Coronavirus : Update from the Epicenter

Posted by in Coronavirus

This is the first of a series of mails that I started sending out to friends and family when it became apparent that the UK and US media were not always being fully transparent, politicians in those countries were, well, being politicians, and the few days or weeks of grace those countries had been granted were not being used to protect the public.

The Covid-19 coronavirus is similar to the flu in the way it transmits and the symptoms it provokes, with the following differences :
1. Flu has a shorter incubation period and a shorter time between successive cases, meaning it can spread faster than Covid-19, however the new virus does appear to spread twice as readily as flu – perhaps due to the fact that 80% of people suffer light or no affects, whilst remaining contagious.
2. Flu remains infectious outside the body (on someone’s hands, or on inert surfaces) for about 15 minutes, but Corona is active for several days.
3. Average mortality rates with flu are 0.1%, whereas the Coronavirus appears to be between 1 and 3% (10 to 30 times higher), with risk rising with age and underlying conditions. 
All this means that although it is easy to sneer at the low initial cases in a country as irrelevant compared to seasonal flu… you only need to wait a few days for the statistics to play out and you’re in the thousands.  2 weeks ago we had three cases; within 10 days we had 3000.  We’re now at 9172 and counting.  You can follow along here :
The WHO is encouraging countries to adopt a two-step policy :
1. Containment.  This is where initial cases must be isolated, their movements traced and contacts quarantined… all in the name of stopping the spread.  Unfortunately this requires early and decisive action, but that really hasn’t happened anywhere.  All governments are too lax at the beginning – preferring to minimize panic or market impact.
Genetic tests on the first cases in Italy and the US show mutations in the virus’ genome compared to cases in Wuhan that indicate weeks of replication and transmission in those countries before the significance of the situation came to light.  It’s extremely likely that the same is true for other countries seeing their first cases now.
2. Control.  This is where you move out of denial and accept that the virus has taken a foothold in the country.  This is when you have to make bold moves like shutting schools, isolating complete communities, restricting movements, cancelling events, encouraging social distancing, etc.  China did it with 60M people and they haven’t had a new case outside of Wuhan for 4 days.  Italy has done it (arguable less effectively) for 16M people – with the probability that it will be extended further over the next few days.
I saw on UK and US news programs comments like “it’s OK to do that in a communist country but not in Great Britain!”… or “it’s one thing to restrict movement in a small country, but it’s not practical in the U.S. of A!”…
It’s good to be proud and to shun authoritarianism, but if effective controls aren’t put in place, and the numbers grow as quickly as they did in China, Italy, South Korea, or Iran, and 20% of those infected require hospitalization, and your intensive care units are already at capacity, then it’s possible to see things degenerate quickly.  If you don’t have a national health service then those without insurance are going to be hit hard.
Such restrictions are unlikely to reduce the overall number of infections, but it will slow it down to the point that a country’s infrastructure can cope with cases.
Italy has pulled out all the plugs and has built emergency production lines for up to 500 new intensive care machines a month, which is pretty cool, and severe cases are being moved by military helicopter in bio pods from the north to the south in order to balance hospital capacity.
Bene and I were on holiday skiing with Cami and Allegra when the news came that Siemens was to close all our offices in Italy, and cancel all travel, and that all schools would also shut down.  So we decided that I would work remotely from the mountains with the kids, while Bene (who’s company has remained open) would go back to Genova. That lasted for 3 weeks until the government shut down all ski resorts this afternoon, so it’s back to Genova for us.  We can expect to be effectively housebound at least until April.
In the newly created red-zones (that include Milan, Venice and 16 million people), restrictions are severe (weddings and funerals are banned, and movements are checked by the army…), but throughout the country everything is on a war footing and everyone has accepted that it’s safety first, economic continuity second, and everything else is on hold.
I don’t think we’re the only country to have run out of hand sanitizer or surgical masks, however :
1. Washing your hands for 20 seconds with soap is apparently more effective than using antibacterial gel2. Masks don’t appear to reduce risk of infection.  They’re supposed to be used by sick people to avoid transmission, or medical staff in constant contact with patients.  Buying them as a healthy civilian only puts those in need at risk.3. If you live in a country with bidets then you can avoid panic buying toilet paper 😉
All shops / bars that remain open are operating a 1m distance rule on pain of fines and being shut down.  There is a limit to the number of people that can enter each establishment, and tables must be arranged to avoid the proximity of patrons.  This is a good rule to observe in general and so we’re avoiding public transport or really any situation where loads of people are jammed together.
Overall spirits are pretty high despite the restrictions and risks.  In absolute terms the proportion of people infected is tiny and risks remain objectively low as long as people take the restrictions seriously.
There is definitely concern amongst my many self employed friends that rent, taxes and bills still have to be paid despite the effect of the restrictions on income.  In many countries the governments have reduced interest rates, but that only makes borrowing cheaper.  Here they are talking about more direct stimulus such as tax cuts (although I’ll believe it when I see it).
So please don’t worry about us, we’re fine – despite what you read in the papers!  My only advice is that as viruses don’t respect national borders, this is likely to play out to some degree in the UK and US.  If and when you see cases increase, don’t panic.  Wash your hands, avoid crowded places, go for a run rather than the gym, stock the fridge with beer, work from home if you can, fist bump, don’t complain if they close the schools or football matches to the public, and hope that the measures that are put in place slow things down until temperatures increase.
On this final note, it does appear that the virus is highly temperature sensitive.  8 Celsius is the optimum temperature for transmission, and there is evidence that it can’t survive outside the body at all above 26C.  That’s no guarantee that it will peter out like seasonal flu come May, or that it won’t return in October like the Spanish flu did, but it’s likely to provide an important respite.