Recent articles in Science Journal and Nature reference statistical models that predict the current surge of the Covid-19 virus will result in anywhere from 600,000 to 1.6 million deaths. The scale and duration of this surge in China are also bad news in the global battle with the Covid-19 virus, as the predicted infection rate of close to 1 billion people in China will provide the virus a vast sandbox for further mutation (especially the incubation afforded the virus in immuno-compromised individuals). This “mutation surface” (to leverage a framing device used by the cybersecurity community) will most likely extend the threat of new variants and related societal impacts (and thus the cumulative total duration of this pandemic) well into 2023 – and possibly beyond.
From Science Journal:
“A study based on vaccination rates in March, published in Nature Medicine in May, found that lifting zero-COVID restrictions at that point could ‘generate a tsunami of COVID-19 cases’ over a 6-month period, with 112 million symptomatic cases, 2.7 million intensive care unit (ICU) admissions, and 1.6 million deaths. Peak demand for ICU beds would hit 1 million, more than 15 times the current capacity. The unvaccinated would account for 77% of the fatalities, according to the authors, primarily at Fudan University. Boosting vaccination rates could slash the toll, but China’s elderly population has remained wary of vaccination. Even today, only 66% of those ages 80 and older have received two doses—versus 90% of the population as a whole—and just 40% have taken boosters.” (1)
“Up to one million people in China could die from COVID-19 over the next few months, according to some of the first projections since the government lifted many of its strict ‘zero-COVID-19’ measures. ‘There’s no doubt that China is in for a bad couple of months,’ says James Wood, an infectious-disease modeler at the University of New South Wales in Sydney, Australia. A new study released on 28 November by Airfinity, a London-based health analytics firm,…COVID…could cause between 167 million and 279 million cases and between 1.3 million and 2.1 million deaths over 83 days, according to the report.” (2)
How big will the death toll be in China?
The Washinton Post’s Joel Achenbach also synthesized some of the findings in the Airfinity study:
“Outside experts observing the outbreak are predicting hundreds of thousands of deaths in the coming months. Several modelers predict more than a million covid deaths in China in 2023. The caveat: Modeling is an inexact science, and there are many variables in the equation that could push the death toll up or down. Airfinity, a company based in the United Kingdom that analyzes data in the life sciences for its clients, has projected 1.7 million deaths by April. ‘That’s 1.7 million within the space of four months,’ said Louise Blair, who heads the company’s epidemiology team, emphasizing the ‘very steep growth’ of cases.
The company’s modeling relies heavily on the example of Hong Kong, which had a rapid explosion of illness and death in early 2022 when the omicron variant arrived. Hong Kong, which had low vaccination rates, had maintained a zero-covid policy that mirrored that of the mainland but was unable to contain omicron’s spread. The Institute for Health Metrics and Evaluation (IHME) at the University of Washington has modeled the outbreak and forecasts 300,000 deaths by April 1, and 1.25 million by the end of the year — or as many as 1.6 million if there are no more mandates and restrictions, said institute epidemiologist Ali Mokdad.” (4)
How to think about the validity of the infection rate in China
WP’s Achenbach also provides this perspective on the infection rate in China relative to numbers that can be validated in the U.S. during previous surges:
“Jeffrey Shaman, an epidemiologist at Columbia University who has been studying the pandemic from the beginning, said in an interview that he expects something like 600 million to 900 million infections in China in 2023. The death toll depends on the infection fatality rate of the virus, which is the ratio of deaths to infections. The rate is difficult to calculate. Infections often go undetected or are misdiagnosed, and deaths can be misattributed. The rate also shifts over time depending on levels of immunity, which can rise with vaccinations or fall because of the natural waning of antibodies. By Shaman’s estimate, the current infection fatality rate in the United States is about 0.15 percent. If that holds true for China and his estimate of infections proves accurate, that would lead to a death count between 900,000 and 1.35 million.
