The Best-Case Outcome for the Coronavirus, and the Worst
Will we endure 2.2 million deaths? Or will we manage to turn things around?
Here’s the grimmest version of life a year from now: More than two million Americans have died from the new coronavirus, almost all mourned without funerals. Countless others have died because hospitals are too overwhelmed to deal adequately with heart attacks, asthma and diabetic crises. The economy has cratered into a depression, for fiscal and monetary policy are ineffective when people fear going out, businesses are closed and tens of millions of people are unemployed. A vaccine still seems far off, immunity among those who have recovered proves fleeting and the coronavirus has joined the seasonal flu as a recurring peril.
Yet here’s an alternative scenario for March 2021: Life largely returned to normal by the late summer of 2020, and the economy has rebounded strongly. The United States used a sharp, short shock in the spring of 2020 to break the cycle of transmission; warm weather then reduced new infections and provided a summer respite for the Northern Hemisphere. By the second wave in the fall, mutations had attenuated the coronavirus, many people were immune and drugs were shown effective in treating it and even in reducing infection. Thousands of Americans died, mostly octogenarians and nonagenarians and some with respiratory conditions, but by February 2021, vaccinations were introduced worldwide and the virus was conquered.
The Best Case
I’ve been speaking to epidemiologists about their best- and worst-case scenarios to gauge what may lie ahead and see how we can tilt the balance. Let me start with the best case, since we could all use a dose of hope — which may even be therapeutic — before presenting a bleaker prognosis.
“The best case is that the virus mutates and actually dies out,” said Dr. Larry Brilliant, an epidemiologist who as a young doctor was part of the fight to eradicate smallpox. Brilliant was a consultant for the movie “Contagion,” in which a virus evolved to become more deadly, but that’s the exception. “Only in movies do viruses seem to become worse,” he explained.
Two other lethal coronaviruses, SARS and MERS, both petered out, and that is possible here. “My hope is that Covid-19 will not survive,” said Dr. Charles G. Prober, a professor at Stanford Medical School.
Several countries have shown that decisive action can turn the tide on Covid-19, at least for a time. China, astonishingly, on Thursday reported not a single new case of domestic transmission. While China is still vulnerable to a second wave, it has apparently shown that the virus can be squelched.
The West isn’t going to copy the coercive tactics of China, but Singapore, Taiwan, South Korea and Hong Kong have also demonstrated that, at least temporarily, the virus can be controlled.
Singapore and the other successful Asian models responded with the standard epidemiological tool kit: vigilance and rapid response, testing, isolating the sick, tracing contacts, quarantining those exposed, ensuring social distancing and providing reliable information. They did not shut down their entire countries, and Singapore managed to keep its schools open throughout.
“Singapore is a best-case scenario,” said Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention. He said that there was some possibility that with social distancing and limits on gatherings, the United States could knock down the numbers of infections and begin to adopt Singapore-style strategies to reduce new infections.
“The most important lesson is that the virus can be contained if people are responsible and adhere to certain simple principles,” said Dr. Christopher Willis, a physician in Singapore. “Stay calm. For most people it’s like the common cold.”
Dr. Tom Inglesby, an expert on pandemics at the Johns Hopkins Bloomberg School of Public Health, said, “The fact that Singapore, Hong Kong, Taiwan, South Korea and China — and to some extent Japan — have all flattened their curves despite having the initial onslaught of cases should give us some hope that we can sort out what they’re doing well and emulate it.”
One encouraging sign is that in Washington State, which had an early outbreak, the number of positive tests appears stable.
Image
Lines on the ground help customers stay six feet apart at Dick’s Drive-In in Seattle.Credit...Brian Snyder/Reuters
The weather may also help us. Some respiratory viruses decline in summer from a combination of higher temperatures and people not being huddled together, so it is possible that Northern Hemisphere nations will enjoy a summer break before a second wave in the fall. That’s what happened during the 1918 Spanish flu pandemic: It hit in the spring of 1918, went away but returned worse than ever in the fall.
