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The truth about COVID-19 statistics, death rates, cases in the community - impact on business, public health, government policy and wider world

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What is the truth about actual numbers of people in different nations who have already been exposed to Coronavirus and had very mild COVID-19 illness, possibly now immune as a result?  

I am writing as a physician and Futurist, as an advisor to many pharma companies, governments and other industries, and as someone who for over two decades has repeatedly warned of huge risks from new viral pandemics. (Updated August 18th 2020)

Statistics are very confusing.  Here are some important facts...

The rate of new infections is slower than expected (doubling time) 

In March, most nations were reporting that numbers of new infections were doubling every 4-5 days.  This is a critically important statistic.  To compare, HIV cases of new infection at the height  of the global AIDS crisis in the early 1990s, were doubling every 12 months.  

With 10 doublings, a single case becomes 1000; or 1000 becomes a million; or a million becomes a billion. So a COVID-19 doubling time of 4-5 days was extremely serious. Even worse in London, where the doubling time was just 2 days.  That's 40 days to go from a single case to a thousand, and from a thousand to a million in less than 3 months - which is what happened.

However, when you look at WHO charts for all nations of the world from April to August, you can see that doubling times have stabilised in most places at around 20 days or longer.  

That's a radical slow down for reasons that are not clear because it's the same in emerging markets, in megacities with dense slum districts where lockdown has been impossible.  And even where lockdown has been hugely relaxed, we are seeing pockets of new local infections, but massive second waves have been slower to get going than many experts feared.

You might think that the figures are all wrong anyway and such nations may only be detecting a small proportion of cases.  While that may be true, so long as that error remains consistent, the trend appears to be valid.

One key reason for the global change may be that the virus is continuing to mutate.  With most viral pandemics, the virus tends to weaken as it spreads, becoming more effective in transmission, killing fewer carriers.  Indeed the most lethal new viruses we see each decade tend to be wiped out fairly rapidly, because those infected tend to die before many others are infected. The greatest spread tends to happen with viruses that produce only mild symptoms or none, but are highly infectious, so people carry on as normal at home and at work, shedding virus widely.

Tests for coronavirus can miss 30% of COVID-19 cases

Recent research suggests that negative tests don't mean as much as you might think.

The reason is that the test is for fragments of virus which are hard to detect, even more so when the immune response begins, which happens just a few days after symptoms develop.

Failure to detect people who are indeed infected is a nightmare for hospitals trying to separate sick people into infected or non-infected, especially for units like dialysis for kidney failure, where a single infectious patient who is missed can result in major contamination.

Tests for antibodies can miss 66% of those recovered from COVID-19

Recent research suggests that antibodies tests may miss two out of three people who have recovered from COVID-19.  

The reason is that a very important part of immune responses to the coronavirus is delivered by a type pf white cells themselves, called T-cells, rather than by antibodies made by white cells.  These T-cells are not detected by antibody tests.

By early July 2020 in London for example, 17% of the population was testing positive for COVID-19 antibodies, but that would suggest 51% of the population had actually been exposed to coronavirus by then.

The reason this is so significant is that most experts agree that once levels of previous exposure to any infectious virus reach around 70%, spread tends to slow right down.

Of course, this assumes that exposure in the past will protect you in the future which was still unclear on that date.  (See below)

80% of coronavirus pandemic infections do not cause any illness

An important study of over 3000 people on a cruise ship found that 80% of infections with coronavirus did not result in COVID-19 symptoms.

Symptoms can be vague and non-classic eg aches, diarrhoea, tiredness, hoarse voice etc without fever or cough

Many other types of coronavirus infection produce only short term immunity

With every week that goes by, our knowledge of COVID-19 increases dramatically around the world, with tens of thousands of researches and billions of dollars being spent.

The most important question we face is whether people can become sick more than once with COVID-19.  

In other words, do the antibodies continue to circulate permanently after exposure?  Do T-Cells remain permanently on guard against another attack?  

Many other coronaviruses produce only short term protection, so someone can get the same cold for example, year after year.

