Apocalypse missed, or how the Coronavirus could have been so much worse

One of the most defining points about the spread of Coronavirus has been how unprepared the world has been. And yet novel viruses and pandemics are hardly new, in the 21st century alone we have seen outbreaks of novel viruses time and time again. SARS (2003), MERS (2012), Ebola (2014), and the infamous H1N1 strain of swine flu (2009). That is just in the last 20 years. One thing they all have in common is that they were all transmitted from animals to humans. That is where the similarities stop. When looking at Coronavirus SARS-CoV-2 we can clearly ignore Ebola, which is probably one of the scariest of the diseases out there right now. Transmitted by touch, and with a high mortality rate, it remains on the fringes, kept in check by the fact that it’s a fast killer meaning it spreads slowly. The rest on the other hand are a different matter.

The big question therefore is why has the world been so unprepared for a new novel Coronavirus? It’s not like there’s been no previous Coronavirus outbreaks, both MERS and SARS were Coronaviruses. Coronaviruses are not exactly rare either, although the types like MERS and SARS are a lot more dangerous than the most common Coronavirus family out there, the common cold. And H1N1 showed that novel influenza viruses could still pop up and cause concern. It has to be remembered that the most deadly viruses of the last few hundred years have been flu viruses, the last big one being the Spanish Flu pandemic of 1918-1919. More on Spanish Flu in a bit. So why has no one been warning us about the potential for a new deadlier Coronavirus?

Well actually they did. As a result of the H1N1 Swine Flu outbreak in 2009 the US government created a special department within the White House to deal with emerging pandemics. They were actually more concerned with another outbreak of influenza as a result of the intensive factory farming of animals in the USA, so research was into influenza strains, the fear being what would happen if a new virus with the mortality rate and infectiousness of the 1918 Swine Flu was to appear. Considering the 1918 outbreak killed an estimated 40 million people worldwide (some estimates go as high as 75 million). You can see why people might be scared. It’s also a good time to point out that while the 1918 outbreak was named Spanish Flu, it, like H1N1, actually originated in the USA. By 2016 they had run simulated outbreaks and came to the conclusion that the incoming Trump administration needed to prepare. The current shortfall in the National Stockpile was raised, as well as the need to have plans in place at a federal level in case the worst was to happen.

In May 2018 this was highlighted again at a conference to commemorate 100 years since the 1918 flu pandemic. As a result of that conference the head of the CDC’s flu division, Dr Daniel Jernigan, gave a presentation that warned that the USA was unprepared for another flu pandemic. By then it was too late, the pandemic response team had been fired and Donald Trump had drastically reduced the CDC’s budget resulting in the withdrawal from the Wuhan laboratory in China of their liaison. The CDC was left blind to what was happening in China, and everyone who could have put in place a plan of action was gone. The official line was that they didn’t need a federal response, it would be up to states to provide a response. But the individual states made it clear that it wasn’t a priority to them and anyway, they didn’t have the money for pandemic response planning.

As an engineer one of my jobs was risk analysis. As an IT manager one of my jobs is disaster mitigation. We have plans for a variety of scenarios. What to do in the event of a major power cut. What to do if a server dies. What to do if the entire building burns down. In any scenario I can turn to a document and there will be a list of things to do. Who do I call first? Who do I call next? How do we get back up and running in the shortest time possible. While pandemic response wasn’t in our planning the fact that we had plans meant we were able to adapt. For a multi-million pound company our pandemic response cost us about £20,000. When the call came to send people home we had laptops, VPN connections, and a server already setup. The plan was pretty much the same as for a loss of part of the building, what do we need to get back up and running as quickly as possible? Over 2 weeks we recognised what was coming, planned, and implemented. We beat the entire country rushing to buy laptops in order for their workers to work from home. How? We looked at what was happening in other countries and acted on what we saw. Partly this was down to the fact we have an office in China, but we recognised early on that it wasn’t going to be contained. This was the job of the White House pandemic response team. A section of the CDC, embedded within the White House itself, ready to tell the President what decisions he needs to make, and when. The problem was, businesses don’t plan for pandemics, and narcissists don’t listen to advice. This wasn’t just an American issue though, we had a similar situation over here in the United Kingdom, with political advisers ignoring the recommendations of actual experts in infectious diseases and, as with Donald Trump, making the mistake of believing this new Coronavirus was just the flu.

Don’t get me wrong, there are a lot of similarities. Infection rates and transmission methods are very similar. As are many of the symptoms. But that’s where the similarities end. Had SARS-CoV-2 been just another flu virus, even with a 0.5% – 1% mortality rate, we wouldn’t be in the position we are in now. We would be reacting the same way that the USA did in 2009. We have a variety of treatments for influenza viruses, as well as vaccines, meaning we’d already be partway to a vaccine. And flu viruses have a very low hospitalisation rate in comparison, at least where ICU admissions are concerned. This is partly due to influenza viruses attacking the upper respiratory tract. SARS viruses attack the lungs. And the symptoms for COVID-19, the disease caused by SARS-CoV-2, are much worse than the flu.

