It stepped out of the dark, to test your reflexes, your systems, values, fears, your ability to adapt, your foresight, and this is how it knows who you are.
The problem with this virus is that it is very small and new, never experienced by humans before (this particular strain) and well suited to match human cells when it enters any soft tissue.
It, therefore, does not cause much of an effect in some people, but that can still transmit it, in others, it takes a long time for their immune system to perk up to the virus, and they still spread. There is a gap, of 5-10 days and then in some ~7% percentage the virus requires hospitalisation, but the problem at that point is that infrastructure cannot handle the size of this population needing help so you get all sorts of messy problems.
The spread mechanics seem to be through contact, any fluids (urine, faeces), spittle, droplets, even smaller droplets that fly a bit further and surfaces. In my mind, I imagine fine dust across surfaces, and coming from the ill person which then either I breathe-in, directly or touch and then rub my eyes, or even maybe eat on uncooked food that was sneezed on. It is not completely known, but it poses a big challenge to our systems.
What I find a source of relative comfort from humanity’s point of view is that China did manage to get this pretty much under-control in regions outside Hubei, but what is difficult is that the civil costs of this process to get things under control was way higher than we (not in China) are used to.
The story I hear is that now returning back to work, people are tracked by presenting a coloured code at different checkpoints through an app that describes their status through a traffic light pattern. Presumably, the app code is generated in a way that can’t easily be hacked either (which means tightly tied to identity, to location and past locations etc…). Also, people are scanned on entry and exit of their apartment blocks for temperature (a delayed marker for some people of the disease, and an unspecific but cheap one). This sort of setup allows the authorities to reverse lookup which new case might have been in contact with other cases by means of traffic data.
Now outside China, it is hard to believe we would participate in such a system, and any system at all that doesn’t tie identity somehow to location and health status would be inadequate. But this virus is unlikely to be completely extinguished 100% for the same reasons that it is so hard to detect.
So it leads us to a few possible scenarios and mix between them:
- Cultural change
- Ubiquitous testing
- Eventually vaccination
Cultural Change
The cultural change needed would be actions performed by enough people, and enough stigma on others that itself sustains, to lead to a reduction to the infection rate. Take two example people: one parent goes travelling gets a light-flu and hangs out with his children and family party relaxed celebrating his return from the business trip, versus another parent that as a precaution self-isolates, even imperfectly, for 10 days or so. These two scenarios will have dramatically different outcomes, in the first worse case the person could infect many people say 10 or so, in the second in the worse case the number would be few. This key difference applies across every aspect of social interaction.
I cannot re-invent how we go to the Pub in this new Culture but for example, how we shake hands is something I can envision very simply. We should stop it, and use some other gesture, a bow or the Asian hands together in front.
In this new culture, you need to establish the right rules to the “game” to make sure you get the right outcome. A good example story is how in the Middle Ages during the plague Florence had some of the least worse cases of the disease compared to other cities. In Florence there also was good care for the poor sick, they would get healthy “free” food (even if not in massive amounts). This meant that if anything people would be more likely to self-report as sick rather than try to hide it and lead to spread.
I translate this to, say if we gave free masks to people that are sick, but then charged a fine to those that were in public with any symptoms not wearing a mask. This sort of fairly harsh initiative would have an impact on transmission in a definite way.
Ubiquitous Testing
An alternative outcome is that we just manage to create a huge number of very cheap, or free test kits that you can perform at home. This scenario would lead to a quick quenching of the worse cases and give people some independence. The only problem with this scenario is that it would still rely on others to test themselves, which I think would still lead to outbreaks periodically unless some sort of mandate was enforced.
Communities could require testing to be part of their shared space, for example, but poorer areas, areas in conflict or with loose borders would retain the virus and become likely further ostracized from the communities that could test.
For this to work well, ideally, the testing would be almost free, and global, and sustained, repeated multiple times.
Vaccination
Eventually, maybe, we would identify a vaccine which would help a lot. But likely it would be similar to the flu jab we currently have, and not really eliminate the virus completely rather allow health services to have a more moderate impact over the course of a season.
