Do the right things that experts say: killing three (wrong) arguments heard in mainstreet

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  • J. Bughin

Dr Jacques Bughin, UN consultant, Solvay Business School ULB, Portulans Institute and G20Y, former Director McKinsey Global Institute, and senior partner McKinsey & Company.

Table of Contents:

  1. Introduction
  2. Argument 1: This is like a flu. Wrong.
  3. Argument 2: We have time to act. Wrong.
  4. Argument 3: A old timer disease. Wrong.

1. Introduction

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March 13

Europe is in the middle of the pandemic, and governments are now scaling measures to significantly limit social contacts. Here and there, measures of quarantines and restrictions are often not very welcome. Not only do they lead to socioeconomic disruptions, but also because they may hurt the democratic feeling of freedom and choic or simply because people believe that the crisis is limited. They are however clearly wrong, at this time of the outbreak, and given large uncertainty on how the virus behaves, the measures launched are necessary and of the right scale.

Here are the three arguments deconstructed by those still not bought, or not willing to comply with experts:

2. Argument 1: This is like a flu. Wrong.

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Typically, the seasonal flu has (a potential) to kill between 300,000 to up to 700,000 people every year, or roughly 0.01% of population worldwide. In some cases, a flu epidemic may become more lethal, even if this is a rare event. In the last 300 years, less than 10 cases prevail with excess mortality rates in the range of 0.03% to 0.1%, which would lead globally to 2 to 7 million fatalities a year.1 As an example, the Asian Flu (H2N2) in 1957 killed a proportion between 0.04% and 0.27% of the population. The largest one, perceived to be less than 1% chance probability by insurance companies, has been the 1918-1919 pandemic, or more than 0.5 to 0.7% of population. If scaled to all countries, and to today’s population, this may have led to a fatality close to 40 to 70 million people, across a cycle of 10 to 12 months.

We are at the average flu type for COVID-19, some argue. This is not right:

  • In the Hubei region where it all started, with about 60 million inhabitants, slightly more than 3,000 casualties have been reported at this time of writing. The concentration of cases lie in Wuhan, a city of 11 millions inhabitants, with about 2,500 deaths, or 0.02 percent of the city inhabitants, already above the seasonal flu. Furthermore, the numbers have been heavily driven by rolling out the types of actions pushed by the European government today, such as major social distancing. If this has made the reproduction rate cut by half, as per our recent articles cross triangulate, the real casualties could have been more like 10-20 times the current figure of deaths. Scaling this to the world, we are more in the 6 to 20 million deaths.

  • As more and more countries come in, the crude fatality rate seems to increase, going from 2% in China a few weeks back to up to 3.6% today (and already above 5% in China) , while the COVID-19 contamination speed seems to double every 3 days in Western Europe, twice the average rate of China (which was doubling every 6 to 7 days).

  • We do not have any vaccine for COVID-19, so it might be difficult to control, and worse, we may not know if people can or can’t be re-infected. Reinfection may cause new waves of outbreaks, as well as too vast release of social distancing.

  • Finally, multiple studies at WHO using recent Chinese data seem to suggest that up to 5% of close contacts of people contaminated by the COVID-19 were also tested positive. If one believes the 6 degrees of separation argument, everyone has 44 contacts, leading in total to 1.2 secondary contagion, or between 6 to 10 million fatalities depending on 2% or 3.6% current fatality rates. About 5% to 10% of second members in households tend to be affected by one contaminated member of same household. If average household size is 3.5, we have as well 5 to 8 million fatalities.

3. Argument 2: We have time to act. Wrong.

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There are still a lot of uncertainties regarding how the virus works; we should wait and gain time instead of going with full shutdown. This is not right:

  • Virus outbreaks are typically exponential in their first phase, but may continue to expand, especially if no viral medecine exists to limit contagion, and if no vaccines can be found and administered. Vaccines might be found in case of COVID-19, but it will take at least one semester to have it secured, and possibly same time to have its produced and distributed, at the time the exponential diffusion has exhausted a large part of the population at risk.

  • People understate the power of exponential or power law — by doubling every 3 days in Europe, this means that in one month (or 10 times intervals of three months), the scale of diffusion will be 1,000 of today, if we add again one month, this will be a factor of 1 million. Clearly, acting every day and week faster is a major plus.

  • The capacity of beds or emergency rooms at hospital is typically planned based on non-extreme events. As discussed here, figures ten times the flu means that hospital capacity may be binding faster than believed, and will create not only an operational flow problem, but also a critical choice problem against other patients.

4. Argument 3: An old timer disease. Wrong.

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There have been arguments that COVID-19 is especially weighting on the old generation. This is possibly one of the largest mistake we make. Here is why:

  • First, everyone is affected, but this is true that there is a power law happening where the fatality rate is roughly doubled by decade of life, that is the fatality rate is 0.2% at 30 to 39 years old bracket, double to 0.4% between 40-49, and like this up to 15% for the 80 years old more bracket, that is the fatality rate indeed doubles for 5 decades from 30 years old (or there is 2 at the power of 5, or 32 times more fatalities at 80 than at 30).

  • Nevertheless, everyone is affected as said above. Recent figures compiled from various sources suggest that less than 15% of the contaminated are above 70 years old in China, but 1/3 is between the bracket 30 to 50 years (and about 42% between 50 to 70 years). While representing 13% of the Chinese population, about 7.5% of the 20 to 29 years old tend to have been contaminated.2

  • An interesting comparison is also risk of COVID-19 versus the flu. We know that fatality rate is higher, 12 to 24 times more, for COVID-19 than for the normal flu, but how does that look per age bracket? The rate is only 4 to 7 times higher for old timers as many old timers still die from flu), but it goes up to 9 to 21 times for the 50’s and older, 6 to 16 still for the 20 to 49, and 14 to 25 for the people less than 20 years old. This is thus affecting relatively all classes, and the younger, more than it seems.

© Jacques Bughin. Written March 13. Comments more than welcome. All errors are mine. References listed as they are found in the text

  1. See Fan et al., 2018, Pandemic risk : how large are the epxected losses, Bulletin of the World Heath Organization

  2. See Riou et al., 2020, Adjusted age-specific case fatality ratio during the COVID-19 epidemic in Hubei, China, january and february 2020, MedrXiv

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