Coronavirus Caution and Hope

Like almost everyone else, I am A) intensely worried about the coronavirus (AKA novel coronavirus AKA Covid 19), B) have zero medical expertise and C) am spending ridiculous amounts of time reading through random items on the Internet to try to make sense of what is going on. Also, events are moving so quickly that anything someone writes is out of date before it is published. Nonetheless, if only to provide myself a record of how I was thinking, I’m going to share my thoughts.

As mentioned above, I’m not an expert, so I’m not going to try to provide useful advice. What I am going to do is to step back and try for a big-picture perspective on what is a turbulent and panic-inducing time.

First, it’s pretty clear to almost everyone other than a few delusional politicians that the coronavirus is a serious problem. As my friend Ramit Sethi wrote, panic is bad, but overreaction may actually be good. I’m a very social person, so I won’t enjoy isolating myself and my family at home, but it’s a price worth paying for reducing the risk to ourselves, and to others. If history is any guide, areas that act quickly to implement social distancing measures will do better than those that don’t. This is exactly how things played out during the 1918 influenza epidemic.

I’ve had a number of people in my life who told me, “I’m not going to worry about it. Everyone is going to get it eventually.” Whether or not this is true, this is no excuse for inaction. “Flattening the curve” isn’t just a hashtag, and the more we slow down the infection rate, the more people will survive. Part of the reason that the outbreak in Italy has been so deadly is that the volume of patients requiring intensive care, such as ventilators, has overwhelmed the healthcare system. Even if you’re not worried about your own health, taking precautions will help protect others.

Furthermore, the “everyone is going to get it attitude” treats the situation as static, even though it is clearly fluid. Former biotech entrepreneur (and fellow Silicon Guild member) Safi Bahcall points out that just three months after discovering Covid 19, the world has launched 338 clinical trials of various treatments and vaccines. The concentrated brainpower of the entire world is at work, and chances are that it will produce game-changing results. Right now, the only thing we can do for coronavirus sufferers is to keep them alive while their bodies fight the infections. This is why the situation in Italy is dire–the healthcare system is being overwhelmed by the number of patients who need hospitalization, ICU beds, ventilators, or ECMO. Worse, medical staff are getting infected, which reduces capacity when it is most needed. Nations like South Korea that have managed to “flatten the curve” have sufficient healthcare capacity, and are seeing much lower fatality rates. Similarly, early outbreaks like the Diamond Princess cruise ship have shown relatively low fatality rates, perhaps because healthcare was readily available.

Now imagine if, in a matter of weeks, the FDA approves effective treatments. A recent French study found that the combination of two established, cheap, readily available drugs, chloroquine and azithromycin, produced a cure in six out of six patients. The numbers are small, and the trial was not double- or even single-blind, but a 100% cure rate in less than a week is certainly promising. And, since both drugs have long proven their lack or harm, they simply need to prove effective in a trial to be approved. (This is what President Trump was referring to when he wrongly said the FDA had approved chloroquine; it is approved for treating malaria, not the coronavirus, a fact the head of the FDA quickly clarified.)

In addition to developing treatments and vaccines, we also need to develop the infrastructure to test for the virus. Aggressive testing has worked in South Korea and Singapore; it even worked in Italy, at the heart of the outbreak, where a hard-hit town went from epidemic to cured in four weeks by testing all residents (and found that 50% of infected people were asymptomatic). The tests are coming, and should be broadly available in the next few weeks, which makes it even more important that we slow down the growth of the pandemic until then.

Social distancing isn’t a cure; it’s a way to slow down the infection rate so that we have time to roll out testing, effective cures, and eventually, a vaccine. In a few weeks or months, the coronavirus really might be about as deadly as the regular flu…but that won’t help you or a loved one if you catch it before that point in time!

