Covid-19 July Observations

I haven’t done a summary update related to Covid-19 in a while. I’m doing this one now, and will try to do a new summary observation post at least once a month.

The statistics surrounding total tests, infections, hospitalizations, and deaths are difficult to ascertain with both accuracy and precision. I am working on the following assumptions.

1. The total number of tests seems largely to be tracked in places where the statistics are most accurate (e.g. Western nations, as well as certain Asian countries like Korea). Very few countries seem to report the number of tests, but if they do, that number is probably both accurate and precise for the moment the snapshot was taken.

2. The total number of infections is almost certainly accurate in the sense that it is not exaggerated or deceptive as a floor. But there are problems with precision, some of which I outline below. And certainly, the case numbers are not an accurate ceiling.

  • In many places—especially the United States, where the most cases currently are found—there are not enough tests. Many infections are untabulated and often even undiscovered. It is impossible at this point to know exactly how many are being missed. Some studies are being done to try and ascertain this number, and these early studies seem to suggest infections are actually 10X known infections, at least in the United States.
  • In some places, such as Central and Western Asia, it seems very likely the total number of infections is being deliberately understated if not outright hidden. Observers have seen indications the number of cases and deaths far exceed the number being reported. So in these cases, the numbers are no less than what is reported, and very definitely more.
  • In some places, such as Southern Asia (India, Pakistan, Bangladesh), I have doubts about the quality of the number. I’m not sure there’s any conspiracy to hide case counts as there are demonstrably so in other places, but I also wonder, given the situation of these countries, if the numbers could possibly be so low.
  • In all places, we need to remember the numbers for infections or cases lag the actual infection point. One of the key elements to the spread of Covid-19 is the asymptomatic nature of the early stage of infection. Many people show no signs of infection–and yet are still infectious, able to spread Covid-19–for the first week or so of the disease. Once they have the disease, some will go to the hospital or to get a test, and some will not. (In some cases, if they have a mild case, some doctors will say “you are a presumed positive, go home, self-manage”–but they will never have a test, and so not enter the official statistics.) The time between symptoms showing up and going to the hospital/getting a test is another lag. And, there’s yet another lag in reporting (this especially shows up over the weekend). So today’s reported cases are really infections from at least a week, and maybe two, earlier; and today’s infections (as a result of transmission) won’t show up for another week or two.

3. The number of deaths is likewise challenging, though perhaps less so than counting infections. Deaths are obviously more visible than the first infections (especially due to the asymptomatic period). However, multiple factors nearly always contribute to any single death. A good article on how deaths are counted are “The Uncounted Dead.” Unfortunately, the total number of deaths has become a politicized factor, with some arguing that either deaths are exaggerated, because:

  • people who are older, or who have underlying symptoms, are more likely to be killed by Covid-19. For example, a 90-year-old with persistent asthma would be more at risk to Covid-19’s attack on the lungs and heart. Might they have died this year anyway? Did Covid-19 kill them, or did it aggravate the underlying symptoms that killed them?
  • some believe the numbers are being inflated because hospitals are “counting everything as Covid-19, to get more money.” I haven’t seen any instances of this, but I’ve seen lots of cases of hospitals being overwhelmed with cases.
  • Due to many infections not being reported, and indeed many Covid-19 related deaths not being counted as Covid-19 deaths, it seems to me far more probable that the death statistics undercount the actual situation. Studies in excess deaths are being undertaken to document this.

4. “Case fatality rates” and “Infection fatality rates” are calculated by dividing the total number of deaths by the total number of cases or infections. In the USA, 127,461 is 4.9% of 2.6 million cases. By comparison, influenza is estimated to have an infection fatality rate of 0.1%. Of course, if there are many more infections than we presently know about, the rate would be lower. Still, if infections were just 10X, the fatality rate would be 0.49%–some 4X worse than flu.

With this basic context, here are some things I’ve observed from June’s trends:

  1. Understanding that the global numbers are a floor, not a ceiling, the current global number of infections–10.4 million or so–represent just 0.13% of the world’s total population. In the United States, 2.6 million is 0.78% of the total population of 330 million. Even if the actual number of infections were 10X higher, this would still mean only 1.5 to 2% of the population has been infected. For all it has done so far, the virus can go a lot further.
  2. Even if we reached infections of 0.5 million per day, the virus could continue for another 15,600 days (42 years!) before it infected everyone in the world (and that doesn’t account for children born during that time period). (A million a day would cut that to 21 years.)
  3. How do we stop Covid-19? There are two possibilities: (1) a vaccine, or (2) existing infected people are isolated until the disease has run its course without them infecting anyone else. A vaccine may be created sometime in 2021, but making it widely available will be challenging, and could take months or even years (worldwide). Isolation has worked in some countries (e.g. Southeast Asia, New Zealand, etc); in others, it’s problematic for logistical and cultural reasons. And, isolation only works if new instances of the virus aren’t imported from other places.
  4. Until Covid-19 is stopped, it must be “lived with.” How we live with it is a subject for national debate in some places, and national control in others. But one factor is: if our national policy allows us to stop it, what do we do to keep it out?
  5. Because different countries will have different approaches to the virus, travel barriers have been and will continue to be established. In some places, “travel bubbles” are being defined (e.g. travel between Australia and New Zealand but no one else). In other places, countries and states are requiring quarantines for arrivals from certain places. In still others, they are barring travelers from some countries (the most notable recent case is the EU’s barring of Americans).
  6. I anticipate that these travel barriers will almost certainly have enormous effects on the missionary enterprise in the next months to years. I think travel bubbles, barriers and quarantines will be one of the most impactful factors on us. I think it very likely they will decimate the short-term trip side of things–in many places, it will be simply impossible to take an effective 2-week trip anywhere. (This will also have impacts on tourism.)

If your agency used to do significant numbers of short-term trips, and you aren’t this year, and you don’t anticipate doing so next year, I’d like to hear from you. I won’t use your name or shame anyone (there’s no shame in this!) but I’d like to confirm if my view of this trend is true.

  1. The travel barriers will also make certain passports more important than others in certain areas (for example, might European divisions of some multinational agencies be about the only ones able to get around in the EU?). These passports will likely not be the traditional Western ones.
  2. For existing workers, the question of visa renewal is also very stressful. Many workers who have to leave their existing countries are wondering if they’ll be able to get back in.
  3. In this context, rising xenophobia is being noticed. People who come from virus-laden countries are being treated differently. In the case of Americans, globally accessible images of people fighting over being required to wear masks is not playing well. People who live in Korea, for example, have noted “we freak out over 40 new cases, and you have 40,000 new cases per day and don’t want to wear masks.” The people in countries where the virus is under control do not feel positive about the people traveling/immigrating from places where the virus is perceived to be running rampant.

Note that in some countries – like China and India – pandemic xenophobia is merging with other trends. China, particularly, seems to be a “perfect storm” that is leading to very strong barriers of entry. If you’re finding that to be true, too, I’d like to hear from you also.

  1. Long-term service will also be complicated. A 2 week quarantine is completely doable if you plan to be in country for years. (It might also make 90-day “tourist visas” more problematic in some places.) However, many of the places worst affected by the virus are also highly unreached countries. Being able to work long-term in the context of disease and lockdown will also challenge missions in the near future. For all Americans have bemoaned the lockdown in the United States, these have not been nearly as severe as some other countries have endured.
  2. The travel barrier/bubble is a rapidly changing story. I am monitoring for news articles and government releases on this topic, and would welcome any pointers people have for specific countries.

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