely to happen anytime soon. We’d need a miracle treatment that was at
least 95 percent effective to stop the outbreak. Most of the drug candidates right now are nowhere near that
powerful. They could save a lot of lives, but they aren’t enough to get us back
leaves us with a vaccine.
has never had a more urgent task than creating broad immunity for coronavirus.
Realistically, if we’re going to return to normal, we need to develop a safe,
effective vaccine. We need to make billions of doses, we need to get them out
to every part of the world, and we need all of this to happen as quickly as
daunting, because it is. Our foundation is the biggest funder of vaccines in
the world, and this effort dwarfs anything we’ve ever worked on before. It’s
going to require a global cooperative effort like the world has never seen. But
I know it’ll get done. There’s simply no alternative.
you need to know about the race to create a COVID-19 vaccine.
is creating this vaccine on a historically fast timeline.
Dr. Anthony Fauci has said he thinks it’ll take
around eighteen months to develop a coronavirus vaccine. I agree with him,
though it could be as little as 9 months or as long as two years.
eighteen months might sound like a long time, this would be the fastest
scientists have created a new vaccine. Development usually takes around five
years. Once you pick a disease to target, you have to create the vaccine and test
it on animals. Then you begin testing for safety and efficacy in humans.
efficacy are the two most important goals for every vaccine. Safety is exactly
what it sounds like: is the vaccine safe to give to people? Some minor side
effects (like a mild fever or injection site pain) can be acceptable, but you
don’t want to inoculate people with something that makes them sick.
measures how well the vaccine protects you from getting sick. Although you’d
ideally want a vaccine to have 100 percent efficacy, many don’t. For example,
this year’s flu vaccine is around 45 percent effective.
To test for
safety and efficacy, every vaccine goes through three phases of trials:
is the safety trial. A small group of healthy volunteers gets the vaccine
candidate. You try out different dosages to create the strongest immune
response at the lowest effective dose without serious side effects.
settled on a formula, you move onto phase two, which tells you how well the
vaccine works in the people who are intended to get it. This time, hundreds of
people get the vaccine. This cohort should include people of different ages and
phase three, you give it to thousands of people. This is usually the longest
phase, because it occurs in what’s called “natural disease conditions.” You
introduce it to a large group of people who are likely already at the risk of
infection by the target pathogen, and then wait and see if the vaccine reduces
how many people get sick.
vaccine passes all three trial phases, you start building the factories to
manufacture it, and it gets submitted to the WHO and various government
agencies for approval.
works well for most vaccines, but the normal development timeline isn’t good
enough right now. Every day we can cut from this process will make a huge
difference to the world in terms of saving lives and reducing trillions of
dollars in economic damage.
speed up the process, vaccine developers are compressing the timeline.
Vaccination Coverage Is at Its Highest. Read our Annual Letter –
& Melinda Gates’s full 2017 Annual Letter
Vaccination Coverage Is at Its Highest
traditional process, the steps are sequential to address key questions and
unknowns. This can help mitigate financial risk, since creating a new vaccine
is expensive. Many candidates fail, which is why companies wait to invest in
the next step until they know the previous step was successful.
COVID-19, financing development is not an issue. Governments and other
organizations (including our foundation and an amazing alliance called the Coalition for
Epidemic Preparedness Innovations) have made it clear they will support whatever it takes to find a
vaccine. So, scientists are able to save time by doing several of the
development steps at once. For example, the private sector, governments, and our
foundation are going to start identifying facilities to manufacture different
potential vaccines. If some of those facilities end up going unused, that’s
okay. It’s a small price to pay for getting ahead on production.
compressing the trial timeline isn’t the only way to take a process that
usually takes five years and get it done in 18 months. Another way we’re going
to do that is by testing lots of different approaches at the same time.
dozens of candidates in the pipeline.
