In these difficult days for all of us, I’ve heard all sorts of things. From the fake news sent through Whatsapp, like vitamin C can save your life, to holding your breath in the morning to check if you’ve been hit by COVID-19. The mantra that everyone keeps repeating is “stay at home!”, okay fine, but what exactly does “stay home” mean? The question seems ridiculous when you think of a relatively short period, 15 days? A month? But if we look critically at the situation, we surely realize that it won’t be 15 days, and it won’t be a month. It will be a long, long time. Why am I saying this? Because “stay at home” doesn’t protect us from the virus. Staying at home is to protect our health care facilities from collapse. And I’m not saying that this is wrong. I’m just saying that if we want to protect the health care system from collapse, well then we’ll stay home a long, long time. But in doing so we will irreparably damage the economic system by profoundly changing our social and political model. It is inevitable. Let’s face it and not have too many illusions.
This implies a much deeper change than many people expect. Many of you are probably thinking: “Well, everything will go back to the way it was before!”. I have heard comments like “Well, the banks are much more solid than they were in 2008” or “We got through the 1987 crisis, we will get through this too”. The bad news is that this is not a financial crisis, or at least not only that. This is and will be, a very deep crisis affecting the whole economic chain. This is not a crisis linked to the ill-considered securitization of high-risk mortgages on the American real estate market that affects some limited and weak segments of the population. No, this is the crisis of the small hairdresser’s shop that will not be able to survive because it is completely devoid of any means to deal with the situation. This is the crisis of any entrepreneurial activity that is part of the economic chain. From the small men’s accessories shop to the big bank. And the bad news is that socially, this time, it will be difficult to say “too big to fail!”, also because there will not be only the big banks to be saved. No gentlemen, this message will not be socially acceptable this time. This time it will be “All or none!”. The risk is much more social and political than “simply” health. The real economy will be the detonator of this change. This time the choice will not be between Meryl Lynch, Lehman, UBS, or Credit Suisse. This time you will have to save everyone or no one. Or rather, save everyone is the only option, because the alternative, if not, is to reach levels of nationalism, internal and external social opposition, and economic inequality that the sovereign parties of the recent pre-COVID-19 past will look like a group of carnival party boys compared to what we might see.
It will all depend on how long the lockdown lasts. The longer it lasts, the more these economic and social problems will become more acute, and the harder it will be to return to the initial situation. Why am I telling you this? Let’s take a small example, just a very small example. Switzerland today offers 42 billion Swiss francs to support the economy. Two professors at the ETH Zurich, Hans Gersbach, and Jan-Egbert Sturm have calculated an actual need of 100 billion. If, and the conditional is a must, they were right with 42 billion for a need of 100 billion we could save about 42% of our current real economy. If this is a conceivable scenario, what will happen with 58% of the people we cannot support with the economic intervention? Who will ride the discontent of these masses and channel this force into a social and political change that is unimaginable at the moment?
As I said, everything will depend on the lockdown, the window of time that the lockdown will last and, proportionally, the time and size that state aid will be there to support the economy. It is said that it will last the next few weeks, it is said that at the end of April we will be able to return to a normal life, but from other sources, there is not so rosy news. It could be a time frame of 18 months with different waves of the virus, in the summer it may decrease, and then return violent during the fall. This is what is foreseen in an internal US government document. A document published by the New York Times on 17.3.2020. Another point of view in supporting this long period is the one of Marc Lipsitch, an infectious disease expert at Harvard TH Chan School of Public Health. According to him, it is a myth that another coronavirus that caused SARS in 2003 disappeared on its own when the climate warmed up: “SARS did not disappear due to natural causes. It was eliminated by extremely intense public health interventions”, such as isolating infected people and quarantine those who had been in contact. According to Lipsitch, while we can expect modest declines in SARS-CoV-2 infectivity in warmer, wetter climates and perhaps with school closures in the temperate regions of the northern hemisphere, it is unreasonable to think that these reductions alone can totally eradicate the virus.