In this scenario again, we would have a split between communities that could enforce, afford and encourage vaccination versus ones that have fewer means. It would likely lead to permanent travel restriction controls from territories that do not manage to get themselves under control from a public health perspective.
Conclusion
I have two ideas as take-away, the first is that no matter what, I see we will need to change cultural habits to reduce the risk from this virus spreading, and these may persist even when we get it under control because the control will likely not be total.
Second I expect humanity will prepare technologically and socially for a response to this sort of problem in a more robust way in the future. Much of our biotech is able to generate new options, explore new areas, look at new organisms. It is easy today to create new strands of genetic material, but it is hard to know how to break them down and control them.
Links I found informative:
Still looking for a resource that has now been taken offline that compared live data across different countries. It showed with the clear impact of how the infection rate can vary so much between different countries, cultures and based on different initiatives.
Questions And Answers
In the course of sharing this article, friends return to me with questions which I add here to try to further explain the way I see this. The underlying defence system of our society is made of institutions and people and rapid response units, that handle any number of issues, in this case, sick people that could go on to create more sick people.
What is important to realise is that like any system, our societal defence system can only deal with a certain rate of problems before which it can really struggle and end up in a new state where completely different more tragic solutions are necessary. So, this is why the rate of infection is so critical, a rate of 2 say means that the sick person managed to infect two people before being isolated. If we assume that the average incubation period before the person is isolated and shows symptoms is 6 days, then we would find a doubling of the total number of infected every 6 days. But if instead, people change their behaviour this rate can go down dramatically, imagine a world where people:
- wash their hands thoroughly
- learn to not touch their faces
- never cough without covering
- avoid shaking hands
- stay home with any cough or fever
- disinfect their elevators/bank tellers etc..
- do not spit on the ground
- avoid tightly crowded events
The infection level might go down to 1.5 or less, which means doubling over a much longer time, say 12 days or longer. And this change in a culture gives time for the societal immune system to get the virus under control that we struggle with individually. What this means is that any social change carries important side effects, so the best route is not always the most obvious one.
In China, serious social control measures had a massive effect, but the problem will now become tuning them to new outbreaks while trying to get the economy moving along.
What about self-isolation, should it be for “everyone”?
It would be better to have a self-isolation that you can tune. If there is a protocol that people can follow, then they will be more likely to stick to it and it will not lead to breaking rules in potentially arbitrary ways. It is important to not punish anyone self-isolating because again we would encourage the virus to spread in this way.
So for example a self-isolation that people are allowed to take if they feel feverish and have a dry cough, and if it lasts more than a few days they might persist to make sure. This sort of self-isolation, while expensive would avoid the need to impact everyone, and we can keep infrastructure moving.
What about blocking travel?
Again it would be better to have a process one can tune rather than shut the whole system down. It would be better if you could travel only with no symptoms of any kind. Make the trip much more expensive, ask people to self-isolate a few days before the trip, send a controlled cab to pick them up, and require self-isolating on the other side. Give free protection during the trip to everyone. Make sure the final destination of the person is aware of the need for a self-isolation.
If there is “some way” to travel, even if inconvenient, it is much more likely that people will follow it and in this way reduce the infection rate. If there is no way to travel, people will just find ways of making the same trip through other routes and increase the infection rate.
What about stopping public transport?
I think this is a bad idea because those that really need it will then take other means and cause worse problems potentially. I would have some means to self check and require people to take transport only without symptoms. This would be a good place to monitor temperatures of people automatically.
What about our food safety?
I think we don’t really know, but as far as I can find there does not seem to be a clear impact on food, partly because there do not seem to be clear or many cases of food-based infection and partly because food is controlled to some extent. I would, in general, expect that there will have to be a revision of all processes to double-check and to be safe I would rely on cooked food in this period a bit more than raw. The virus multiplies on human cells, so it would not do as well on other surfaces, though it might still survive for a day or so.