Yes; this is bad

We have entered the pandemic phase which will likely be followed by seasonal recurrence of the disease unless and until we have a vaccine (which may not be available until 2022).

This is not a normal flu

Not even in the best case

In pandemics, it can take years to determine the infection fatality rate. This is normal. Most experts now estimate the range to be between .5% and 1%. However, keep in mind that even 1% would be ten fold higher than a typical seasonal influenza year. Moreover, mortality is not the full picture. Coronavirus can affect multiple organs. Even for those who recover, there could be longer-term implications that are not yet well understood.

Keep the main thing the main thing


A lot of ink has been spilled on speculation about the “true” rate; however we are still in the early phase of the pandemic and it could take years to precisely determine the rate. Evidence to date is more than adequate evidence to warrant continued vigilance. Far and away, the most important thing to do is to find sustainable interventions that flatten the curve of the epidemic so that our health systems can cope and to give time for the scientists to research vaccines and treatments, and to ensure that the pandemic proceeds slowly so that we can avoid surpassing the number of infections required to get past the peak (see explanation here).

It is (still) here

Assume that the virus is still in your city / town / workplace / church / etc. Your local testing capacity may vary, so it may not be possible to detect an outbreak in time to curtail it. However, not all venues are equally risky. During the strictest parts of the lockdown, infections tend to be localized to high-risk environments such as care homes, prisons, and meat-packing facilities. As things open up, expect more infections to be in places where there are larger numers of people congregating indoors at one time, especially when there is also generational mixing, and an emphasis on close contact.

Of those who get infected, some people (aka ‘superspreaders’) readily transmit virus but others do not. The specific reasons for this are not yet well understood. If you happen to be in the presence of any such person, even an otherwise low-risk encounter might result in your getting infected.

No country is fully prepared, including the United States

Although the WHO’s JEE report from 2016 rates the US highly in preparedness for a public health emergency, a Johns Hopkins University study noted that “there appear to be significant gaps in pandemic influenza and other infectious disease outbreak planning among the hospitals”. According to the IHME’s projections from April 1st, “the US is predicted to need 262,092 total hospital beds (39,727 for ICU), and 31,782 ventilators to support COVD-19 patients. This demand on hospital resources could lead to a nationwide shortage of 87,674 total hospital beds and 19,863 ICU beds given current COVID-19 trajectories.” We simply don’t have the equipment, training, or messaging in place and we need to ramp up fast. No one does. That is why your choices today matter so much.

Certain policies are more effective for pandemic control

  • Universal healthcare coverage.
  • Universal guaranteed paid sick leave.
  • Paid sick leave duration of 4-6 weeks.
  • Guaranteed paid family leave (to care for sick members).
  • Coordinated financial or operational support for people who should self-quarantine.
  • Policies that incentivize insurers to provide rather than withhold care.
  • Policies that separate health care from employment. (Otherwise when people get sick they are also vulnerable to bankruptcy, or when unemployed lose healthcare. In a pandemic year both are devastating.)
  • Clear, truthful, and transparent public messaging at all levels about the seriousness of the threat and what ordinary people can do to help.

The fact that such policies have not previously existed in some countries complicates the behaviors required to #flattenthecurve.

There is a nice summary here of the public health measures that are also vital to an effective pandemic response

There is hope. You’re it. That’s the work

You can help by following as much as possible of the following guidance. The earlier the precautions are taken, the more precautions are taken, the more lives are saved. It is that simple. Expect yesterday’s under responders to be today’s over-responders. Resist the urge to ricochet or give up hope. The key is to stay calm and do the steady work of infection control and urge others to follow suit.

From a dear friend in Beijing “Use wisdom but don’t allow the pandemic to become an empty excuse for not loving your fellow humans. Choose generosity instead of hoarding. And on those really hard days (or maybe after watching too many news reports) turn up the music and dance! Celebrate the goodness! It’s there, it will remain and you can be a catalyst for it!”

Here’s how.