Of the four coronaviruses that cause the common cold, two diminish in warm weather, while two are more variable. SARS and MERS did not have clear seasonal variations, and even seasonal flu is transmitted in the summer, although less than in winter. So while experts hope that hot weather will shortly bring a reprieve from the coronavirus — the flu is already on the retreat — there’s no solid evidence.
One reason for measured optimism is the prospect that antiviral medicines will beat the coronavirus; some are already in clinical trials. Scientists have hopes for remdesivir, originally developed for Ebola; chloroquine, an old anti-malaria drug; and some anti-H.I.V. and immune-boosting drugs. Many other drugs are also lined up for trials.
Even without proven treatment, the coronavirus may be less lethal than was originally feared, so long as health care systems are not overwhelmed. In South Korea and in China outside Hubei Province, about 0.8 percent of those known to be infected died, and the rate was 0.6 percent on a cruise ship.
That’s still roughly six times the rate of seasonal flu, about 0.1 percent, but Dr. John Ioannidis of Stanford University argues that the fatality rate may end up even lower. He warns that we are engaging in hugely disruptive interventions without firm evidence of the threat that the virus poses. Singapore has had more than 200 confirmed cases of the virus and not a single death.
About four out of five people known to have had the virus had only mild symptoms, and even among those older than 90 in Italy, 78 percent survived. Two-thirds of those who died in Italy had pre-existing medical conditions and were also elderly; Dr. David L. Katz, the former director of the Prevention Research Center at Yale University, notes that many might have died soon of other causes even if the coronavirus had not struck.
That said, a new C.D.C. study finds that of coronavirus cases in the United States requiring admission to the intensive care unit, nearly half involved patients under age 65; there is also concern about lasting lung damage among survivors.
Putting it all together, Dr. Tara C. Smith, an epidemiologist at Kent State University, said: “I’m not pessimistic. I think this can work.” She thinks it will take eight weeks of social distancing to have a chance to slow the virus, and success will depend on people changing behaviors and on hospitals not being overrun. “If warm weather helps, if we can get these drugs, if we can get companies to produce more ventilators, we have a window to tamp this down,” Smith said.
So that’s the best case, and it’s plausible. If you want to feel upbeat, stop reading here.
The Worst Case
Now we get to the other end of the range of possibilities. Dr. Neil M. Ferguson, a British epidemiologist who is regarded as one of the best disease modelers in the world, produced a sophisticated model with a worst case of 2.2 million deaths in the United States.
I asked Ferguson for his best case. “About 1.1 million deaths,” he said.
When that’s a best-case scenario, it’s difficult to feel optimistic.
Ferguson questions whether South Korea and other countries can sustain their success for 18 months until a vaccine is ready, even as new cases are constantly being imported. Indeed, a burst of new cases has been reported in recent days in Singapore, Hong Kong and Taiwan.
As for the hope that the United States can emulate Singapore or South Korea, that may be a leap.
America and South Korea reported their first Covid-19 cases on the same day, but South Korea took the epidemic seriously, promptly created an effective test, used it widely and has seen cases go down more than 90 percent from the peak. In contrast, the United States badly bungled testing, and President Trump repeatedly dismissed the coronavirus, saying it was “totally under control” and “will disappear,” and insisting he wasn’t “concerned at all.” The United States has still done only a bit more than 10 percent as many tests per capita as Canada, Austria and Denmark.
Police officers in Milan performing checks at Piazza Duomo on Wednesday.Credit...Marco Ottico/EPA, via Shutterstock
By some counts, the United States is just eight days behind Italy on a similar trajectory, and it’s difficult to see how America can pirouette from the path of Italy to that of South Korea. The United States may already have 100,000 infected citizens — nobody knows. That’s too many to trace. Indeed, one can argue that the U.S. is not only on the same path as Italy but is also less prepared, for America has fewer doctors and hospital beds per capita than Italy does — and a shorter life expectancy even in the best of times.