If so, let us prepare for the worst. “When you’re dealing with an emerging infectious disease outbreak, you are always behind where you think that today reflects where you really are” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force. How long, then, until we’re no longer behind and are winning the fight against the novel coronavirus? The hard truth is that it may keep infecting people and causing outbreaks until there’s a vaccine or treatment to stop it. So the most tangible proposal right now is to stay home for the next 18 months. I do not say all 18 months, but unfortunately at intervals linked to the different waves of the virus, which in the absence of a vaccine, would reoccur at more or less regular intervals.
Someone will tell me that in the next few months you will be able to achieve the immunity of the herd that Boris Johnson has so widely flocked. No, that’s not true! Herd immunity is not guaranteed. Currently, it’s unclear if, after a period of months or years, a person can lose their immunity and become reinfected with the virus (which would make achieving herd immunity more difficult). Also, herd immunity will come at the cost of millions of people becoming infected, and possibly millions of people dying. Boris Johnson said this without too many words, and on this, unfortunately, I agree with him.
What makes me angry is that our politicians here in Switzerland have not considered a less drastic way economically, and indirectly sociopolitically: isolating infected people from uninfected ones. Clearly, this option involves the massive use of tests, which inexplicably here in Switzerland, home of the world’s largest pharmaceutical companies, are not available in such large quantities to support this model. It is the approach used by South Korea that seems to be yielding positive results with fewer socio-economic impacts. Of course, on the other hand, one could shout out the scandal about the strong control of mobile phones and credit card transactions, but I wonder, every day we get our personal data swiped for free from Facebook, Google, Apple, etc. and we laugh about it. When should we do it for a noble cause, then do we shout scandal? We are simply incoherent and paralyzed by panic.
The impression I got up to this point was certain general unpreparedness, improvisation in the responses, and a lack of coordination of the message to address to all those people, including myself, who need clear answers at this difficult time. I don’t think “stay at home!” is enough anymore. I fully understand that we are trying to avoid a collapse of the health care system that can only cope with a certain number of seriously ill people. But is this really the only way to achieve it? If you decide on that path, however, on the other hand, you need clear communication and long term plans, you need to reassure all these people that after the “stay at home!” they would like to know what will happen. If these uncertainties are not given strong answers and, above all, in the long term, the danger of a drift of the socio-political system towards previously unimaginable models, from my personal point of view, is around this corner.
We must have clear objectives, what do we want to achieve? I think we can all converge on 3 specific goals together:
1. Protecting high-risk population groups
2. Avoid the collapse of the health care system
3. Preventing the economy from collapsing
List the goals we want to achieve where to start? First of all, start with a good data crunching. We’ve got a huge amount of data on COVID-19, let’s take it seriously. Let’s start with the data presented by John Hopkins University, what do we know? At the moment (24.03.2020) we know that there are 381,621 cases in the world compared to 16,563 deaths for a mortality rate of 4.34%. We also know that the data of those infected are abundantly low because the tests are not carried out in a blanket manner. Let’s take again the case of South Korea where the tests were carried out in a censorship manner, the numbers tell us anything but 9,037 infected against 120 deaths for a mortality rate of 1.32% This number is in line with the data published by the New England Journal of Medicine which attests a mortality rate of 1.4% studying 1,100 subjects hospitalized in China at the beginning of the pandemic. I’ll say more, we take other cases of countries where the tests are followed across the board, Germany at the moment has a mortality rate of 0.4%, Austria 4,477 cases for 21 deaths a rate of 0.46%, Norway 2,625 cases and 10 deaths for a rate of 0.38%. What do these figures tell us? That you have to perform a lot of tests to have solid figures on which to make serious decisions.
Still, the death rate for COVID-19 appears to vary by location and an individual’s age, among other factors. For instance, in Hubei Province, the epicenter of the outbreak, the death rate reached 2.9%; in other provinces of China, that rate was just 0.4%, according to the China CDC Weekly study. Besides, older adults have been hit the hardest. The death rate soars to 14.8% in those 80 and older; among those ages 70 to 79, the COVID-19 death rate in China seems to be about 8%; it’s 3.6% for those ages 60 to 69; 1.3% for 50 to 59; 0.4% for the age group 40 to 49; and just 0.2% for people ages 10 to 39. No deaths in children under 9 have been reported.
