Preamble: as these microscopic bundles of non-alive Coronavirus DNA completely change our way of living – possibly indefinitely – a few of my readers have been asking for a post about it. This is that post.
There is plenty of Coronavirus content out there in the world. There is fake news and semi-fake news; semi-real news and this-feels-unreal news. There are personal horror stories and conspiracy theories.
So what I am going to try to do in this post is pull together three of the bigger picture story-lines (or questions) that I’ve been thinking about over the last few weeks:
- Why is Coronavirus hitting high income countries so badly?
- What lessons from Wuhan have we not learned? (Alternative title: “Lockdowns need enforcement”)
- What will life be like in a post-Corona world?
QUESTION 1: WHY IS CORONAVIRUS HITTING HIGH INCOME COUNTRIES SO BADLY?
Let’s start with some maps.
Here is a scaled map of Coronavirus cases as at 5 April 2020:
Here is a scaled map of Gross National Income:
Here is a scaled map of Population:
On the face of it, you might be forgiven for thinking that the Coronavirus is infecting income rather than people.
Now we can certainly find some explanations for why a map of Coronavirus cases is almost a mirror image of Gross National Income (rather than Population). But it’s strange that we have to explain it, right? How is this pandemic not racing along population lines? Instead, we are in the middle of a global pandemic that is more closely aligned with income than number of people.
Here are some of the explanations that have been offered to the world at large:
- The weather (the virus may spread faster in cold, dry climates than in hot, humid climates – and the Southern Hemisphere is still in summer – and it’s a coincidence that higher income countries are mostly in the Northern Hemisphere)
- The BCG vaccine (countries with compulsory TB vaccines seem to have less infections than those that have already eradicated TB, and now only have optional TB vaccination programs)
- 5G (ah, the conspiracy theories)
- Global travel patterns (ie. the virus has not reached certain areas yet)
- Undertesting in low income countries (as though high income countries haven’t been undertesting as well)
- Population demographics (where higher income countries have older populations that are more vulnerable).
Of those options, if you have a look at a map of air travel routes, global travel patterns seem the obvious candidate:
Which is certainly the conclusion that the WHO is drawing. Coronavirus is airborne (in that it’s travelling on planes), and once you follow the flight paths, this leads you to the current map of cases.
And the implication is that we’re still in ‘Stage 1’ of the spread: once local transmission begins, the “global income” distribution map of Coronavirus will eventually turn into the “global population” distribution map of Coronavirus.
Therefore, Africa, India and Latin America should shut themselves down immediately, and count their lucky stars that they get less air travel than Europe.
So is this just how it starts?
Well, I’m no epidemiologist, so I should not be answering this question. But there is some general speculation on the interwebs that says the current allocation of Coronavirus cases is still disproportionate. As in: African countries should have more cases than they do already.
I’ll give an example here:
- Iran was one of the big hubs of Coronavirus cases after China.
- In terms of travel:
- Tehran’s airport gets around 7 million international passengers through its doors every year.
- OR Tambo International in Johannesburg has around 9 million international passengers each year.
- But South Africa has far fewer cases.
Perhaps that is just a data outlier – because those are to be expected.
But it’s not the only outlier. South Africa went into lockdown on the expectation that there would be over 10,000 cases by earlier this week (note: these were infections that should have already taken place before the lockdown was implemented). The lockdown was meant to prevent those 10,000 cases from moving around and causing the caseload to balloon in two weeks’ time.
But those cases have not materialised – and the lack of them is currently a mystery.
Is it just under-testing?
This is the big fear, right? That all the cases exist – but we’re not picking up on them because we’ve restricted tests, or the tests are not working, or <other reasons>.
But in most of the worst-affected countries, the first indicator of the severity of the localised spread of Covid-19 has been the medical fraternity – not the number of tests being done. Widespread testing is a secondary response, once governments are compelled to act.
The main examples of this:
- When the Chinese authorities were still in denial, it was the heroic doctors of Wuhan who were sharing the full picture on social media.
- While the Italian authorities were still trying to figure out how to approach the crisis, it was the health workers of Bergamo and Lombardy who were having their whatsapp conversations shared across the world.
- In New York, while President Trump was still accusing reporters of being nasty, doctors and nurses were writing exposés in newspapers about the true nature of the disease.
But strangely, in South Africa and Zimbabwe (at least), these medical horror stories are not circulating.
Instead, in South Africa, the medical community are pleasantly surprised by the quietness of Emergency Rooms on the weekends, now that alcohol sales have been banned.