Mitre, a nonprofit that does work on health care, calculated that coronavirus cases are doubling more quickly in the United States than in any other country it examined, including Italy and Iran.
The nightmare is a surge that overwhelms the hospital system. A Times colleague, Stuart A. Thompson, and I worked with two epidemiologists to develop an interactive model of the virus that suggested that up to 366,000 I.C.U. beds might be needed in the United States for coronavirus patients at one time, more than 10 times the number available. A Harvard study reached a similar conclusion.
This is an interval of quiet when the United States should be urgently ramping up investment in vaccines and therapies, addressing the severe shortages of medical supplies and equipment, and giving retired physicians and military medics legal authority to practice in a crisis. During World War II, the Ford Motor Company turned out one B-24 bomber every 63 minutes; today, we should be rushing out ventilators and face masks, but there’s nothing like the same sense of urgency.
Peter Hotez, an eminent vaccine scientist at Baylor College of Medicine, told me that he and his colleagues have a candidate vaccine for the coronavirus but still haven’t been able to line up sufficient funding for clinical trials.
A store in New York City indicating protective gear in supply on Wednesday.Credit...Bill Tompkins/Getty Images
Already there are stunning unmet needs for personal protective equipment. After initial missteps in Wuhan, where the coronavirus was first discovered, China adopted protocols for protective gear that are more rigorous than those in the United States, involving N95 masks and face shields, double gowns, gloves and shoe covers, plus special areas to remove protective clothing — and all this worked. Not one of the 42,000 health workers sent to Wuhan is known to have become infected with the coronavirus. The United States isn’t protecting health workers with the same determination; it seems to be betraying them.
Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, said he had received a phone call from a major Florida hospital that had run out of masks. A doctor wanted to know: Could cloth be used to construct makeshift masks?
The answer: not very well, but it’s better than nothing. The need is so acute that the C.D.C. has posted official guidance advising that doctors and nurses “might use homemade masks (e.g., bandanna, scarf) for care of patients with Covid-19 as a last resort.”
“If people think that a hospital crisis is coming, it’s important to know that it’s already here,” Redlener said. “It’s affecting front-line health workers, who are probably the highest risk group. These are like combat troops on the front lines of a war.”
In Italy, 8.3 percent of coronavirus cases involve health workers. A doctor in the Seattle area who is forced to reuse N95 masks told me that she and her colleagues fear that the lack of supplies will be deadly.
“We are all making dying contingency plans at this point just in case,” she said. “Wills, backup people to take care of kids, recording bedtime stories.”
In the worst-case scenario, will social services collapse in some areas? Will order fray? Gun sales are increasing, because some people expect chaos and crime.
The United States is in a weaker position than some other countries to confront the virus because it is the only advanced country that doesn’t have universal health coverage, and the only one that does not guarantee paid sick leave. With chronic diseases, the burden of these gaps is felt primarily by the poor; with infectious diseases, the burden will be shared by all Americans.
NICHOLAS KRISTOF’S NEWSLETTER
Get a behind-the-scenes look at Nick’s gritty journalism as he travels around the United States and the world. Sign up here.
It’s Up to Us
So where is the United States headed? Will we endure the worst case, with 2.2 million deaths? Or will we manage to turn things around, with help from summer?
Image
A road sign in San Francisco.Credit...John G. Mabanglo/EPA, via Shutterstock
No one knows, so the optimal path forward is to hope for the best while preparing for the worst. Dr. Brilliant, whom I quoted above as hoping that the virus mutates and dies out, also warns that the coronavirus may “cause global disruption on a scale we have not seen from any epidemic in more than 100 years.”
Outcomes depend in part on us — and my conversations with experts leave me concerned that we still are not doing enough.
“If anything, we’re still underreacting,” said Dr. Chaz Langelier, an expert on respiratory infections at the University of California at San Francisco. “In the last week, in terms of public health response and testing, we’ve maybe gotten to the pace we should have been at a month ago.”
