C-19: Taking stock + exploring ideas to overcome the pandemic

Updated: May 11, 2020

Introduction: an abridged and simplified chronology of events

The following narrative reflects on much of the insights that we have learned thus far through our coverage of the COVID-19 pandemic across our range of published articles since late March. We thought it best to begin this article by first setting some context to ensure the reader is on the same page

  • The first cases of the Coronavirus, or COVID-19 as it is now known, were detected in the city of Wuhan, in the Chinese province of Hubei; where over a period of just 2 months a total of 68,000 people were detected to have been infected by the virus and 3,200 people died. As it happened, news coverage highlighting the plight of the Chinese people in overcoming the outbreak had sent a clear signal to neighbouring regions in Asia to be vigilant. By late January, much of the population in Southeast and North Asia took strong notice of this news and began very early steps towards mitigation; for example wearing masks, avoiding public areas and large crowds - this fortunately led to a visible early decline in mobility across a range of countries, namely; Hong Kong, Singapore, Thailand and Malaysia

  • As the outbreak spread across the world, case detection rapidly fell appallingly short in almost every country; not all had assays prepared, and almost every country was riddled by shortage of test-kits. In fact, it is not misguided to say that not a single country really got on top of their testing game except for South Korea. And without proactive case detection that would allow authorities to chase the virus, many countries were practically fighting an unseen enemy; not knowing how fast the virus was spreading within their population

  • In late February through early March the situation worsened dramatically for Italy, deaths started climbing and locked-downs were announced in the epicentre of Lombardy, followed by Milan, Rome and the rest of the country by around March 9th; as the world stood witness to the unfolding spectacle. The notion of lock-downs was mooted to the rest of world leaders, which must have seemed like an impossible and preposterous thought when heard the first time

  • By the end of the second week of March, deaths in Italy had reached some 1,400, sending an even stronger signal to world leaders to take action. The UK and US namely were still deliberating their options; their leadership perhaps weighing hesitantly against the potential negative impact that lock-downs would have on their economies. While many others stood by awaiting the next move by their neighbour countries. Eventually by the third week of March nearly every country in the world, save for a few, had relented and caved in to the decision to implement some form lock-downs. Even those with a handful of detected cases had closed their borders, put in place a social distancing policy, and implemented some form of full or partial lock-down of their population

  • It bears noting that, up to mid-March, the World Health Organisation (WHO)'s primary advice via their press conferences and situation reports was still on increasing testing capacity, along with some general guidance on physical distancing and personal hygiene. One feels that they may have missed the real crux of the issue here, as we feel the organisation failed to identify with the contextual reality of the situation for some countries who were in fact in dire need of urgent action. A generous comment perhaps would be that they did not want to overstep their reach by being the ones calling for lock-downs. Whatever the reasons were, many lives could have been saved had they been more assertive in their advice

  • In spite of the locking down, it was already too late for some countries, namely a handful in Europe and the US. Stealthily, COVID-19 had entered and infected large swathes of their populations. By the beginning of the third week of March, the theoretical infection figures (computed by back calculating COVID-19 deaths at an assumed mortality rate) for the UK, US, Spain, France, Belgium, and Germany stood at some 120-, 200-, 500-, 240-, 40-, and 40-thousand respectively; while officially reported case detection figures stood at a range of at least 5-20 times less. For comparison, a second group of countries on the other side of the world had equivalent figures between 1,000 to 5,000. These were namely; Thailand, Indonesia, Malaysia, Philippines. Clearly the first group were at a significant disadvantage; one feels they should have acted sooner

  • The mitigation and lock-downs eventually worked to slow down and inhibit spread of the virus. But for countries where a critical mass of the infected already existed, the hefty momentum of community spread was inevitably going to keep going for some time. And it didn't help that, rather perversely, the stringency of lock-downs were not as effective at reducing movement and social interaction if compared to countries in the East. Civil liberties perhaps took priority, and leaders had to bake-in compromises in the rules they deployed; on the other hand, the compliant peoples of the East more readily accepted their instructions with obedience. Our analysis suggests that European nations in general have shown a notably slower taper and higher residual transmission compared to the majority of Asian territories. The most aggressive of all being the provinces of China, including Hubei