As of April
9, there are 115 different COVID-19 vaccine
candidates in the
development pipeline. I think that eight to ten of those look particularly
promising. (Our foundation is going to keep an eye on all the others to see if
we missed any that have some positive characteristics, though.)
promising candidates take a variety of approaches to protecting the body
against COVID-19. To understand what exactly that means, it’s helpful to
remember how the human immune system works.
disease pathogen gets into your system, your immune system responds by
producing antibodies. These antibodies attach themselves to substances called
antigens on the surface of the microbe, which sends a signal to your body to
attack. Your immune system keeps a record of every microbe it has ever
defeated, so that it can quickly recognize and destroy invaders before they
make you ill.
circumvent this whole process by teaching your body how to defeat a pathogen
without ever getting sick. The two most common types—and the ones you’re
probably most familiar with—are inactivated and live vaccines. Inactivated
vaccines contain pathogens that have been killed. Live vaccines, on the other
hand, are made of living pathogens that have been weakened (or “attenuated”).
They’re highly effective but more prone to side effects than their inactivated
and live vaccines are what we consider “traditional” approaches. There are a
number of COVID-19 vaccine candidates of both types, and for good reason:
they’re well-established. We know how to test and manufacture them.
downside is that they’re time-consuming to make. There’s a ton of material in
each dose of a vaccine. Most of that material is biological, which means you
have to grow it. That takes time, unfortunately.
I’m particularly excited by two new approaches that some of the candidates are
taking: RNA and DNA vaccines. If one of these new approaches pans out, we’ll
likely be able to get vaccines out to the whole world much faster. (For the
sake of simplicity, I’m only going to explain RNA vaccines. DNA vaccines are
similar, just with a different type of genetic material and method of
foundation—both through our own funding and through CEPI—has been supporting the development
of an RNA vaccine platform for nearly a decade. We were planning to use it to
make vaccines for diseases that affect the poor like malaria, but now it’s
looking like one of the most promising options for COVID. The first candidate
to start human trials was an RNA vaccine created by a company called Moderna.
an RNA vaccine works: rather than injecting a pathogen’s antigen into your
body, you instead give the body the genetic code needed to produce that antigen
itself. When the antigens appear on the outside of your cells, your immune
system attacks them—and learns how to defeat future intruders in the process.
You essentially turn your body into its own vaccine manufacturing unit.
vaccines let your body do most of the work, they don’t require much material.
That makes them much faster to manufacture. There’s a catch, though: we don’t
know for sure yet if RNA is a viable platform for vaccines. Since COVID would
be the first RNA vaccine out of the gate, we have to prove both that the
platform itself works and that it creates immunity. It’s a bit like building
your computer system and your first piece of software at the same time.
Even if an
RNA vaccine continues to show promise, we still must continue pursuing the
other options. We don’t know yet what the COVID-19 vaccine will look like.
Until we do, we have to go full steam ahead on as many approaches as possible.
not be a perfect vaccine yet—and that’s okay.
smallpox vaccine is the only vaccine that’s wiped an entire disease off the
face of the earth, but it’s also pretty brutal to receive. It left a scar on
the arm of anyone who got it. One out of every three people had side effects
bad enough to keep them home from school or work. A small—but not
insignificant—number developed more serious reactions.
vaccine was far from perfect, but it got the job done. The COVID-19 vaccine
might be similar.
If we were
designing the perfect vaccine, we’d want it to be completely safe and 100
percent effective. It should be a single dose that gives you lifelong protection,
and it should be easy to store and transport. I hope the COVID-19 vaccine has
all of those qualities, but given the timeline we’re on, it may not.
priorities, as I mentioned earlier, are safety and efficacy. Since we might not
have time to do multi-year studies, we will have to conduct robust phase 1
safety trials and make sure we have good real-world evidence that the vaccine
is completely safe to use.