This crisis should be a wake-up call to address long-term vulnerabilities. That means providing universal health coverage and paid sick leave — and if you think that the coronavirus legislation Trump signed on Wednesday achieves that, think again. It guarantees sick leave to only about one-fifth of private-sector workers. It’s a symbol of the inadequacy of America’s preparedness.
More broadly, the United States must remedy its health priorities: We pour resources into clinical medicine but neglect public health. What’s the difference? If you get lung cancer, surgeons operate to save your life, but public health professionals keep you from smoking in the first place. If you get the coronavirus, a doctor will treat you; public health aims to keep the pandemic from getting near you. The United States has a decentralized and spotty public health system, and it has endured painful budget cuts, yet historically public health has saved more lives than clinical medicine.
We may dodge a bullet this time, but experts have been warning for decades that a killer pandemic will come; typically, they expected an avian flu like the 1918 pandemic rather than a coronavirus. Singapore and South Korea did well this time partly because they had been frightened by SARS and MERS and were vigilant; if we, too, can be scared enough to invest in public health and fix our health care system, then something good can come from this crisis — and in the long run, that may save lives.
The Big One is approaching, whether now or later, whether we’re prepared or not. Dr. Ferguson, the infectious disease modeler who predicted deaths in the United States might reach 2.2 million, came down with a cough and fever a few days ago. He tested positive for the coronavirus.
Barron’s Weekend Summary: As the coronavirus pandemic rages, a robust fiscal response from Washington is imperative if the US economy is to avoid a deep, lengthy recession; The outbreak presents a rare opportunity to buy tech’s Big Five
* Cover story: The coronavirus pandemic is the ultimate black swan event, unlike any threat faced by the US since the Spanish Flu of 1918; “Washington must go all in now on fiscal aid, or America will pay later—a robust fiscal response is an imperative if the US economy is to avoid a deep, lengthy recession or, as some fear, a depression. And it’s going to have to be bigger than many of us can even imagine.”
* Tech Trader: Positive on AMZN, AAPL, FB, GOOGL, MSFT: The clear lesson for investors grappling with how to respond to the coronavirus pandemic is that cash is king—“and on that score, tech stocks are far better positioned than any other sector”; For investors looking to jump back into the market, this is a rare opportunity to buy tech’s Big Five—the outbreak affects them all, but each is likely to come through the downturn with its business intact.
* Trader: The impact of the government’s efforts to battle the pandemic will take some time to play out—once markets start trading like normal again, investors can turn their focus to what the way out of the current crisis will look like; Positive on T, TMUS, VZ: Americans who are forced to shut themselves up in their homes during the coronavirus outbreak will lead to a far greater reliance on the Internet, TV, and phone connections—and potential gains for wireless carriers.
* Interview: Inigo Fraser Jenkins, portfolio strategist at Bernstein Research, says a strategist can provide a framework for looking at the market and probable future returns, and that it could be time to buy stocks, if investors have a two-year horizon.
