TLDRUpFront: The outbreak of a novel coronavirus in Wuhan province of China has resulted in 2,000 confirmed cases and as many as ten times that number may remain undiagnosed. China has quarantined 50M people in an effort to halt the spread even as the country is on the move for the New Years. As alarming as all this sounds – its important to understand the structure within which viruses operate and take this information in context. We’ve included links to two analytics dashboards tracking both confirmed cases and risk of contagion, as well as an interactive educational simulation of a virus’s behavior.
Cause for concern, but not alarm.
FullContext in the Back:
Beginning in late December a novel coronavirus emerged in Wuhan province in China. Only a dozen of original infections were monitored from an outbreak believed to have centered on a food market, indicating possible animal-to-human transmission. This is why the outbreak caught immediate attention from Chinese health officials, the World Health Organization (WHO), and Centers for Disease Control (CDC). Animal-to-human virus transmissions are concerning because when a virus previously limited to one species obtains enough exposure, or mutations, to allow it to crossover to another species the new species has little in the way of existing defenses. (1) Considering a ‘human’ defense to viruses is our adaptive ability to create antiviral treatments, a novel virus presents the challenge of a difficult development cycle to find the right treatment and then the time of testing, determining efficacy and administering. Examples of these crossover viruses which began in one species and switched over to humans include HIV/AIDS, Ebola, SARS, H5N1 and about half of all Hollywood pandemic movies.
We have nothing to fear, but Facebook itself
This is important to remember. The range of human impact of these crossover viruses can be from a few thousand (H5N1) to hundreds of millions of HIV/AIDS. And the incubation to symptomatic period can be from a few days (Ebola) to years (HIV/AIDS). But only in Hollywood do these factors typically combine to result in a pandemic that threatens to wipe out the planet unless plucky ex-CDC Grandpa Smurf Dustin Hoffman saves the day, all in under two hours. Before the crowd spreading “WWIII!” memes just a few weeks ago stirs the social-media pot spreading “Pandemic Take Cover!” memes let’s inject a little context into the soup.
Even though viruses themselves have a bewildering array of genetic configurations and pathways, at the level of a system they all operate in a simple structure. I’ve linked an interactive educational simulation, used to demonstrate the spread of Flu in a classroom, to help illustrate these basic elements.
Known as the “SIR” model, this method of understanding contagion has been well studied for decades in epidemiology. SIR stands for Susceptible, Infected, and Recovered. These are the three states (or “stocks”) which a population passes through during an outbreak as shown below. (2)
System structure of viruses, circa 2016, colorized. Dustin Hoffman not shown.
The movement of people from one state or stock to another, along the flows of Infection Rate and Recovery are determined, in simplest form, by three factors. Contact Rate, Infectivity, and Recovery Rate. These are the frequency with which people interact with other people, the ease of which an infected person transmits the virus to another, and the time it takes to recover from the virus and no longer be infecting others.
The three factors combine in unexpected ways. A high infectivity rate and contact rate sounds terrifying but is more likely to “burn out” the virus in a local area before it can spread broadly. The ‘super virus’ drained the immediate Susceptible stock turning them all into Infected who are on the pathway to recovery. With no people remaining in the stock of Susceptible to replicate upon replication opportunities dies off. The premise of vaccination through herd-immunity is to introduce a weaker-than-normal disease or virus to as many of the Susceptible population as possible so that they all move quickly through Infected and into Recovered. When an outbreak of that type shows up later, there’s too few in the Susceptible stock, such as people who may be immunocompromised or unable to take the vaccine for medical reasons, that despite Contact Rates and Infectivity the virus can’t “find” them among the much larger Recovered population.
There are more complexities to this in the actual SIR model, this is a classroom example. For example, the duration of infection before recovery, the delay between infection and evidence of symptoms all matter a great deal. But the simulation is interactive – follow the link and play with your own combinations to see the general effects play out.
This is why although paying appropriate attention is fine – engaging in panic right now is premature. We don’t know yet enough about the outbreak, which is just in its early stages.
The Wuhan Outbreak
With this structure in mind we can turn to the specific outbreak with greater context. Because the location, circumstance, and limited resources available to manage the outbreak are causes for concern, just not panic.