  • This brings us to where we are now. At the start of the third week of April; with US recorded deaths stood at 34,000; Italy 22,000; Spain 19,000; France 18,000 and the UK 14,000. There is much cheer among certain political leaders as they claim victory in 'flattening the curve', as visible tapers begin emerging in case detections and deaths. This perhaps sits in stark contrast against the thousands of families who grieve and mourn the loss of their loved ones to the virus. It is disheartening to think about how so much loss could have been averted, but was not

  • Lock-downs are now being slowly lifted in some countries, in order to breathe some much needed life into their economies. Austria and Spain started earlier this week (the week of 13th April), and parts of Italy have begun the process too. Economies the world over have already suffered significantly from barely a month of shutting down, with most markets down at least 20-30% from baseline levels, and GDP estimates for the quarter already down an equal amount for most countries. Job losses have already been tremendous, although not fully tallied up; particularly in the airline, hospitality and retail/F&B sectors. Future economic outlook is bleak with strong signs of recession, as demand today has been obliterated and massive uncertainty looms on future demand, output and global trade

  • As we inch closer to mid-year, economically speaking China is expected to pull ahead of the rest having gone through the first COVID-19 wave before anyone else. Much of the nation's population is already returning back to work while every other country's is still practically marooned in their homes. China's penchant for draconian control likely gives the nation an advantage to find a workable balance between safeguarding lives and livelihoods at the same time; achieved perhaps by putting civil liberties to one side. Meanwhile, some hard-hit countries will take time to heal and recover from the massive loss of lives; while the rest breathe a sigh of relief in having averted one crisis (of deaths), but lay paralysed by the question posed by the next one - how to open their economies for business without costing too many lives. Given what we know, none are assuredly safe at this point from an impending economic disaster of monumental magnitude that will possibly define our lifetimes

What we know about the virus, thus far (as at 17 April)

  • COVID-19 is extremely transmissible. Carriers of the virus can be pre-symptomatic and asymptomatic (made worse by long incubation), creating many invisible vectors for transmission

  • The virus SARS-CoV-2 is hardy and able to survive on surfaces up to 3 days. It can be airborne if aerosolised (particle size ~100nm), however more likely to fall 1-2 meters from the infected person

  • Viral shedding occurs up 5 days before symptom onset, and up to 8 days after symptoms resolve, during which transmission can occur

  • Vaccines in development although expected at least 12-18 months away; meanwhile multiple treatment options that have emerged but none yet definitive

What we know about the pandemic, thus far (as at 17 April)

  • COVID-19 has been detected in some 185 countries to date; with some 2.2 million detected cases and 145,000+ deaths

  • Infection and death doubling time ranging from 2 to ~10 days from country to country; tacit agreement by most authorities that there is major shortfall in case detection measurement given test-kit shortages

  • Spread can and has been inhibited through blunt social distancing measures; e.g. closed borders, banning crowds, closing down retail, public transport and other such measures - resulting impact on economies is devastating

  • No clear playbook at present for a way forward that objectively and fairly balances interest to save lives, with broader societal interests; different countries are trying markedly different approaches

Now for the ideas... (these are outlined specifically for Malaysia). We will continue to add, subtract and refine this list from time to time.

General theme I: overcoming the spread

  • Faster, more comprehensive, and strategically deployed testing and medical care. Strategic here means, for example, smart tactics such as randomised testing to get representative composition of the population with possible pre-symptomatic infection and to help pre-emptively identify high risk clusters. Likewise, counter-intuitively prioritise testing of the young to find asymptomatic carriers, while on the other hand accelerating immediate care for the old or those with cross-morbidities showing symptoms regardless of whether or not they have been tested

  • Crowd control strategies, SOPs and targeted enforcement, particularly for malls/retail centres, public locations, and public transportation (both hubs and vehicles) and wherever else crowds may congregate. Guidelines, resources and tools that can help operators moderate traffic to central locations, e.g. procedures to set up laneways to control footfall/traffic, informational guides for visitors, procedures for cleaning, alerts for on new case detections

  • Ensure adequate hospital and medical services capacity by understanding the math behind the virus' spread, and track a robust view of its trajectory at all times rather than constantly playing catching up. Beyond the grief and distress of death, this is the only hard threshold that ultimately needs checking for. As deaths are reasonably predictable given an infection spread, statistics gleaned from ICU admissions and ventilator usage so far should provide an adequate view of where this threshold is

  • Authorities should announce (and solidly stand by) a few general rules that outline bare minimum requirements for personal hygiene and conduct in public spaces, e.g. compulsory mask wearing, prohibiting physical contact, rules about maintaining distances, guidelines for touching surfaces (including food items in supermarkets); likewise, granting mandate to persons/authorities in charge to mete out punishments for non-adherence