We have a
bit more wiggle room with efficacy. I suspect a vaccine that is at least 70
percent effective will be enough to stop the outbreak. A 60 percent effective
vaccine is useable, but we might still see some localized outbreaks. Anything
under 60 percent is unlikely to create enough herd immunity to stop the virus.
challenge will be making sure the vaccine works well in older people. The older
you are, the less effective vaccines are. Your immune system—like the rest of
your body—ages and is slower to recognize and attack invaders. That’s a big
issue for a COVID-19 vaccine, since older people are the most vulnerable. We
need to make sure they’re protected.
shingles vaccine—which is also targeted to older people—combats this by amping
up the strength of the vaccine. It’s possible we do something similar for
COVID, although it might come with more side effects. Health authorities could
also ask people over a certain age to get an additional dose.
safety and efficacy, there are a couple other factors to consider:
doses will it be? A vaccine you only get once is easier and quicker to deliver.
But we may need a multi-dose vaccine to get enough efficacy.
does it last? Ideally, the vaccine will give you long-lasting protection. But
we might end up with one that only stops you from getting sick for a couple months
(like the seasonal flu vaccine, which protects you for about six months). If
that happens, the short-term vaccine might be used while we work on a more
How do you
store it? Many common vaccines are kept at 4 degrees C. That’s around the
temperature of your average refrigerator, so storage and transportation is
easy. But RNA vaccines need to be stored at much colder temperature—as low as
-80 degrees C—which will make reaching certain parts of the world more
My hope is
that the vaccine we have 18 months from now is as close to “perfect” as
possible. Even if it isn’t, we will continue working to improve it. After that
happens, I suspect the COVID-19 vaccine will become part of the routine new-born
have a vaccine, though, we still have huge problems to solve. That’s because…
We need to
manufacture and distribute at least 7 billion doses of the vaccine.
In order to
stop the pandemic, we need to make the vaccine available to almost every person
on the planet. We’ve never delivered something to every corner of the world
before. And, as I mentioned earlier, vaccines are particularly difficult to
make and store.
lot we can’t figure out about manufacturing and distributing the vaccine until
we know what exactly we’re working with. For example, will we be able to use
existing vaccine factories to make the COVID-19 vaccine?
What we can
do now is build different kinds of vaccine factories to prepare. Each vaccine
type requires a different kind of factory. We need to be ready with facilities
that can make each type, so that we can start manufacturing the final vaccine
(or vaccines) as soon as we can. This will cost billions of dollars.
Governments need to quickly find a mechanism for making the funding for this
available. Our foundation is currently working with CEPI, the WHO, and
governments to figure out the financing.
those discussions senter on who will get the vaccine when. The reality is that
not everyone will be able to get the vaccine at the same time. It’ll take
months—or even years—to create 7 billion doses (or possibly 14 billion, if it’s
a multi-dose vaccine), and we should start distributing them as soon as the
first batch is ready to go.
agree that health workers should get the vaccine first. But who gets it next?
Older people? Teachers? Workers in essential jobs?
that low-income countries should be some of the first to receive it, because
people will be at a much higher risk of dying in those places. COVID-19 will
spread much quicker in poor countries because measures like physical distancing
are harder to enact. More people have poor underlying health that makes them
more vulnerable to complications, and weak health systems will make it harder
for them to receive the care they need. Getting the vaccine out in low-income
countries could save millions of lives. The good news is we already have an
organization with expertise about how to do this in Gavi,
the Vaccine Alliance.
vaccines, manufacturers sign a deal with the country where their factories are
located, so that country gets first crack at the vaccines. It’s unclear if
that’s what will happen here. I hope we find a way to get it out on an
equitable basis to the whole world. The WHO and national health authorities
will need to develop a distribution plan once we have a better understanding of
what we’re working with.
though, we’re going to scale this thing up so that the vaccine is available to
everyone. And then, we’ll be able to get back to normal—and to hopefully make
decisions that prevent us from being in this situation ever again.
It might be
a bit hard to see right now, but there is a light at the end of the tunnel.
We’re doing the right things to get a vaccine as quickly as possible. In the
meantime, I urge you to continue following the guidelines set by your local
authorities. Our ability to get through this outbreak will depend on everyone
doing their part to keep each other safe.
scientific advances we need to stop COVID-19.
leaders can do now
decisions will affect the course of COVID-19.
and answers about COVID-19
on what to do now and other topics.
© 2020 The