The outbreak occurred in Wuhan a city of 11M people which is the capital of Hubei province with 60M people. That’s a large initial population in the Susceptible stock. Although it took several weeks for the virus to grow beyond its initial outbreak group who all had proximity at the live-animal food market its growth has a doubling function of two days. In other words, it took only two days to grow from 500 to 1,000, and another two days to grow from 1,000 to 2,000 confirmed cases. We can see this in two charts, one of which shows the breadth of the entire contagion and another just focused in the last few days. (3),(4)
Confirmed Cases – Two Weeks
Confirmed Cases – One Week
This is the power of compounding growth acting upon that large initial Susceptible population. Even if Infectivity and Contact Rate are initially low, the more people who become Infected the greater the chance they spread it to more people, who have their own Contact Rates, introducing it to an ever-larger population. This growth pattern is not atypical for virus infections (see the interactive model above.)
The timing circumstance of this virus which ads an additional level of concern. And that’s because hundreds of millions of Chinese are on the move for annual celebrations of the New Year, which occurred Saturday the 25th, but often involves a full week of festivities, travel, and visits. This means the Contact Rate of that Infected population is not limited to Wuhan or even Hubei province and may rapidly spread to new populations. This then repeats the pattern as the virus takes hold in a new population with a large Susceptible population.
The final cause for concern are questions about the Chinese government’s ability to effectively respond to the crisis with sufficient resources. When SARS broke out China was roundly condemned for not being transparent, hiding crucial information that hindered responses. And although the communist government is being more forthcoming this time – there’s real questions on whether China can contain and respond to the outbreak.
One part of their response is to reduce the Contact Rate through travel by quarantining the cities where the virus has appeared. This effort has already gone well beyond the Hollywood depiction of a small California town enclosed. A dozen cities, with more being added every day, are being restricted in travel. (5) The 50M people impacted, in raw numbers, would be similar to the United States quarantining the population of Texas and Florida. And while the rest of us might cheer in that case, freed from the tyranny of Aggie references and Florida Man depredations, it conveys the difficulty China is facing. Even though China is much larger than the US, proportionally it would be similar to quarantining all of Los Angeles. And I’ve seen that movie many times, it never works.
Worse is that the impacted areas don’t have enough resources to respond to the crisis. There aren’t enough beds, testing equipment, or protective gear for the health care workers to respond too. Getting infected patients to a controlled environment reduces their Contact Rate while surrounding them by staff fitted with the right kit reduces the Infectivity factor in the models above.
Because there aren’t enough beds, local officials are advising all but the most serious cases to stay at home, self-quarantine and ride it out. (6) But this doesn’t reduce their Contact Rate and their Infectivity stays high. Because the cities are cut-off and everyone staying at home, services are running low with reports of basics like food being hard to acquire, and this reduces Recovery rates by weakening the bodies system while it’s trying to fight off the virus. (6)
If only the most serious cases are being tested, the number of infected could be well low of the actual number. NorthEastern’s Laboratory for Modeling of Biological systems has estimated that the period between infection and demonstrating symptoms may be as high as 10 days. From this they estimate that the actual infected population may be 10x higher than currently reported, closer to 20,000 than 2,000. (7)
And even when a serious case reaches a hospital, shortages in proper protective gear mean that many hospitals and clinics can only protect the workers directly working with the patients. Reports of plastic sheets and garbage bags being used as a substitute have emerged. (6) This reduces the effectiveness of hospitalization to reduce Infectivity through proper procedures, and worse, concentrates new infections within the very healthcare community that must respond to the crisis.
Local and national officials are doing what they can with what they have. This includes building a hospital overnight to house new patients in Wuhan and workers at protective gear plants to return home for emergency shifts during the holiday. (8) But the systemic issues of a one-party centrally planned government will be put to the test. China has planned its economy in five-year increments going back to 1953. And unless the Thirteenth Plan (2016-2020) work breakdown structure includes “novel coronavirus outbreak” it’s going to be time to improvise. Waiting for the Fourteenth Plan won’t cut it.