* Features: 1) As the nation battles the coronavirus, the Trump administration, Congress, and the Federal Reserve are working to shore up the economy, yet healthcare—the industry facing the greatest crisis—is not the focus of Washington’s current $1 trillion-plus push, a situation that needs to change as states run out of supplies; 2) Cautious on BAC, C, GS, JPM, MS, WFC: Big banks say they have never been better prepared for a crisis, but even though the sector has gotten hammered as investors worry about whether banks can deliver and get past the crisis without being swamped by bad loans, their stocks are appealing on some fronts; 3) When the world emerges from the coronavirus pandemic, some businesses, and perhaps entire industries—including airlines, energy, and cruise operators—will have taken a major hit and may need a federal rescue if they are to continue operating at full strength; 4) Robert Sluymer of FundStrat Global Advisors, Katie Stockton of Fairlead Strategies, and Andy Addison of The Institutional View discuss what their indicators say about the market’s future—there is bad news, such as further downside for the S&P 500, but also good news, such as the relative outperformance of healthcare and stocks such as WMT; 5) The nation’s regional banks are particularly sensitive to the challenges posed by the pandemic—they have less diversified lines of business and loan portfolios and can be concentrated in one particular area, though many are less exposed to commercial business than they have previously been; 6) Positive on REGN: The company has identified hundreds of virus-neutralizing antibodies that could potentially be used in a Covid-19 cocktail drug that might offer efficacy in preventing and treating the virus, according to SVB Leerink analyst Geoffrey Porges; Regeneron chief Leonard Schleifer tells Barron’s how the company’s technology platform is speeding drug discovery, and how to think about the economics of treatments for pandemic diseases; 7) Cautious on AAPL: “Disgruntled customers and developers say Apple adds to its advantage by weighing the scales in favor of its own products, charging outsize fees, restricting how and when developers may distribute phone apps, and collecting and hoarding valuable business information about the developers’ own customers.”
* European Trader: Industries haven’t all been equal in the month since the stock market rout began—the European banking sector has been hit particularly hard, and in spite of the hundreds of billions pledged by governments in the form of credit guarantees for struggling companies, bad loans could still come back to haunt balance sheets
* Emerging Markets: Brazil so far hasn’t faced a major Covid-19 outbreak, and while it does export slumping commodities like oil and iron ore, its $3 trillion-plus economy is mostly driven domestically—but bargain hunters had better pause for breath before pouncing on devalued Brazilian stocks.
* Commodities: “Retail gasoline prices have hit their lowest level in more than three years, though US drivers might not be fully able to enjoy it with many states on lockdown due to the coronavirus.”
* Streetwise: “At some point, adding money to falling stocks starts to feel like dollar-cost hemorrhaging,” says columnist Jack Hough, who adds that if investors are buying stocks, financial strength is key.
Hedge fund tycoon Crispin Odey makes £115million from this month's coronavirus stock market crash - and now he's betting on a recovery
- Crispin Odey revealed bets on plunging share prices had netted him a fortune
- Investor said his flagship hedge fund was down 12 per cent at end of February
- But huge falls in share prices since then have left him 20 per cent up for 2020
- Hedge fund tycoon thinks share prices are bottoming out and could rise soon
- Coronavirus symptoms: what are they and should you see a doctor?
PUBLISHED: 22:04 GMT, 21 March 2020 | UPDATED: 22:08 GMT, 21 March 2020
Brexiteer hedge fund tycoon Crispin Odey has made £115million from this month’s stock market crash – and now he’s betting on a recovery.
In an interview with The Mail on Sunday, Mr Odey revealed his bets on plunging share prices had netted him a fortune over the past three weeks.
The investor – who is a friend of Boris Johnson and donated to the campaign to leave the European Union – said his flagship hedge fund was 12 per cent down for the year at the end of February.
Optimist: Crispin Odey says markets will rebound. In an interview with the Mail on Sunday, he revealed his bets on plunging share prices had netted him a fortune over the past three weeks
But huge falls in share prices since then have left him 20 per cent up for 2020, adding an extra £115million to the funds he manages.
Mr Odey now thinks share prices are bottoming out and could rise soon.
John Lewis closes all 50 shops for first time in its...
'I didn't believe this was possible in February': Senator...SHARE THIS ARTICLE
‘The stock market has to rally because a recession has now been priced in,’ he said. ‘I’m buying some shares now. It’s a good time to be stock-picking.’
Mr Odey – thought to be worth about £775 million – hit the headlines in 2012 after spending £150,000 on a Palladianstyle coop for his chickens at his mansion in Gloucestershire.
Traders, some in medical masks, work on the floor of the New York Stock Exchange on March 20. Trading on the floor will temporarily become fully electronic starting Monday (file photo)
He has been predicting a market downturn since 2015 and suffered several years of poor returns as shares soared.