Another issue I’ve seen is that young people are acting as though they are immune to the worst effects of the coronavirus. It is certainly true that they are far less likely to die (especially if they are 18 or under), but this is far from a guarantee. A CDC study of US cases found that 38% of those hospitalized with the coronavirus were under 55. (FYI, 71% of the US population is under 55.) And 80% of patients who die are over 65 (seniors make up 16% of the US population), but that still leaves another 20% for the remaining 84% of the population, such as 34-year-old Dr. Li Wenliang, who was one of the first doctors to raise the alarm in China, and later died of the disease. Why take the chance? Avoid getting the disease until effective cures are available, and your chances of dying drop to nearly zero.

Finally, I have seen a number of people arguing against the measures that policymakers are taking to slow the spread of the coronavirus (social distancing, closing schools, closing bars and restaurants) because they claim that the economic damage caused by these efforts exceeds the benefits of slowing the pandemic. One intelligent person I know argued that spending $1 trillion to save 1 million lives ($1 million per life) was a bad bargain, and that we’d be better off simply letting 1 million Americans die.

My response was that I valued my own life far more than $1 million dollars, and I suspected that my friend’s spouse and child would have their life more than that as well.

The argument that we’d be better off simply letting people die is absurd; it presumes that watching 1 million Americans die of the coronavirus would have no other effects on the economy. In Italy, military truck convoys have been called in to transport bodies because there isn’t enough room to bury or cremate all the victims–does anyone seriously think this wouldn’t cause panic in the streets?

The economic fallout of this pandemic is already terrible (the stock market has plummeted, and numerous layoffs have occurred), and will get worse. Social distancing is destroying entire industries, such as restaurants, travel, sports, and entertainment. But there is no magic way to prevent this harm, and desperately wishing that the coronavirus is just like the usual flu, and that no interventions are necessary simply extends the crisis.

Our objective should be to minimize the duration of the shock to the system. Most restaurants can survive being closed for 30 days, especially if the government provides cash payments to help cushion the economic blow. But barely any could survive being closed for 90 days. Aggressive action has worked in South Korea and Singapore; aggressive action now is likely the lowest-cost, lowest-impact approach in the long run.

Or as the old Wall Street saying goes, if you have to eat shit, take big bites.

Since I’ve dumped so much information on you, I’ll provide a quick, point-by-point summary of my big picture perspective.

1) The coronavirus is a serious threat. Anyone who doesn’t agree should board a flight to Northern Italy or Iran to prove the strength of their stated beliefs.

2) We should aggressively practice social distancing. It’s not the cure, but it buys us time to develop better testing, treatment, and vaccines.

3) We are close to breakthroughs in testing and treatment that will completely change the prognosis for containment and treatment. We just have to hold on a little bit longer.

4) If we limit the problem now, we’ll be able to cure it that much faster when better tools come online, and that will allow us to minimize the economic damage in the long run.

Stay safe out there!

6 thoughts on “Coronavirus Caution and Hope

  1. Eben Harrell

    Thank you for sharing your thoughts, Chris. I wish we had had the conversation about how much a life is worth before this crisis hit. It’s fraught, but important. Here’s some interesting background from an interview I did, egad, eleven years ago:,8599,1888006,00.html

    Have you done any research on the virus’ stability and how likely it is to mutate into something more lethal? I haven’t seen much on this. That might be an argument for building herd immunity more quickly.

    1. Eben, thus far it appears that the coronavirus is not as prone to mutation as we feared. Still very difficult to create a successful vaccine though.

  2. Last Places In Europe Ireland and Iceland. Island Healthcare Systems, my the projected curve be as we with hope predict or better project and scale for.

    1. Sorcha,

      Islands’ relative isolation may indeed help them flatten the curve by carefully screening incoming passengers. This is one of the factors that has helped Singapore.

  3. At least St Louis / stl county isn’t waiting any longer. We may be fly over country, but it’s definitely here unlike what some politicians think and tell everyone!

    Seems like a lifetime ago when we hung out discussing startups in your car!

    1. Great to hear from you, Rex. St. Louis was a model of the correct response to the 1918 flu epidemic; I’m glad that Midwestern practicality still holds!

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