A year ago I started the blog in the hope of gaining a better understanding of COVID. For myself. To determine my attitude. That’s difficult. Experts are popping up everywhere, fighting for a place in the media and telling us how to act and what the others are doing wrong while a child can see that we know too little and fail to listen to each other enough for informed decision making.
It’s strange. But if you are looking for what you can do best yourself, individually, in a pandemic caused by a new virus, you are potentially doing the same as all the experts do. Try to understand and recommend to yourself what to do. You have to, if you don’t want to drift along with public opinion. But you don’t have to ‘tell you what I think you should do’.
That does not mean that I keep my thoughts secret. But what I come up with and report is not a recommendation or assignment. By the way, what could such a message be today, on February 14, 2021?
First of all, that I know very little about how COVID-19 strikes and will strike further. As a 75-year-old who weighs too much, I know I am one of the vulnerable. And also that keeping social distance and limiting the number of contacts helps to reduce the numbers of infections and deaths. And that vaccines became available in December 2020, at about the same time that viable mutations of the virus were noticed in England and South Africa. They don’t seem too different: slightly more contagious and possibly slightly less sensitive to the vaccines. Today there is another new variant on the news, a Brazilian one that is feared to turn out more dangerous.
I show the infection and mortality figures for the Netherlands in Fig. 1 and, additionally in Fig. 2, these figures for England, South Africa, Brazil and New Zealand.
There are four verticals in Fig. 1, at April 3, July 3, October 2 and December 31. I remember what I knew and thought about COVID in the Netherlands on those four days. I imagine that on every vertical the right part of the figure is a white spot. Each time I can look at the past and try to sketch for myself what would happen after such a moment without looking ag it. At those moments the graph stopped at the relevant vertical line. I had to shape the future according to what I knew or could know, not only about the virus, but also about how people reacted.
On April 3, I see the panic caused by the exponential rise in deaths and hope that the measures taken two weeks before will work. Expect that will be so, also given the experiences in China.
On July 7, I think we have had the worst and am convinced that with our behavior we can get and keep the virus under control, and that we actually do control it for the most part. I have doubts about a counter cyclical policy approach because it assumes that there is a broad understanding and awareness of what exponential diffusion means, while there is no trace of such in the public debates.
On October 2, I noticed how difficult it actually is to achieve the discipline required for effective counter cyclical policy and expect an intelligent or non-intelligent lock-down in the near future.
On 31 December that lock-down is in place and the number of infections will shrink again while the numbers of deaths continue to grow for some time. I am concerned about the combination of the advance of the new English variety, the possibility of constantly emerging mutations, whether the existing vaccines will cope, and if so, whether they will be available on time and will be acceptable to the public.
In Fig. 2 I show the COVID-19 silhouettes of four countries for comparison. Numbers are harmonized per million inhabitants. The black line represents the deaths per day and the red the registered infections divided by 33. If you try the same reading of these graphs as in fig. 1, you will see that Germany and New Zealand were attacked by the virus at approximately the same time as the Netherlands and experienced a first wave. The differences in harmonized numbers are striking: the Netherlands, Germany and New Zealand have 90, 30 and 3 deaths per 10 million inhabitants per day respectively at the peak of their first wave. In New Zealand, the pandemic was immediately brought under control with strict measures and is now, after society reopened there, closely monitored and brought back into lock-down where necessary (as in Auckland today after the discovery of three infections).
The number of registered infections is not a very reliable indication of the actual number. And the structures of the graphs do not allow for solid insights either. Most guidance comes from the mathematics developed around epidemics: the so-called SIR-related models. In those models, the pandemic spreads exponentially as long as there are enough potential victims who are not yet immune. After that, the pandemic will end with these numbers declining. Immunity can arise from previous infection or being vaccinated. SIR-related models can be used to measure key figures of how the virus develops, assuming that the virus is stable and does not mutate and, moreover, that these numbers are measurable (for example, when it comes to asymptomatic infections).
Another approach tries to influence the curves of this math by measures that curb contact contamination. This was preferred with the considerable mortality rates observed during the first wave. Sometimes halfheartedly (as in the Netherlands, South Africa and Germany), sometimes rigorously (as in New Zealand), sometimes not or reluctantly, as in Brazil.
Incidentally, the emergence of new viable mutations in England, Brazil and South Africa is remarkably well in line with the evolutionary-biological assumption that the chances of the emergence of new viable mutations are larger where a lot of virus reproduction is going on.
It is clear that there are differences of approach in different countries. It is arguable that an anti-cyclical approach really only works with great awareness and immediate severe intervention at the very beginning of an outbreak. It is now also arguable that this approach is not considered acceptable everywhere. And then the emergence of divergent conspiracy theories must be noticed, with narratives that encourage rejection of measures and / or vaccines or even of science tout court.
Understanding the whole thus becomes a matter of understanding mixed virological-socio-legal-economic complexity. With that realization, I move on to the second phase of my project with confidence. After all that is what I expected at the outset.