Daily figures for confirmed infections and deaths are now available by country.
Data from the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC) and the European Centre for Disease Prevention and Control (ECDPC) is available separately from each organization, across countries.
Figures are being collated in a dashboard maintained by the Johns Hopkins University Center for Systems Science Engineering, which has combined data from the WHO, CDC, the ECDPC and the Chinese Center for Disease Control and Prevention (CCDC). It also incorporates data from the Chinese medical community website DXY, which aggregates live situation reports from the Chinese National Health Commission and local CCDC. This can be accessed on ft.com.
The pandemic is still spreading into new countries, notably tropical countries, many of which do not have the same level of sophisticated medical systems as Europe, urban China and the US.
For these areas to avoid becoming a reservoir, from which the infection could return, they may need assistance from wealthier countries. Many counter-infection measures are simple and low-cost such as handwashing, ‘distancing’, although even these may not be very accessible if you live in a shanty town. However, once a patient needs hospitalization, ventilators and anti-viral drugs, then countries need assistance to afford these, especially given the crash in global economies which will hit the poorest countries worst.
The reported infection rate in China seems to be leveling off or even declining, although imported cases (from citizens returning home from abroad) are creating new infection reports. However, all infections have yet to work their way through the data.
The actual infection rate will only be known in several months’ time when it may be possible to test for antibodies to see how many people were infected, but showed no symptoms. Protocols for management of an outbreak of this type are inexact because the disease profile is not fully known, but will be a priority for research when data is available.
Peak timing from initiation of disease in a population to peak infection appears to be about nine weeks, using the data from China. Secondary infections appear unlikely on previously-exposed subjects, but a ‘second wave’ from newly-arrived infectious subjects (returning from abroad, for example) appears to be happening in some territories.
If there is a rapid return of large groups (e.g., to office work or schools) who start to mix, secondary outbreaks can be expected.
SECOND AND THIRD-ORDER EFFECTS
Things to look out for:
LARGE-SCALE PROBLEMS REQUIRE LARGE-SCALE RESPONSES
Diseases, like weather, do not know political boundaries. There are some factors which are not susceptible to a state-by-state approach, and where an impact is better measured by the number of people affected within a physical area rather than the political systems which happen to operate there.
For fast-moving diseases, the ability to close down transit mechanisms like mass transit, airlines or ports requires pre-agreed protocol between national authorities and owners across national boundaries. That, or a highly authoritarian state which does not have to consider attitudes among voters first.
In the case of maritime law, transnational procedures are well-established: there is an international ‘Law of the Sea’, overseen by a UN convention since 1982, through the International Maritime Organization. Legal cases are pursued at national level.
Meteorological agencies around the world co-operate through the World Meteorological Organization (WMO); WMO World Weather Watch networks the observing stations to national, regional and global weather and climate prediction centers 24 hours a day in real-time.
In the case of health, there are several international bodies which monitor and record health issues, but these only come together to create protocols under extreme conditions (e.g., Ebola and similar highly contagious and fatal outbreaks) and they do not have authority over national systems. The WHO monitors and researches, but has no legal power to enforce.
The existence of a centralized expert information hub with research capacity creates strategic and planning capacity to respond to emergencies. However, note that none have transnational legal powers.
National agencies, if they exist and have legal authority, can move much faster. However, moving fast does not necessarily mean moving effectively, and high-profile moves may not be the most effective. The risk for national bodies is that local political requirements will interfere with effective action.
Countries without comprehensive and accessible national health systems will find it harder both to monitor and to treat patients.
RELATIVE RISK
To date (January to March 23, 2020), there are 2,433 diagnosed coronavirus cases in London health regions. There have been 129 deaths, a rate of about 5.3% among diagnosed and recorded cases.
At the date of writing, total diagnosed cases in the UK were 6,650. Coronavirus-related deaths for the whole of the UK were 335, a rate of 5% among diagnosed and recorded cases.
For comparison, in London in 2019, 126 people were killed in road traffic accidents (as of 19/12). In an average year, there are about 30,000 reported road casualties in London.
In 2019, in London 149 people died from stabbing incidents. In total, in the month of January 2020 (a typical winter month) there were 4,990 deaths in London from all causes.
In recent years in England, there have been about 15,000 deaths a year from lower respiratory diseases, and 12,000 deaths a year from influenza and pneumonia. (All data from Office for National Statistics (ONS), accessible through the gov.uk portal).
While diagnosed infections are rising as the disease spreads and more people come forward for testing, the rate of lethality is still expected to be under 1% for the general population, although higher in the oldest age-groups, as is usual for respiratory infections.
The risk from coronavirus is time-related: overloading of facilities, the impact on nursing and support staff, and the displacement of resources away from usual requirements for long-term and critical care.
The closest parallel to current actions that the writer can think of is the bovine spongiform encephalopathy (BSE) crisis, where a very large and economically expensive program was put in place to remove the risk of a very rare, but very nasty fatal disease.
The number of deaths from variant Creutzfeldt-Jakob disease (CJD) (the kind attributed to contaminated meat) peaked across the UK at 28 individuals in the year 2000, rising from 3 individuals in 1995 and falling back to 2 individuals in 2008. The incubation period may be more than 10 years, but since 2014 there have been no deaths.
Total variant deaths from 1990 to 2020 are 178. Deaths from sporadic CJD, not thought to be caused by contaminated meat, over the thirty years is 2,226 (NHS website and cjd.ed.ac.uk).
THE GIANT PETRI DISH
Like it or not, we are in the middle of a giant series of experimental procedures. The reduction in travel means the question of what turning from internal combustion engine (ICE)-powered vehicles towards electric vehicles (EVs) would do to pollution can now have figures attached.
One answer is that air pollution drops surprisingly fast. Most is exhaust gases, but some is reduced traffic activity, which reduces road dust from tyres, brake pads and road surface abrasion. In ICEs, exhaust gases are removed, but road dust is still an issue (although gentler braking in automated systems will reduce it).
The reduction in CO2 from reduced economic output needs to be examined more closely to see how much would ‘bounce back’ just due to higher economic activity, and where that and other greenhouse gases could now be accurately targeted for reduction.
Both costs and potential savings from more home-working and less commuting can now be calculated more accurately. This will have exposed out-of-date business systems which are not scalable for distributed working (and possibly some out-of-date management ideas, too).
It will be a useful exercise – preferably before there is a rush back to ‘doing what we did before’ – to record the financial and operational impact.
The points of lowest resilience are also exposed:
- undue reliance on a single supplier
- the limits of up-scaling through gig or temporary workers
- the difficulties within long-distance supply chains such as trans-ocean freight.
Example: Samsung and LG produced over 94% of the global smartphone organic light-emitting diode (OLED) display market in Q4 2019, within the Daigu area of South Korea (FT article, 19 March), which is now the center of an infection ‘cluster.’
Resilience means having more facilities than you think you need, day to day. It is more expensive than ‘optimized’ systems. It may mean dealing with several local suppliers rather than one distant supplier. Like all insurance, it may be hard to justify why you don’t need to make a claim, but could save your business when you do. For this reason, it may become part of the environmental, social and governance (ESG)/risk factor disclosure/standard corporate reporting required for public corporations and by large external investors. It is why we have two of most organs, like eyes, kidneys, and hands, and a brain which can repurpose its regions, if one is damaged. Having one of something – like a heart – is inherently higher risk.