“But Shaman points out that there are variables that could drive the infection fatality rate higher or lower. There is a lingering concern, for example, that Chinese vaccines are not as effective in preventing severe disease as vaccines used in other countries. ‘We’ve had so little information coming out of China as to what’s actually happening,’ he said. ‘Do we really have any idea what’s going on there?’ World Health Organization officials received a briefing from Chinese health authorities on Dec. 30 about the country’s evolving strategy for managing covid. During the meeting, the WHO urged China to share information about the outbreak, including genetic sequencing data and vaccination rates, especially in vulnerable people and those over 60 years old.” (4)
ZERO TO 100: The Public Health Company PHC predicts global disruption resulting from China ending its “Zero COVID” policy
We introduced OODA Loop readers to Dr. Charity Dean in our February 2022 post Future Pandemics and Managing the Exponential Risk of Infectious Disease. Dr. Charity Dean is a central character in The Premonition, Michael Lewis’ fantastic book about the early months of the pandemic. By the time we were in the early stages of crisis management, Dr. Dean found herself at the center of the pandemic response for the State of California (first as the Acting State Public Officer and then as the Assistant Director of the California Department of Public Health). The timing of her resignation from her position with the State of California is very telling: July 2020. Her frustration and reasons for her resignation are discussed in The Premonition.
Based on her experience, Dr. Dean was approached by venture capitalists and has shifted gears to a private sector response to public health. Her start date as CEO of The Public Health Company was August 2020. Dr. Dean and her team have already generated solutions-based white papers for public consumption. One of their first white papers, How is your Business Managing the Exponential Risk of Infectious Disease? is a great place to start when assessing your organization’s current position vis a vis the ongoing pandemic and future resources and responses.
A couple of weeks ago, Dr. Dean and her team at PHC released a 3-page pdf that briefly itemizes their assessment of the impacts of the current surge in China. The full pdf can be found here. Following are some of the vital excerpts from the document:
“The sudden reversal of China’s Zero COVID policy and lack of a robust vaccination strategy has enabled rapid, widespread transmission of COVID-19, with the potential for major global health, business, and economic impacts extending throughout 2023.
How this will unfold
Global disruption from December 2022 through much of 2023 is expected due to China’s position as a labor and manufacturing hub for global economies. An expert within the China CDC projected 60% of China, or about 10% of the planet’s population, may become infected in this first wave of infections over the course of the next 90 days. Up to 1 million deaths are estimated in China by the end of 2023 if COVID-19 spread remains uncontrolled. China’s health system will struggle to provide quality healthcare. Lack of access to medicines and healthcare will result in more severe cases and deaths, creating short-term labor shortages and manufacturing delays during a time of increased global demand for medications (e.g., seasonal cold and flu products), disposable medical products (e.g., respirators), and myriad other products. The surge in Chinese cases will likely unfold in three waves. The first in Beijing and Shanghai – ongoing now – with approximately half of Shanghai’s 25 million population forecasted to be infected by the end of 2022.
The second wave has already started and will continue to grow exponentially, primarily impacting large urban centers in the Zhejiang, Guangdong, Henan, and Sichuan Provinces. The third wave will likely peak in February and early March, predominantly in outlying rural areas following widespread travel for the Lunar New Year. The impending Lunar New Year travel season is of added concern since it begins in mid-January and is characterized by mass travel with over one billion passenger trips recorded in 2022. Without substantial government intervention, COVID-19 will continue to spread in waves across the country and, potentially, the world. Rapid infection from person to person in a large population makes the emergence of new variants that may evade immune protection more likely. Countries with the highest risk for early exposure to emerging variants outside China include those with significant air travel connectivity to Beijing and Shanghai, notably the US, Japan, the UK, Canada, Australia, Singapore, South Korea, Germany, and New Zealand.
What business leaders can do about it
To mitigate risk to employees and their families, consider:
- Delaying in-person work requirements in regions with severe impacts. Forecasting is an offering of PHC on the PHC Pharos™ platform;
- Remain flexible and responsive to work-from-home and sick leave requests;
- Implement regular testing for in-person work;
- Enforce the use of high-quality respirator masks; and
- Support being up to date with all recommended COVID-19 vaccines.
To mitigate risk to enterprise operations:
- Procure reasonable supplies for the next 4-6 months without stockpiling;
- Adjust business forecasts assuming supply delays and price increases; and
- Pivot to alternative suppliers outside of the region.
- Monitor global and domestic locations of interest while simulating outcomes from various future events to better understand the risk of travel and gatherings. PHC offers a Scenario Management module on the PHC Pharos™ platform;
- Consider purchasing travel insurance for the first quarter of 2023 until the situation has been clarified; and
- Ensure bio-threat resilient business plans are up-to-date and operational.” (3)
- Domestic U.S. risk awareness regarding the current surge of the highly transmissible and immune system-evasive XBB 1.5 variant: We based our timeline for the duration of this pandemic on the expert advice of journalist Laurie Garrett (“I’ve been telling everybody that my event horizon is about 36 months, and that’s my best-case scenario,”), We have used this 36 months event horizon as the timeline of this pandemic on which to base strategic risk assessments. Unfortunately, the harsh realization (as validated by Dr. Dean and her team at PHC) is that 2023 will be marked by a prolonged period of further “multiplier effects” coming out of China ( supply chain disruptions, possible future surges based on new variants, etc.) that will put us outside of Garrett’s 36 months/best case scenario. Like this post, we will continue to track and post about these impacts as they manifest.