But the countries ability to respond has improved over the years as market demands have it to shift from simple mass production into fast-changing supply lines and technical design. When Apple wants a new screen, some Chinese factories are able to retool the entire design process in under a day. If government and producers can quickly arrive at an understanding China has more than enough productive capacity to fill these gaps. If they can pick the right ones and distribute them to the correct places. And with a history of top-down finger-pointing in the party the question arises whether local officials will be willing to admit challenges to central offices.
Data for Education, not Fear
The global risk of the novel coronavirus is hard to estimate at this point. Key elements of its infectivity, transmission pathways, lethality, and recovery periods just aren’t known. We’re including two interactive dashboards below (click on the pictures to go directly to the dashboards.) The first, hosted by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) tracks the confirmed cases worldwide. You can zoom into any region, scroll across the globe, and track what’s “known” based on official reports. The second tool, from the NorthEastern Modeling Biological Systems Labs tracks the “risk” of contagion to countries based on scheduled flight routes and normal travel patterns, noting which countries have already received cases. As the virus spreads, risks to areas originally unconnected to China by direct travel risk contagion by proximity to those who do. (4),(7)
Dashboard of Confirmed Cases, JHU (click to follow)
Dashboard of Contagion Risk, Northeastern (click to follow)
But a single or few cases in any one country is not cause for panic either. First, the virus manifests a form of pneumonia, which though worrying and potentially life-threatening, isn’t as lethal as the Ebola virus. Second, the factors of concern in China are not going to be the same wherever it goes. The rest of the world is not celebrating the Chinese New Year for example, nor are cases in the United States likely to suffer from inadequate healthcare resources or gear unless things get much worse than they are. The ability to identify, isolate, and aid Infected patients increases Recovery rate while reducing Contact and Infectivity. Add to this that most of China’s travel is into developed economies, where these resources exist. The virus landing and taking hold in a developing or undeveloped economy may create real problems, but so far that doesn’t appear to have happened.
This is all said in the context of an unchecked pandemic being my number one concern for the next ten years as I responded to an Ask me Anything question about “what keeps you up at night” on New Years Eve:
“Antibacterial resistant bacteria and antiviral resistant viruses, or new viruses we struggle to make the antivirus for. This is the top of my list, where for many others it’s climate change…we are well equipped evolutionary and materially to adapt and engineer responses to climate change, as we have as humans for thousands of years. In contrast, we’ve only been able to master disease and infection within the last 100 years or so. Pandemic infections without effective treatments we’ve developed can easily wipe out 5%, 10%, or 20% of the population in a year or two. There is no threat we face, short of a meteor strike or nuclear war that can cause so much death so quickly. And in a highly coupled world such massive death would have enormous consequences.”
But being concerned by a thing is different from being panicked by a thing. The tools above are useful for monitoring and tracking, but I wouldn’t recommend going out and stocking up the doom shelter just yet.
A greater risk, though not for most reading this, is that the virus will be contained globally, but in doing so the Chinese government mishandles the response locally. This was similar to SARS, an outbreak that killed thousands in China but few elsewhere. When asked about instability risk around the world in 2020, my New Years Eve forecast China was that there was little risk barring one contingency:
“So as long as economic growth remains high, I think the contagion risk is low. If there is mass-instability and civil unrest in China, my forecast is that it doesn’t arrive via Hong Kong….I think instead if there are to be mass-protests or instability it’s going to arise from an entirely domestic, corruption or incompetence-of-government based grievance…which sparks protest, setting up the scenario of the Dictator’s Dilemma I’ve written about before.”
Heuristic Advice on the Coronavirus
I don’t get asked much about epidemics (that’s my sister’s department) but whenever there’s a terrorist attack I get asked “What can I do to be safe from terrorism?” And in that case I answer: “Buckle your seat belt, stay off ladders, and avoid pools.”
The affect heuristic (9) biases our risk-sensing to those threats that are unusual and scary to our everyday experience, even if they are remote in probability of occurring. While the threats that are much more likely to harm us, because they are around us every day and are familiar, we ignore. And if someone asked me what to do to protect themselves from the coronavirus I might add to the above “drink some water, put on clean socks, get your flu shots and stay current on vaccinations.”
This is a story we’ll be tracking.
Do you have questions or want to discuss this post?
If you have questions or want to join the discussion on this article please join us over at on Facebook. Please mind the community rules (pinned as first post) but otherwise all are welcome.