But coronavirus has caused stock markets to slump, boosting socalled short-sellers such as Mr Odey, who profit from falling share prices. He made his fortune in the financial crisis a decade ago, betting against the shares of failing banks.
Mr Odey, who has recently benefited from falls in firms such as Fevertree and Metro Bank, said: ‘The big difference between now and 2008 is the machines (used by traders to sell automatically when the market dips).
'The machines just never stop selling when the market falls. That’s why you are seeing such big moves down.’
UK urges vulnerable people to stay at home for 12 weeks
Johnson warns country could go the way of Italy without ‘heroic’ national effort to slow coronavirus
Boris Johnson has urged people to stay away from their elderly mothers on Mother’s Day as the prime minister urged 1.5m vulnerable people with health issues to self-isolate for at least three months.
In a message to the nation on Saturday night, Mr Johnson warned that the UK was only “two or three” weeks behind Italy in terms of the accelerating number of Covid-19 patients.
“The Italians have a superb healthcare system. And yet their doctors and nurses have been completely overwhelmed by the demand. The Italian death toll is already in the thousands and climbing,” he said.
“Unless we act together, unless we make the heroic and collective national effort to slow the spread — then it is all too likely that our own NHS will be similarly overwhelmed.”
The government said up to 1.5m people with underlying health issues in England alone — who face the highest risk of being hospitalised by the virus — should stay at home to “shield” themselves. “Do not leave your house for at least 12 weeks starting on Monday 22 March,” it said.
People with specific underlying health conditions, including some being treated for cancer, will be contacted by the NHS this week.
Mr Johnson, meanwhile, urged people not to visit their aged mothers this weekend in a U-turn from Thursday, when he said he intended to visit his mother on Mothering Sunday.
All over-70s in the UK have already been advised to avoid unnecessary social contact as the number of people afflicted by Covid-19 continues to rise.
“I know that everyone’s strongest instinct is to go and see their mothers in person, to have a meal together, to show them how much you love them,” he said.
“But I am afraid that this Mothering Sunday the single best present that we can give — we who owe our mothers so much — is to spare them the risk of catching a very dangerous disease. The sad news is that means staying away.”
The list of 1.5m includes people either taking medication or receiving treatment or have health conditions which puts them at greater risk of developing serious complications if they get the virus.
This includes those who have received organ transplants, are living with severe respiratory conditions such as cystic fibrosis and severe chronic bronchitis (COPD) or specific cancers like of the blood or bone marrow.
People identified as belonging to one or more of the at-risk groups will be contacted by their GP practice, specialist or both strongly advising them to stay at home for a period of at least 12 weeks.
They will all receive a letter this week and then frequent text messages providing reassurance and advice, the government said on Saturday night.
Paul Johnstone, director at Public Health England, said it was “vitally important” that those receiving the letter acted on it and did not go out for any shopping, travel or leisure.
“Those of us who are less at risk can play our part in protecting other people by following the government’s advice on social distancing and volunteering to give extra support to vulnerable people who are staying at home,” he said.
The list of those considered extremely vulnerable include organ transplant recipients, people with specific cancers, people undergoing active chemotherapy, those with severe asthma or cystic fibrosis or those having immunotherapy.
The government will also set up a helpline and make provisions to deliver basic groceries and medicines to those most at risk from the virus — who are now stuck at home — through a new “Local Support System”. That will involve the government working with councils, the groceries industry, emergency partners and voluntary groups to ensure that essential items can start to be delivered.
The efforts will also be supervised by a handful of military logistics experts who are already helping “Local Resilience Forums” in various regions.
“This will be an especially worrying time for those with serious underlying health conditions and that is why we are urgently acting to ensure extremely vulnerable individuals are taking extra steps to shield themselves, and that the essential items they need are supplied to them,” said Robert Jenrick, communities secretary.
“We will ensure that vulnerable and older people in our society are left in no doubt of their importance to us and our determination to protect them as best we can.”