And in Zimbabwe, the main stories are not about mounting case-loads. They’re about the general inadequacy of the medical facilities that are available – and the inappropriate testing protocols – but not (yet?) about how the hospitals are being overrun with cases.
And to be clear, the press and the main opposition parties in South Africa and Zimbabwe are desperate to find these stories. This is not a reporting issue. If there was a whisper of them, you can be sure they would be spreading like wildfire across Twitter.
At the very least – the current situation is surprising.
Perhaps we need to reconsider that Income connection…
By the end of this, I think we might well find that the spread of Coronavirus really was linked to a country’s overall GDP, if only because high income countries have widely-used public transit systems.
It’s a personal observation: but I would never drive a car in a European capital city. I’d take trains everywhere.
But here in South Africa, I use a car to move around. And when I travel to other African countries for work, I hire them.
It makes me think of this picture (which is often used to promote the green-ness of public transport):
Yes, the public transit bus on the right is more efficient.
But in a post-Corona world, that picture on the left is very effective social distancing.
I realise that I haven’t addressed the risk of people who travel on commuter taxis – but that is because my starting point is global travellers. Covid-19 did not depart China on a boat, or by foot, or in a taxi. It spread first by aeroplane. The real assumption I’m making is that, for the most part, the business people and holidaymakers that travel to and from low income countries are not going to be taking commuter taxis to work. And so they’re not passing on the infection as quickly as they would if they were taking a subway train into work every day.
But even talking about commuter taxis, these are probably better for ‘social distancing’ than metro systems. Commuter buses act like shuttles, collecting a group of people from one point, and then dropping off at various points along the way. This mostly limits exposure to the people in the bus at the start. Once rush hour is over, the vehicles are parked (and get cleaned – if you recall how scandalised South Africans were by the taxi drivers washing their vehicles during the Cape Town water crisis). Metro trains, on the other hand, run all day – with people getting on and off at every stop along the route – turning them into indefinite petri dishes*.
*that’s my inner-germaphobe speaking
So I do wonder if the ironic reason that lower-income countries are doing better than expected is because their transportation systems are relatively inefficient. Meaning that those most likely to be infectious are driving themselves around, rather than getting onto buses and trains?
It would be no more ironic than the fact that the worst-hit countries are the high income ones which were already self-isolating from lower income countries in order to protect their economic status.
The Universe, it seems, has balanced that out.
High Income Countries: “We’re tired of letting people in. We want to be left alone!“
The Universe: “Hold my Corona…”
But I do hope that the explanation turns out to be involve some kind of high-income correlation. Because then it means that the outlook for the less affected countries is better than expected.
But there is clearly something else going on as well
Spain, Italy and Germany all reported their cases at roughly the same time (late January). Somehow:
- Italy and Spain have mortality rates (on reported cases) sitting at somewhere between 10% and 12%
- Germany has a mortality rate on reported cases sitting at around 2.21%
Look at this set of data from April 9 from Statista, which is sorted by the countries with the most confirmed cases:
- The first country to report a case of Coronavirus outside of China was Thailand.
- Next, the USA, Nepal, France, Australia, Malaysia, Singapore, South Korea, Vietnam and Taiwan confirmed their first cases at roughly the same time (around January 19th).
- A week later, the first cases were reported in India, the Philippines, Russia, Spain, Sweden, the UK, Canada, Germany, Japan, and the UAE.
- Italy only reported its first confirmed case at the end of January.
- But somehow, Nepal, Malaysia, India, Vietnam and Thailand aren’t even on this list of countries with the most Covid-19 infections.
- As I write this, Nepal has had nine cases. Nine.
- And the mortality rates are all over the place (like really all over the place). Perhaps there are good medical reasons for it, but if you gave me this data with no context – I’d be really surprised to hear that we’re talking about the same untreatable, highly-infectious disease, for the worst hit countries, all infected within a very similar timeframe.
There is no question that some of this variance in mortality rates will be the result of different testing regimes, population demographics, speed of response by authorities, etc.
But there’s a lot of explaining that needs to to be done because the data is so messy.
And the WHO call for ‘testing, testing, testing’ clearly indicates that they don’t know what story to tell yet either.
QUESTION 2: WHAT LESSONS FROM WUHAN HAVE WE NOT LEARNED?
Back in January, where Coronavirus was still mainly a Chinese problem, there were two things that I was particularly amazed by:
- How many hospitals were springing up overnight in China; and
- The video clips of Wuhan residents having the doors to their apartments welded shut.
Two months on, many countries are now building those ‘overnight’ hospitals, and a significant portion of the world is in lockdown.
But it seems to me that we haven’t really interrogated why those apartment doors were being welded shut.