We know the disease affects everyone, not just the elderly. It’s the results of the infection that are very different. In countries where so many tests are taken (Germany, Korea, Austria, Norway) the data are unequivocal: the infected are distributed fairly evenly by age group. However, it is captious to say that young people are at risk. Under 50 years of age, the mortality rate without previous pathologies is very close to zero, less than 0.1%. Analyzing these data it is clear that the population group to be protected is the one starting from 65 years of age.
So let’s seriously protect the over-65 segment that is at very high risk. We create an intermediate security segment between 55 and 65 years old, and a third segment from under 55. At this point we start to isolate “stay at home” the over 65s, simply because we need to protect them and indirectly protect health facilities. Then we carry out tests to identify positive cases. This is, for instance, the right choice adopted by Canton Uri in Switzerland and the following day declared illegal by the Government of the Swiss Confederation. (!)
Using South Korean data to proportionally calculate the infected to the dead, we can say that Italy at this moment has 457,598 infected and not 63,927 as reported by Johns Hopkins University while using the same proportions of Austria, Norway and Germany Italy would have 1,434,172 people infected or infected and cured by the virus. The lower number is only because no blanket tests are carried out on the entire population. In Switzerland the number appears to be quite truthful with 8,795 reported cases, using the proportion of South Korea there would be 9,036 cases in the Confederation, while with the proportion of Germany and Austria at the moment Switzerland would number 28,320 people infected or infected and recovered. What do these numbers tell us? That countries that do not perform sweeping tests are managing the situation with wrong numbers and adopting completely wrong decisions! We need to follow the tests massively, correct the numbers and make decisions for our future.
Going back to the 3 groups once the over 65s are protected with a clear “stay at home”, you have to test the 55–65s and isolate the positive cases from the negative ones, and then the same for the under 55s. Let us remember well that in these age groups the mortality rate is extremely low. Therefore manageable by the health infrastructure. Let us also remember that in 95% of cases the COVID-19 does not give rise to hospitalization, so the serious separation between positive and negative and the strict management of “stay at home!” for the positive does not cause a collapse in health care facilities.
We can gradually restart the economic system for the under-55 age group by carrying out blanket tests and continuing to take hygienic measures to counter the spread. Positive cases must be immediately quarantined and isolated from the rest. There is a need for a sense of civic responsibility to protect everyone, and every person in that age group absolutely must undergo the test and react immediately to any symptoms of the disease. Let us remember, however, that we are talking about a group where the mortality rate is 0.1%. Once we have managed this age group, we can proceed to the 55–65 age group, gradually letting the cases that have been tested negative return to normal life. Once we have managed the under 55 and 55–65 bands, we continue to monitor seriously and run tests. This is what they did in South Korea and brought tangible results. It is also what they are doing in Germany, Austria, and Norway: testing, testing, and more testing.
That’s the real question. We are one of the richest countries in the world, we have one of the largest pharmaceutical industries in the world, but do we have enough tests to handle the situation? Do we have at least 10 million tests available right now, in this precise moment? I see that Roche is providing tests to the United States, but how many tests have been allocated to Switzerland? Can our politicians give us this number? According to SwissInfo, around 6,000 tests are carried out in Switzerland every day. If this is true, we are a long way from the number of tests it takes to get correct figures and make decisions based on facts. Roche’s CEO Severin Schwan admitted on 19.3.2020 that it is not possible to perform sweeping tests because demand far exceeds the supply that Roche can guarantee. Despite the World Health Organization’s recommendation to follow sweep tests. “Demand far exceeds supply,” said the number one pharmaceutical giant in Basel during a virtual press meeting organized by the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA). “It is important that the tests are initially targeted at patients at risk and those with symptoms. Large-scale testing is simply not possible,” added Schwan. Let’s forget the South Corea Model for Switzerland, unfortunately.
It is sad to see that it is not possible to pursue a serious policy of containing the epidemic and, in the meantime, safeguarding the economy in Switzerland. This for two main reasons: the lack of reliable numbers, and the lack of what would help us get reliable numbers, the famous tests. With this in mind, it was decided to follow a very dangerous socioeconomic path: “stay at home!”. The problem is that every day we stay at home, it will become more and more difficult to manage an economic, political and social situation. As I said before, the danger is the advance of political opportunism that will lead to unimaginable social, economic and political models. The Post-COVID-19 society.