Coronavirus: Overblown Hype or Unparalleled Threat?

Novel Coronavirus (2019-nCoV) was first reported to the World Health Organization on New Year's Eve.  This initial report did not identify what the culprit of the outbreak was as research was still underway, but the identity of the virus was supposedly isolated on January 7th, just a little over one month ago.  Three weeks ago, on January 21st, the World Health Organization published its first sitrep ("Situation Report") on 2019-nCoV, reporting that 282 persons, primarily in the province of Hubei, had the virus.  Fast forward 20 days and the latest WHO sitrep records 40,554 confirmed cases and 909 deaths, including 319 confirmed cases outside of China.

Just going by these official statistics (which are fed to the WHO directly from the Chinese government), the virus has spread by over 14,000% in 20 days, surpassing total cases of Ebola, SARS, and MERS.  Media reports have given a particularly murky picture of the situation with many articles suggesting the virus is no more deadly than seasonal flu, and others suggesting that the scale of the outbreak and the mortality rate may be vastly underreported.


What is the truth?


I've adopted a wait-and-see approach, not wanting to jump on either bandwagon, but the evidence we're being presented with every day is that the disease is almost certainly being underreported.  I would be very hesitant to agree with some of the more extreme conspiracy theories suggesting that the mortality rate is over 40%, yet at the same time, proposing that 2019-nCoV is on par with the flu now requires the most significant cognitive dissonance imaginable: it is nearly impossible to reconcile China's reaction to the virus and the myriad of videos sneaking out with the idea that this is nothing more than a particularly bad head cold.  This virus is deadly and spreading fast, but the question is how deadly and how fast.


Let's start with what we know:


1. It's spreading much faster than H1N1 (Swine Flu).  Since it was first discovered in 2009, H1N1 has infected roughly one billion people on earth.  H1N1 was a particularly strong flu that was first recorded in March/April 2009.  Using the WHO's own chart, we can see that Coronavirus is spreading roughly three times as fast:

The comparison we make is to H1N1 on April 30, 2009, when there were roughly the same number of confirmed cases as there were of Coronavirus on January 21, 2020.  20 days later there were approximately 12–15,000 cases of H1N1.  Worldwide, the transmission rate (Ro - pronounced "R naught") of H1N1 is thought to be about 1.5, upwards of 1.7.  In other words, for every one person that gets the infection, another 1.5 will get it subsequently.

Based on just the official statistics we're seeing, Coronavirus appears to have an Ro somewhere in the 3.5–4.5 range, which is extremely high.


2. Despite early media reports to the contrary, there is growing agreement that Coronavirus is truly airborne and not merely spread through contact.  Aerosolization was supposedly confirmed several days ago, meaning that the virus can be spread through sneezing, coughing, and exhalation when contained within droplets (source), but some authorities continue to push back against the claim (source), yet only because aerosolization has not yet been directly confirmed in a lab.  The transmission rate would strongly point to the airborne nature of this disease.


3. China's response to the outbreak suggests that the outbreak is incomparable to the flu.  At the moment, some 400 million Chinese (approximately one-third of the entire population of the country) are under lockdown.  Videos and pictures emerging from the country show that the streets in the capital (Beijing) and the largest city (Shanghai) are completely empty.  In Hubei province where the contagion is the most widespread, numerous videos have shown authorities literally welding shut and dumping dirt in front of apartment doors to keep residents contained inside.

Understanding that the dissemination of pictures and video related to the outbreak in Hubei is illegal to residents, and therefore we are likely only getting a relatively small sample from these, they paint a dire picture of societal breakdown and panic from authorities.

This is undoubtedly the most extreme response to an outbreak in world history, exceeding even the quarantines during the 2013–2016 Ebola epidemic.


4. While some of the more extreme conspiracy theories are probably inaccurate, trusting the WHO statistics as-is (which are being directly fed from the Chinese government) is an exercise in futility.  It is already widely known that China suppressed initial reporting during the 2002 SARS outbreak and the same is happening this time around, as citizen journalists have been jailed and the government has silenced local Wuhan authorities from reporting the facts on the ground.  The truth is likely somewhere in the middle, but time will tell.


5. The mortality rate is simply not known.  Reports to the contrary are either meant to assuage fear or increase it.  The commonly cited 2.2% is calculated by taking the number of fatalities divided by the number of confirmed cases, which is then converted to a percentage.  However, this early on in the outbreak that calculation is essentially useless.  Ultimately, the true mortality rate isn't based on the number of cases, but on the number recovered.  Present statistics show roughly 3,600 have recovered and 900 have died.  That doesn't mean that 25% are fatalities since the gap between the two continues to increase each day, but it does mean that the mortality rate is a true unknown at this point.  If the incubation period is as long as some researchers are suggesting, the mortality rate could indeed be higher than 2.2%.  Time will tell.


6. The possibility that 2019-nCoV was a pathogenic weapon released from a lab is not just a conspiracy theory from a dark corner of the web.  Members of the U.S. government, including Senator Tom Cotton, are entertaining the possibility.  It is true that China's one and only BSL-4 pathogenic laboratory is located in Wuhan (source).  And it was opened just five years ago.  The location seems almost too incredible for coincidence.  The New York Times has vehemently attacked the suggestion, but world renowned molecular biologist Richard Ebright suggested that an accidental escape of the virus from the lab could not be entirely ruled out (source).

What's going to happen?


To be intellectually honest, it's simply too early to make a firm judgment on this.  It seems almost a certainty at this point that Coronavirus will become a pandemic and with a growth rate much higher than H1N1 it could ultimately infect a large portion of the global population.

Best case scenario: the quarantine slows the spread dramatically and the mortality rate is under 2%, but the cat's out of the bag at this point.  It's going to continue to spread.  A lot.  A mortality rate of 2% would result in approximately 20 million deaths if Coronavirus spreads as much as H1N1.  If, by God's grace, we discover that far more were already infected and the mortality rate is in line with a severe flu, it could be several million.  Global GDP is going to be hammered by the outbreak no matter what.  Probably by at least .2–.4%.  Remember that China is one-third of global economic output and is suddenly at a standstill.

Middle scenario: the many, many videos showing people keeling over in streets, in hospitals, and in the marketplaces are an accurate reflection of the severity.  Anecdotal reports of crematoriums running at four to five times capacity add to the concern.  The mortality rate could be over 3% and the transmission virtually unstoppable.  Over 30 million could perish around the world if vaccines are not prepared in time.

Worst case scenario: the report of sulfur dioxide concentrations above Wuhan point to the unthinkable—mass death on a scale hardly imaginable.  It should be noted that the report of sulfur dioxide above Wuhan is accurate, the question is, why?  Mass cremation could explain the sulfur cloud.  Only one other city in all of China had a cloud of such magnitude when the image was taken on Saturday (source).  Reports that the disease is largely restricted to age-related fatality (similar to the flu) are inaccurate, as evidenced by the recent death of doctor Li Wenliang, the otherwise healthy 33-year-old doctor who died over 20 days after first reporting symptoms.  The incubation period is very long and the mortality rate is being significantly underreported, perhaps by 5–10%.  An untold number could perish and the global economy would enter recession within months as China's economic output remains halted indefinitely.

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