- And there is no time like the present: In a tweet last week, Dr. Ashish Jha, the White House’s COVID czar, called XBB.1.5’s rapid U.S. rise “stunning.” See the information-packed Twitter threads below.
Over the holidays, you may have heard about Omicron XBB.1.5
It went from 4% of sequences to 40% in just a few weeks
That’s a stunning increase
So what does it mean? Will it cause a wave of serious illness and death?
Here's what we know, don't know
— Ashish K. Jha, MD, MPH (@AshishKJha46) January 4, 2023
Wow. XBB.1.5 more than doubled across the United States in 1 week, now ~40%, out-competing all variants pic.twitter.com/PeE8P7eAeH
— Eric Topol (@EricTopol) December 30, 2022
The Long View
Our analysis (above) in February 2022 of the lessons learned from the Covid-19 pandemic was an effort to shift gears in our analysis of the future of this pandemic and the threat of future pandemics. We were experiencing a saturation in coverage of the pandemic at the time, which had contributed to burnout and frustration for everyone. We wanted to pivot and provide an analysis of positive, future-forward, solutions-driven issues surrounding the pandemic and future pandemics. We felt it was time to start looking forward in a positive fashion. And we still plan on research efforts in this vain in 2023. Our initial analysis:
- A Huge Dataset and Vast Experiential Learning: At the risk of sounding a bit maudlin, the major silver lining of this pandemic is that it has generated a huge digital dataset and real-world case studies that can be used to prepare for what experts predict will be more pandemics and outbreaks. It is not a question of if but when. We did it the hard way, but we now have a baseline of a variety of fascinating datasets and tools on which to build a future strategic response.
- Encouraging New Strategic Efforts Have Begun: We initiated the pivot in our coverage of the pandemic with an analysis of this promising, vital project: Inspired by COVID-19 High-Performance Computing Consortium, Cabinet-level National Science and Technology Council’s Blueprint for a National Strategic Computing Reserve.
- Dr. Charity Dean and The Public Health Company: Dr. Dean and her team provide an overview of what they term “biosecurity threats”, with the following factors and recommendations:
- Disease behavior and characteristics: As traumatic as the COVID experience was for most, it was simply a dress rehearsal for the real thing – the “next big one” may in fact be much bigger. Although we can’t predict exactly what the next crisis will look like, we do know the underlying drivers of biosecurity risk are increasing rapidly, and it’s unlikely the next crisis will look exactly like the current pandemic. This means the specific actions taken to contain COVID-19 may be ineffective for other pathogens, and businesses will need broad resilience and rapid response capabilities to persevere. It will be critical to establishing a systematic process that has the flexibility to respond to many types of biosecurity risks.
- Underappreciating Exponential Risk: One clear roadblock preventing society from forecasting catastrophic risk is the inability of the human brain to accurately assess the risk of exponential growth. For example, in a well-known survey, when given the option of choosing between taking either (1) $1 million today or (2) a penny today that doubled each day for a month, 90% of respondents chose to take a million dollars. Yet, mathematically, a penny doubling every day would be worth $10 million after a month, highlighting the bias people have in underestimating exponential growth. Another example of society’s inconsistency to evaluate exponential risk is the way businesses use insurance. Insurance is a popular tool for perceived risks even where both the probability and value of loss is low (e.g., airline flights), but what insurance or resilience measures does a company have to protect against another biosecurity event that has previously threatened the entire viability of their business?
- Medical options to fight disease: The scientific response to COVID has been nothing short of a medical miracle. The speed of vaccine development shattered any reasonable expectation, and the deployment of those vaccines is what will allow us to overcome the pandemic. Decades of scientific research in public and private sectors, and partnerships that brought vaccines to production and distribution rapidly, gave us the medical countermeasures we needed.
- Public health infrastructure: The majority of the focus (and funding) centers on science, whereas public health infrastructure and capabilities are the overlooked “blocking and tackling” function. It is incumbent on private sector leaders to ask themselves whether they should take some ownership for the public health sector – particularly since they are liable for its failures.