Saturday, March 14, 2020

The two approaches to the Corona virus

The Western approach to Covid-19 is fundamentally different from that of China.

China treats Covid-19 as a kind of serious disease that must be eradicated. Just like you do with SARS or Ebola. Everyone who is contaminated is isolated - even when he doesn't have symptoms. And when you do that long enough the last patient will recover and the epidemic is stopped.

The West sees Covid-19 more as a kind of flue. It is impossible to stop the flue: it is too contagious and too many people who are contaminated don't show symptoms. Every year sees a new kind of flue. And in some years it is more lethal as in others. This happens usually when a new strain of virus appears. The Spanish Fever of 1918 and the Hong Kong flu of 1968 are good examples. Covid-19 is not some kind of Influenza virus. However, there are several Corona viruses that cause some kind of innocent cold.

So the Western assumption is that "everyone" will get it. Think of Merkel saying 70% of the population will get it and Rutte talking about 50%. The main issue in this vision is to slow down the epidemic so that the health care system doesn't get overwhelmed - as happened in Italy. So unlike in China the goal is not to stop the epidemic but to slow it down.

Both approaches have their risks.

In the case of China the main risk is that the epidemic will start again once the country restarts to function normally. Or that it will start again in the autumn if like the cold it is connected to the season. Officially less than 100,000 people were contaminated until now so the overwhelming majority of the population didn't build any resistance. When the virus reappears the 6 week lock-down would have been almost for nothing. What might change the picture is a vaccine. But until now this isn't available.

The Western approach takes it for granted that there will be casualties. But the number of casualties can be limited with good care. And there is a problem as it is very hard to predict how quick things will go. Nobody foretold the quick escalation in Italy. Many Western governments take a wait-and-see approach rather than being pro-active. Yet there are quite a few things a government can do:
- make testing easy and make the threshold low. Make it also quick. In some countries you need to wait a week for the results. That is not good.
- tell anyone who tested positive to self-isolate. Provide services for those for whom self-isolation is problematic.
- test anyone coming from high risk countries and tell them to self isolate for some time.
- take care that you have enough of everything you might need when the epidemic strikes in full force. Hospitals should be well stocked and its staff well-trained.
- things can get out of hand like in Italy. People who get Covid-19 in combination with pneumonia need two to three weeks of intensive care. So plan where you could put extra IC beds, how you could mobilize extra staff and what other things you could do.
- there will always be bureaucratic obstacles. It has been widely published how Chinese officials initially tried to suppress the news. But similar bureaucratic obstacles happen in Western countries too. In the US Trump's obstruction is well known. But there was also the case of the CDC that had problems creating its own test yet blocked the use of other tests. In fact the decentralized nature of Western medicine makes it more likely that bureaucratic problems will arise. It takes planning and effort to overcome such obstacles in the fight against the virus. This should be addressed before a crisis arises.

Apart from the fact that it requires serious preparation the success of the Western approach depends on how aggressive the virus really is. At some point the number of new cases exploded in China and Italy. Within days it went from tens to hundreds. But in both cases it is suspected that the virus had been around for weeks or even months. The problem with a severe Covid-19 infection is that the weakening of the patient causes other illnesses like pneumonia. So it is easy to label the illness just as pneumonia and overlook the virus. In the meantime nobody knows how many people have the virus but show no symptoms.

Here is the most extensive description I found of the treatment of Covid-19.