The probable answer is that lockdowns are incredibly difficult to enforce.
Oh, people might try really hard for a few days. And do some public-shaming. But then people start venturing out ‘just quickly’.
Someone will decide to drop past a friend on their way to buy something essential. Children will sneak out to see their friends. A few people will decide that they can probably risk a walkabout if no one is around, because honestly, where is the risk if they don’t interact with anyone? A hairdresser might start offering haircuts from their home – because they’re desperate for money, even if haircuts are ‘non-essential’. People will start to trade informally in products that you can’t get in shops (in South Africa’s case, it’s the thriving black market in alcohol and cigarettes).
Worse still, this particular trend of human behaviour is quite inflexible:
- the more effective the lockdown is, the less reasonable the lockdown will seem. After all, if the virus isn’t spreading that fast, why not live a little?
- the less effective the lockdown is, the less reasonable the lockdown will ALSO seem. After all, if I’m already going to catch it, why not live a little before it gets me?
So within weeks (if not days), the authorities are faced with a conundrum:
- Either they double-down on the authoritarianism – ban more things, call in the army, arrest everyone, prosecute, fine, imprison, weld people into their apartment blocks if you have to. Or:
- They have to relax the lockdown and try to beef up the other measures being taken to control the pandemic.
Lockdowns have really short shelf-lives
Temporarily, you can hype up the fear factor to keep people focused on what might happen if the lockdown were not in place. But that fear degrades quickly over time, because hypothetical-scenarios are no match for the reality of life-under-lockdown.
So unless you are ready to North-Korea your citizens, you have a race against time. Lockdowns take away both the reasons for living (through home confinement) and the means of living (through banning people from working). But this puts us into survival mode, and our more base instincts come into play.
The middle-road is a short-but-strict lockdown, followed by a lockdown-lite, where various rules and restrictions are gradually lifted. And governments need to treat the lockdown as a short-term window to up-scale healthcare facilities, and to get ahead of the virus with widespread testing.
Which is what South Africa appears to be doing – so that is good news.
QUESTION 3: WHAT WILL LIFE BE LIKE IN A POST-CORONA WORLD?
The other piece of good news is that our evolutionary advantage as a species is our ability to adapt to change. If we weren’t able to adapt to change, we’d have died out in winter instead of putting on a jacket. Instead, we somehow manage to thrive in all manner of hostile environments.
But our adaptation ability is more than just the skills of sourcing tools and constructing shelters. It is also psychological, in that we ‘normalise’ most experiences quite quickly. People sometimes call it the ‘resilience of the human spirit’ – but that is a romantic description for a fairly universal aspect of human nature.
Resilience or normalisation?
I guess I am conscious of the fact that joy is a short-lived experience. There are plenty of studies that show people are ecstatically happy when they win the lottery (or get a new job/find a new partner/etc), but then their happiness levels revert back to normal within weeks. And I don’t really think that this is because everyone makes bad choices afterward to reduce their happiness levels – this is just your experiential baseline recalibrating itself to your new environment.
It means that people who live in a house-share can be as happy as people who live in an apartment, who can be as happy as people that live in a house with a garden, who can be as happy as people that live in a palace.
Of course, recalibrating to greater ‘abundance’ is a pleasant experience – you just get used to having nicer things, and then you stop noticing them. Perhaps this is why most spiritual paths encourage thanksgiving as a discipline, which constantly brings the good things into focus, resulting in a permanent baseline lift.
The recalibration process for greater scarcity is more difficult, because it involves loss. But with time, your conscious mind get used to having ‘less’ (or doing less, or not seeing a departed loved one), and you stop noticing the loss.
For some people, the recalibration process seems to get stuck, and the loss is never something that normalises. My guess is that this is what happens when you fall into ‘the-opposite-of-thanksgiving’ as a habit, constantly bringing the missing things into focus.
But generally speaking, it seems to me that if you’re prepared to focus on daily tasks, and get involved in Zoom meetings, and all the other things that are happening, then the ‘resilience of your spirit’ will mean that you won’t even notice the difference in a post-Corona world.
And in the same way that people deal with death and lost livelihoods, or dealt with Spanish flu, civil conflicts, repressive dictators and World Wars, life will go back to feeling normal.
Maybe our pre-Corona selves wouldn’t see it that way. But real life has a way of overshadowing hypothetical-what-might-have-been-scenarios.
Perhaps that is more terrifying than the change itself – knowing that a universal reduction in wealth, or health, or lifestyle, is something that will feel totally normal. And that we’re evolutionarily-designed to experience it that way.
But I find it strangely comforting.