Coronavirus (COVID-19) PSA

Elad Gil wrote an excellent post synthesizing much of what we know about the Coronavirus. His intended audience was start-up founders – but most of what he’s shared is broadly applicable.

I’ve also copied sections 1, 2, and 5 of the post below.

The Coronavirus outbreak (note the disease is officially named COVID-19 and the virus SARS-CoV-2) is catching many technology startups unprepared. The second community transmitted case of the virus in California, with no known ties to others, was just reported in Santa Clara county. New cases were also reported Friday night 2/28 in Washington State and Oregon.

Below is a brief summary of some of the data behind the outbreak as well as what I have seen larger companies quietly adopt. I have also been on a number of small group calls with some of the epidemiologists working on this, so passing some of this on. These calls were under Chatham House rules. Hopefully this is useful for startups not in the loop.

1. What is happening?

In December 2019, cases of a new respiratory virus emerged in Wuhan, a major city of over 10 million residents in the Hubei region of China. Although information on this disease was initially suppressed by the Chinese government, the WHO was contacted on December 31, 2019 and a new virus was identified on January 7th. The first non-China cases were identified on January 13 in Thailand and January 16 in Japan. On January 23rd Wuhan was placed on lockdown by the Chinese Government. The virus is a coronavirus, which is a family of viruses that cause SARS and MERS, but also are endemic in people. Humans have at least 4 coronaviruses already that cause 10-30% of all seasonal colds.

At this point, over 80,000 people[1] are infected with the new COVID-19 virus and 2700 dead (mainly in China). Many epidemiologists believe these numbers from China are underreported by up to an order of magnitude, and it may be closer to 800,000 people infected in China alone.

There are major outbreaks happening in Korea, Italy (locked down 50,000 people in 12 small  towns), Japan (Prime Minister asked people work from home and 38,000 person Tokyo marathon cancelled), Iran (deputy health minister infected and cases spread across middle east), and other countries.

2. What should we expect?

Despite the WHO’s assurances that things can still be contained, every epidemiologist I have spoken to thinks the virus has broken out and will spread around the world. Many think >20% or more of humanity will be infected due to a lack of baseline immunity and therefore herd immunity for this disease (as an example, the 2009 H1N1 flu infected 16% of all humans)[3].

Data on the virus is quite preliminary. So far the following appears to be true (you can also play with primary data here):

• Most cases are mild. Most estimates suggest 80% of COVID-19 cases are mild and feel roughly like a flu. Estimates I have seen suggest that roughly 10-15% of cases will be more significant and may necessitate hospital visits (see also) with 1-3% potentially needing an ICU. The concern of many governments is the peak number of cases that occur in a given moment. For example, if 1,000 sick people show up overnight to a hospital that hospital would be overwhelmed. Many of the social engineering policies (shutting schools etc.) are focused on spreading infectious cases out over time, so hospital infrastructure can deal with all the sick. The higher death rate in Wuhan versus rest of China may reflect a local collapse of healthcare infrastructure.
• Death rate: The reported death rate has hovered around 2% but may in reality be 0.2% to 1% depending on country and healthcare system. Many estimates tend indicate an overall expected mortality rate of ~0.5% globally.  The current existing fatality rate is biased upwards by Wuhan cases dominating the mix (which are closer to a 3-4% death rate and make up most cases). It is possible the virus is being undertested for in China / rest of world driving the real death rate down (as many more people are infected than is reported).
  • “”My sense and the sense of many of my colleagues, is that the ultimate case fatality rate … is less than 2%,” Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told CNN’s Jim Sciutto on “New Day”. “What is likely not getting counted is a large number of people who are either asymptomatic or minimally symptomatic, so the denominator of your equation is likely much much larger.”” Source.
  • Outside of Hubei and in China, the death rate in other regions has averaged around 0.7% when I have run it on primary data. Wuhan, where most cases are, has been in the 3-4% range likely due to a collapse in healthcare infrastructure in the region.
  • Outside of China, the death rate has averaged around 0.6% when I have run it on primary data. This is now getting confounded by Iran, which has a higher reported death rate – probably due to dramatic undercounting of cases.
• R0 value: The spread rate of the virus seems to be well over 2 and likely ~3. This means for every person infected at least 2 to 3 more get the disease. This compares to the flu at 1.5 or so.
• Incubation period. Realistically, the incubation period (time from infection to symptoms) appears to be under 14 days and likely 5 to 7 days for the majority of people. People appear to be infectious rapidly after infection, potentially as soon as 12-24 hours. Many experience only mild conditions early, which increases spread rate of the disease as people go to work or otherwise continue with life unchanged.
• Elderly & pre-existing conditions. The elderly and people with preexisting conditions appear especially susceptible to disease and severity or death. It is possible the elderly are susceptible largely because they are more likely to have pre-existing conditions. In contrast, very few cases have been reported in young children.

In general, much of the western world’s policy to COVID-19 appears to be one of delaying arrival of the disease. In particular, delay the disease so that:

• We are out of flu season and free up hospital beds and healthcare infrastructure.
• We have more time to prepare in terms of diagnostic tests for the disease and potential treatments.
• We can work on a vaccine.

If the disease makes it to the US (or your country) the government may enact techniques to decrease spread. This usually means cancelling gatherings, sporting events, schools, or other situations in which groups of people will aggregate. It is possible your movements will be restricted (for example, the 50,000 people locked down in Northern Italy).

5. Expect A Second Wave

In many epidemics disease course follows two waves. In wave one, an initial infection happens followed by governments tightening movements, shutting schools, and in general decreasing the spread of the diseases. Controls are eventually relaxed (people need to work, kids need to go to school etc.) and then a few months later a second wave of the disease hits and infects a subset of the people who were not infected in the first wave. Eventually, enough people get sick, develop antibodies, and there is a strong enough herd immunity in the population to decrease future out breaks in size.

1918 Spanish Flu had two predominant waves of virus spread.

2009 H1N1 flu in the UK had two waves.

If you’re feeling anxious about COVID-19, I hope having some of this info helps. If it doesn’t, it may be helpful to seek help from a medical professional as well.