Firstly, the spread (impact) of COVID-19. I’m not an epidemiologist (my standard opening line at the moment), and the data we have is flawed, but there are a couple of facts we know to be true.
It is a singular virus, but its impact varies. It varies for two reasons: actual differences in the spread and fatality of the virus; and data inconsistencies.
Location-specific factors that influence the actual spread and fatality of the virus will, in turn influence the comparative likelihood and extent of second ‘waves’ of outbreaks pre-vaccine – which inform the political response (and subsequent economic recovery). The top five worth watching:
- Healthcare system: including number of ventilators, ICU and normal hospital beds per capita, and access to personal protective equipment (PPE). This may be obvious, but it is important: capacity to respond will dictate how ‘high’ the curve can be politically allowed to go in re-opening the economy, before more serious trade-offs are put on the table. While the risk of secondary outbreaks continues, access to ‘civilian’ PPE should be monitored to anticipate the extent of staged re-openings.
- Treatments: lower fatality rates can change the political equation – treatment options that are both effective and available within a country or territory will similarly expand the scope and speed of re-opening pre-vaccine. New and repurposed treatments1 are currently undergoing clinical trials; those already authorized likely face shorter times to mass production if proved effective.
- Technology (tracing, testing, and vaccines): current research suggests that the virus is relatively stable in nature – encouraging news for vaccine research. The most advanced contenders2 are already in clinical development, with human testing to take place this calendar year. While emergency use may be available as soon as early 2021, it will take time for broad scale use: for example, given the novelty of their approach, mRNA-based vaccines have a long road to approvals and mass production.
In a pre-vaccine world, the political response will be partially dictated by the likelihood and impact of secondary outbreaks. Expanded tracing and testing capacities will help ‘flatten the curve’ for secondary outbreaks, while extensive serological testing3 means greater certainty about who is immune (at least for now), and who could return to work; for one German town, this is already about 14 percent of their population4 . Other possible technological solutions (like advanced health screening in airports) that provide further nuance will reduce the need for ‘blunter’ social distancing policies.
- Climate, seasonality and epidemiological factors: it is not a case of stopping the spread of the virus, but evidence suggests that weather can slow transmission to a small degree (i.e. natural flattening of the curve). The virus may also mutate to become less fatal.
- Demographics and cultural differences: the only one of these variables more ‘fixed’ in nature, population parameters like age, underlying risk factors (like obesity, hypertension and diabetes), and social structure (i.e. intergenerational interaction) will influence the likely severity of the virus within country and territory boundaries.
Secondly, there are the data inconsistencies. As we all know by now, the case fatality rate can be significantly overinflated by a lack of testing. My personal crystal ball is that more accurate information on the basics of the virus (infectious dose, viral load, transmissibility, infection fatality rate etc.) will similarly speed up the lifting of restrictions as it better contextualizes the impact of the virus. For example, Iceland has done the most testing on a per capita basis in the world; a recent study which screened 6 percent of their population5 suggested that around 50 percent of cases are asymptomatic (i.e. would not be included in the official caseload of most developed countries or territories). Better information influences the equation for the political response.