The Least We Can Do

The latest from the notorious British street artist Banksy. Photo circulating on FB and elsewhere, source not cited. For non-Brits, NHS is their National Health Service.

It appears the first wave of this virus has peaked in much of the world, though the quality of data everywhere is so poor it’s hard to tell. New York, with the stroke of a pen, added about 4,000 deaths to its tally (upwards of 30%) today, including for the first time deaths listed by coroners as “probably” CoVid-19 related on the death certificate, even if they weren’t officially tested. That suggests that even in jurisdictions where there is no political pressure to suppress death counts, the actual death toll from the virus could well be much larger than the official numbers.

Even two months into this pandemic, the answer to most of our questions is still “We don’t know.”

So here’s what we do know, or what seems most likely to be true at this point:

1. Hospitalization rates in Europe and North America are generally slightly past peak, suggesting that roughly half the people who are going to die of the first wave of this virus have already done so. The models suggest that the total “official” first wave death toll in the US will be about 60,000 – 80,000 people (depending on how many others follow New York’s lead and start including the tens of thousands who died in the past two months but could not be tested because of the massive shortage of testing kits and testing centres). The actual CoVid-19 related death toll there is likely to be at least 120,000, plus or minus 50%, with the additional numbers ascribable to uncertainty of cause of death, data errors, long delays in testing, certification and reporting, and data simply missing from those who died in non-hospital institutions and at home. That’s a total of about 0.04% of the population. For Canada, where our data-keeping and behaviour record is only marginally better, the actual death toll is likely to be at least 3,000, plus or minus 50%. That’s about 0.01% of the population. For the world, it’s anybody’s guess, since judging from Putin’s own statements and unofficial reports from Moscow the actual numbers for Russia are probably a couple of orders of magnitude greater than the official numbers, and that’s likely true in many other countries. For Europe including the UK but excluding Russia, the actual first-wave death toll is likely to be 200,000, plus or minus 50%. That’s about 0.03% of the population. That would make the expected global CoVid-19 first wave death toll somewhere between one and two million. In most jurisdictions, these totals are about three times the “normal” seasonal influenza death count.
2. The original guesses at the mortality rate of the disease converged on around 1% of those infected. That means if, as the numbers above suggest, between 0.01% and 0.04% of the population dies in the first wave, then the percentage of the population infected during the first wave was about 1% (Canada), 3% (Europe), and 4% (US) respectively. The variations are attributable to a mix of population density, population mobility, timely and careful social distancing, culture, and dumb luck. But what this means is that between 96% and 99% of the world’s population has not yet been exposed to the virus in sufficient quantities to contract (test positive for) the disease, and hence has no immunity to the disease thus far. Of course, this is only a wild guess. If the mortality rate is actually only 0.2% of those contracting it, then five times as many might have tested positive and might now have immunity to it (and only 80-95% of the population remains without immunity). The only way to find out is by either a massive increase in global testing, and/or the use of serology (blood tests for antibodies), once those tests have been reliably developed and introduced (which is likely to be sooner than a vaccine can be developed). Hurry up please! [EDIT: May 14th: Now it appears the mortality rate is close to 1.0%; see follow-up here.]
3. It would be an insane gamble for us to start to relax social distancing and other restrictions until we know what percentage of our population has been infected and hence what proportion now has immunity to the disease, and therefore what the actual mortality rate is. If in fact 96-99% of the population remains vulnerable and 1% of them, if they contract the disease before there’s a vaccine, dies as a result, then we’re looking at up to 3 million US deaths, 300,000 Canadian deaths, and 6 million European deaths (and potentially 75 million deaths worldwide). While this is probably a worst case scenario, even if the mortality rate is much lower, the number of deaths in many jurisdictions could approach these numbers due to health systems being overwhelmed and little or no hospital treatment (which has clearly dramatically reduced death tolls from what they would otherwise have been). So the least we can do is pour everything we have into ramping up testing (starting with a 100-fold increase in testing supplies and resources, which would still be surprisingly inexpensive), drastically improving data collection and the availability of personal protective equipment (masks, gloves, screens, sanitizer etc), so we’re ready for what comes next: the next wave, the next mutation (which could be much more lethal, or attack a completely different demographic than the first wave version), or the next one of the million-or-so viruses in mammals, birds and fish we eat, to cross the species barrier and become the next pandemic.
4. The number of “novel” viruses (viruses crossing the species barrier for the first time, and, what’s unprecedented and especially scary, sometimes through mutations that draw on RNA combined from more than one host species), has absolutely skyrocketed in the first two decades of this century — far more than in any previous time period. This is entirely attributable to the way we raise (factory farms) and consume (bushmeat and exotic ‘farmed’ meat) animals, and to the rapid development of areas (rainforest, tundra etc) that harbour exotic species and their ‘native’ viruses, viruses humans have no natural immunity to. We must quickly end factory farming and other crowded farming practices, exotic animal farming and consumption, and the development of remote areas of the planet that are allowing viruses to propagate and mutate rapidly and be released in areas where there is no immunity to them.

This is the least we can do.

We know what causes pandemics. We know how to prevent them, how to prepare for them, and how to mitigate the damage they inflict on us. We have received a remarkably gentle warning, and the vast majority have reacted in the moment intelligently and courageously. But if we don’t act to prevent future infections, and to be ready for the ones that will inevitably occur, next time we are unlikely to be so lucky.

Yet I’m not so sure we’ll do any of this. It’s seemingly not in our nature to prevent or prepare for crises, or even contemplate them until we are in the midst of them. That certainly seems the case for our response to climate change, to our teetering global economy, and to the growing storm of biodiversity loss and the sixth great extinction.

And even now the “let’s get back to business” ideologues, misinformed and full of bravado, are urging us to open the floodgates while the flood — or the fire — is still raging out of control just outside our door. And we don’t even know how big it is.

But one way or another, we will soon find out.

Thanks to all those putting their health, their sanity and their lives on the line for all of us in these challenging times. When so many of our leaders have so horrifically and completely let us down, it’s good to see true leadership and courage on the front lines.

Stay safe, everyone.