  • Mobile phone app that provides alerts on new cases and latest developments on COVID-19, while doubling as a location logger to help with contact tracing should there be outbreaks. An anonymous online register for on-going COVID-19 active and suspected cases could be added to geofence them against contact with other persons. Several countries have done this, namely South Korea and Singapore

General theme II: living with the virus

  • Solve directly for the social well-being of the population. Once some ground rules are established, allow people to leave their homes, and encourage families to go for outings to locations where crowds are relatively dispersed, e.g. parks and suburban streets. Define recreational activities that are permissible and encourage these; e.g. walks, individual runs, walking with the family around the neighbourhood. It is time to let people roam the streets

  • Enable the retail economy without unduly harming every person. Begin with measures such as allowing retail locations below a certain square footage to operate, and encourage other types of small retail, e.g. road-side stalls and the like. There is little risk as long as crowds remain small, and community spread is not likely i.e. not in red zones. As such, consider creating a rule limiting patrons in any one shop to less than 25 persons, placed under the responsibility of the store manager to ensure adherence

  • A major overhaul and renovation of public and private shared spaces where the touching of surfaces may be required, by replacing door handles, buttons, rails, and so on. In the meantime, mandate the provision of hand sanitizers and wipes for the public to use in order to avoid touching those surfaces. Similarly, authorities should develop and publicise guidelines that need to be complied to by owners and operators of such establishments

  • Citizen reporting could also feature here to monitor for breaches, and thus lighten the load on authorities. The same app that provides updates on COVID-19 news could double as a means to submit such reports to the authorities, along with pictures and locations of the offending item or person

Theme III: (Preliminary) Big Ideas

  • Temporarily nationalise food-delivery services for a 6 month period, or create a nationwide paid volunteer platform that achieves the same. As every moving person is a vector, we would need a way to (1) efficiently minimise mobility at scale, and (2) ensure safety of delivered items. And given the state of the economy, (3) create more jobs for those laid off. This idea enables us to deliver on all three objectives at once, while keeping more people off the street. If profits are zero-rised, subsidy from the government can flow through as subsidised delivery charges and land in peoples pockets under the guise of 'employment'

  • An on and off rolling lock-down plan that deliberately pauses the economy at specific junctures. This allows us to moderate the spread of the virus from time to time, in order to keep it within manageable and acceptable levels. We estimate that lock-downs could last as short as 7 days, while open periods could be as long as 1.5-2 months. In doing so, government must be able to develop and stand by a clear policy of their willingness to trade off between lives and livelihoods

  • Create a global sharing network and supply chain for rotating use of ventilator equipment. It seems different countries and regions have been and will continue to be facing different levels of intensity of COVID-19 spread at different times. Rather than duplicating resources across multiple countries, a network of shared equipment could help plug capacity gaps over short times as well as provide the necessary confidence to appropriately plan

  • Double down on trade partnerships with countries who seem to be more insulated. Unsurprisingly it has been the largest economies that have been hardest hit by the first wave of the virus. Many countries however still remain relatively unscathed due to early lock-downs. These could be good trading partners to bring to the negotiating table to commence and develop a short or mid term trade arrangements with, so that each can help buoy their economies over the next 12-18 months at least

  • Do practically everything and anything in support of driving up broadband and internet access. During times like this, the internet is practically a public utility. Failing to close the equitability gap for those who lack the proper means of access would mean a sizeable chunk of an entire generation could be left behind. Crucially, school kids would be hard hit if they can't properly learn while at home; and young adults would not be able to fully utilise the time available. A collection and donation drive could reallocate larger screen devices such as laptops and tablets between the haves and the have nots; a decently sized tax break may possibly be all that is needed to create an incentive to kick off such a program

  • A nationwide plan of action to protect the older generation and the vulnerable (those with chronic disease). Too much of what has been implemented so far, by way of blanket lock-downs does not discriminate to this group of people; while in reality they are the ones at far greater risk to the virus. In Wuhan and parts of Turkey and Italy, a network of volunteers has been created to fulfil all the shopping and delivery needs of these groups. Turkey is currently experimenting with a rolling curfew of 48 hours every weekend, and a stay at home order imposed on those aged 65 and above, as well as 20 and below. The latter presumably is in recognition of their role as asymptomatic carriers of the virus

To be continued


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