These questions really matter for vaccine production too: because it might mean people have to be vaccinated over and over again to stay safe.

Previous infection by other coronaviruses may help protect against COVID-19

Since March 2020 we have been seeing hints that previous exposure to other similar viruses may help protect you from becoming sick with COVID-19.

And research published in CELL journal showed that serum from people who have been exposed to common cold viruses has some reactivity against the coronavirus causingCOVID-19.

Other studies in Nature and Science Journals also suggest cross-reactivity in T-cells and antibodies between common cold coronaviruses, the 2003 SARS virus and the COVID-19 virus.

Of course this could help explain a number of things - which don't make sense when we just look at differences in degrees of lockdown etc:

  • Why some populations from different nations appear to have lower infection or mortality rates than others 
  • Why in many towns and cities we have seen very rapid spread, slowing right down long before 60-70% are infected (so called herd immunity)
  • Why these slowdowns seem to be happening independently of lockdown etc
  • Why children seem to have a degree of immunity in many nations and even when infection takes hold, illness usually very mild
If recent exposure to common colds do indeed help strengthen immunity against COVID-19 illness, then it raises the possibility of trying to deliberately spread common cold viruses, as a kind of natural low-grade vaccine.  No clinical trials would be needed. Cold viruses have probably been around for thousands of years.  However we need to be sure that pre-exposure to common colds does not risk a major immune over-reaction in some people.  More research urgently needed but we will have answers to most of these questions by November / December 2020.

What does all this mean?

Implications of all the above are very important - if all above confirmed:

  • Spread of coronavirus pandemic is likely to be far wider than most people realise
  • This is especially the case in nations with limited testing capacity
  • And "natural immunity" may be greater than we think, making mild disease or no symptoms more likely
  • This means that recorded death rates / thousand people infected may be too large by a factor of 5
  • So a nation that thinks 1% of those infected are dying, may in fact only be seeing a death rate of maybe 1 in 1000 or less 
That's really good news if it's confirmed that the mortality rate from infection is far lower than feared, particularly as we know that 80% of deaths in most nations are in those over the age of 75, and are rare in those under that age unless they were at significant risk of dying anyway from multiple other serious medical problems.

What COVID-19 seems to be doing mainly is shortening the life by a year or two at the most, of many elderly people who already had a short life expectancy because of existing ill health.

One thing is clear

85% of people on the earth live in emerging nations, most of whom are on very low incomes, in nations with very low health budgets and little capacity to effectively lock down whole populations.

With densely packed communities in their cities, spread of the pandemic in most of the global population is likely to be rapid, relentless, impossible to resist, resulting in huge short term impact, but also short term recovery.

Vaccines against COVID-19 likely to be too late for most of humanity

The fastest we have ever developed any vaccine before has been four years. But what if we could develop one and prove it works in just 4 months from now?

For most of the world, any such vaccine would still come far too late, even if one is proven to be working by mid to late Autumn, with all the problems of funding, access and scaling up for 7.8 billion people.

To be realistic then, a vaccine would only be likely to have value to most of the world's people if we find that natural immunity only lasts a short time, but also find that a vaccine creates lasting immunity.

Humanity remains vulnerable to many new viral pandemics

We see on average one important new mutant virus every year - 2003 saw SARS and Bird Flu fro example.  So the risks are just as high as they were in the past few years for more pandemics.  

But as the global population soars from 7.8bn today to 11.5bn in 2060, and as more migrate to densely packed cities, the risks will increase.

And every time, unless something changes, we will have to start from scratch to develop a new vaccine.

But there is an answer: one that has been almost completely neglected since the discovery of penicillin in the 1940s.  

We still lack a single antiviral medicine that is as effective against any type of virus as penicillin was against bacteria in the 1940s, and other antibiotics since. 

The real answer to more viral pandemics is effective antiviral medication 

We urgently need a wide range of effective antiviral medicines, as weapons against future pandemics, that can be used immediately in hospitals around the world.

Expect therefore, alongside vaccine research, huge global investment into antiviral medicine.

Our world in 2020 deserves better than this. We have 80 years of wasted time to catch up on.

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