The real question though has to be why governments were so adamant that this disease was just a flu virus when even back in January it was becoming clear it was so much more. The CDC and WHO back then were warning that this was going to be a potential pandemic. And even back in January they were warning that it was a much bigger problem. Initial numbers from China and Korea were showing it to be much deadlier than expected. The clues were there already, but because there was no CDC oversight at the labs in China there was no one able to point out a very obvious, in hindsight, fact. The disease must be transmitted between humans. It was simply spreading too fast to be spread by animals. This was the initial mistake made by China back in December. They had assumed the disease was being spread from bats to humans, and that was the only method of transmission. This mistake meant it was able to spread rapidly through China and then, to neighbouring countries. By February the first death was recorded outside China. By the end of February it was clear that this was not flu, even though there was still much to learn. The virus had reached Italy and its true deadly potential suddenly became very clear, it’s ability to rapidly overwhelm a hospital’s Intensive Care Units. Before Italy the death rate had been assumed to be between 1% – 3.4%. Italy showed the world what would happen if they did nothing. With confirmed cases showing nearly 20% of people requiring hospitalisation, and a sizeable number of them requiring ventilators, the mortality rate in Italy soared. People weren’t just dying from COVID-19, they were dying from being unable to be treated because of the overwhelmed system. Ambulances instead of taking minutes, were taking hours to reach heart attack victims. With a wealth of evidence of what was at stake the narcissists still wouldn’t listen though. Even into mid-March Boris Johnson and Donald Trump were insisting it was no worse than flu. There was an insane conviction that the US and British healthcare systems could cope with everything the virus could throw at them. That if we could infect enough of the right people, we’d build up enough immunity to protect everyone else.

Back in March many people looked at Italy and realised what was needed. Somehow the spread of the virus needed to be slowed down. It became known as Flatten the Curve. A recognition that if you can’t stop the spread of infection, at least you can slow it down enough that at its peak demand for hospital beds and ICU beds can be kept below the capacity of the system. The problem was nobody had modelled the data, and without a model that showed what your capacity truly is it would simply be dismissed as alarmist. Imperial College London would change that. They created a real-time model that could predict how the virus would spread, and included social sciences in the data. Almost immediately the UK and USA governments did a U-turn in policy, recommending people to stay at home. France and Italy enforced their lockdowns. Boris Johnson asked nicely. Donald Trump contradicted himself almost as soon as he opened his mouth. Predictably the public decided it wasn’t really an issue, not understanding that it could take up to 2 weeks for the virus to show signs of infection, and that there was a lag of 2 to 3 weeks before someone died. Coupled with being told repeatedly over the previous weeks that it was no worse than flu, they did what you would expect. They went to the beach to enjoy the sun. To the credit of Boris Johnson he did the only sensible thing that he could, he shut everything and gave the police the authority to arrest anyone not complying with the new social distancing rules. Donald Trump carried on insisting it wasn’t an issue, and anyway it was all Obama’s fault, and nothing at all to do with him ignoring every expert that had been saying this was going to happen over the last 4 years.

By now we should be used to hearing politicians lie. But it’s especially bad when they are lying about people’s lives. Or to be more precise, their deaths. There are a lot of assumptions being made. And this may in part be down to politicians wanting to remain positive, and have hope for the future. But it doesn’t help when they underplay the severity of what the country is facing. The bad news first: the UK is saying we could see up to 20,000 people dying from COVID-19. They’ve also said we could see 70% of the population catch it. The problem with this number is that it is based on the crass assumption that only the young will catch it. There are 64M people living in the UK. 70% of 64M is 65M, give or take. 20,000 deaths would equate to only 0.04%. That’s less than half the mortality rate of seasonal flu. Other countries have seen mortality rates between 0.5% and 8%. But that 0.5% was in a country with a much younger demographic. The UK has an aging population, similar to Italy’s. Assuming we don’t overwhelm our hospitals then we could see close to 1%. Or 450,000 deaths. The USA has been a bit more realistic with their figures, estimating 200,000 deaths. But with 327M people living in the USA that means roughly 229M people could eventually become infected. Again, we’ll go with the lower end of the mortality rate and stick 1% in. That’s 2.29M deaths. And it’s looking likely that it’s here to stay.

Did I say that was the bad news? Well there is some good news. Several actually. Firstly the 2009 H1N1 outbreak was estimated to have infected 64M people in the USA. Remember there was little response to the outbreak apart from calls to stay away from everyone else. But being a flu virus it also spread slower. Flu is also seasonal, it peaks in winter and disappears in summer. By the time it reached 64M people a vaccine had been developed and was being administered. It’s too early to tell yet but there’s some hope that SARS-CoV-2 will also be seasonal. That was one reason the SARS outbreak in 2003 wasn’t as bad as it could have been, combined with a high mortality, it was slow to spread and had a seasonal component. Being slower to spread has meant that it has been relatively easy to contain with less than 9000 confirmed cases. And while it may be more difficult to develop a vaccine for Coronaviruses with the advent of AI technology it’s certainly not an impossibility. We just need to slow the spread down enough that we can cope until the vaccine is found, much like we did with H1N1. The work has already started and should be complete just in time for next year’s outbreak of SARS-CoV-2, assuming the world has gone back to normal before Christmas. That’s the big problem with seasonal viruses, they’re like relatives, they come to visit each Christmas.

Finally, it could have been so much worse. Experts have been warning of a pandemic for years, but they thought it was going to be another 1918 flu pandemic. In many ways this is much worse than 1918, the potential is there for a much higher death toll. But it’s when we look at our other big Coronavirus outbreak of the last 20 years that we have to realise that we have genuinely dodged the bullet. SARS-CoV-2 is a mutated bat Coronavirus. So is MERS. And MERS has a mortality rate estimated to be around 34%. Thankfully MERS has been limited to the Middle East, but the potential is there for a Coronavirus mutation with the infection rate of the common cold, and the mortality rate of the Black Death. That would see a potential 100M deaths in the USA alone. Let’s hope someone has funded the CDC’s pandemic response team by then.