My take on COVID-19

I have a bit of time on my hands right now, so I figured I'd write up my current COVID-19 take. Not really because I think anyone cares. I mean, there are many better informed takes out there. I'm mostly writing this for myself, so I can look back on it and see how my perception has changed.

I've been worried about COVID-19 for a while, but there were ways to imagine it not getting too bad. Like maybe it would be contained by the early response in China. Or maybe there was some genetic or environmental factor that would limit its spread or its deadliness.

I've been very worried ever since Italy took a turn for the worse around February 23. Their number of known cases jumped from ~10 to ~100, and things progressed rapidly from there.

On February 24 I started stocking up on nonperishables, figuring that there was a good chance that a time would come when I'd have to lay low for a few weeks. I also started telling my friends and family to similarly prepare, which resulted in multiple people telling me they were a little freaked out by my concern, since I tend not to get worked up about whatever "crisis" dominates the news cycle.

As the news trickled in from the US and Europe, it gradually became clear that many countries were indeed on the same trajectory as Italy. Western countries did not act as swiftly and strongly as East Asian countries like South Korea, Japan, and Singapore. Most troubling, particularly in the US, was the lack of testing. All we knew about the spread of the disease came from severe cases, but for each severe case there are many asymptomatic cases, some of which will soon be severe. This lack of information continues to impede decisionmaking.

Today, I believe there are two big outstanding questions.

First, how many people have already been infected by COVID-19 and experienced no or mild symptoms? Without knowing how many people will catch COVID-19 and ultimately be fine, it's really hard to say what the appropriate political response is. This article by John Ioannidis really hammers the point home, while questioning if our response might be too strong. While I do hope Ioannidis's skepticism turns out to be correct, I wouldn't bet on it. I agree with Nicholas Christakis when he points out that there is at least some evidence about the fatality rate of people with COVID-19, and it doesn't very look good; and a huge number of cases happening all at once is a big deal.

Regarding the huge number of cases happening all at once, there is much talk of "flattening the curve". Unfortunately, if the pandemic is bad enough, flattening the curve becomes kind of infeasible. If you need to flatten the curve for 10 years, that's never going to work. But like I mentioned above, we really lack the data to conclusively say much here.

My second big outstanding question is, what is the long term prognosis of people after infection? Do they retain some level of immunity? How good is that immunity? And how long does it last? Already there have been isolated reports of individuals catching COVID-19 twice, suggesting some very pessimistic answers to these questions. And I have read that evidence from similar viruses suggests immunity may not last forever. However we shouldn't jump to conclusions without more data. And this is not just a matter of testing, like the first question. It is also a matter of time.

These questions are important because they will determine the success or failure of government responses to COVID-19. Of course, ideally the outbreaks would have been limited by more testing and more careful social practices. But in the US and Europe, it seems like the cat is out of the bag. So what? Strict lockdown like Wuhan? Let it burn through the country and develop herd immunity? Something in between?

To my first outstanding question, since we don't really know how bad COVID-19 will be if it just burns through the population, it's hard to evaluate those options. I believe that the available data suggests that lockdowns are appropriate, but there's much uncertainty.

More troublingly, to my second outstanding question, we don't know if either of those strategies will actually work! If people can be reinfected with COVID-19 multiple times, without experiencing a substantial period of immunity, then herd immunity will never happen. So we lockdown... and then what? As soon as the lockdown ends, the pandemic will resume. So we let it burn through the country... and then what? Next year it just burns through again, since nobody is immune?

Scary scenarios. We simply don't know enough right now. We absolutely should be doing as much testing and monitoring as possible to help answer these questions. And hopefully we find that it's not as severe as originally thought, and that catching it once confers long term immunity. Time will tell. But right now, it seems like there's a distinct possibility that Earth is now simply a worse place for humans than it was before, and we'll just have to learn to live with that.