Models for the COVID-19 Second Wave

Europe, the Middle East, Oceania, part of South Asia and the U.S. progressively exit the COVID-19 lockdowns and relax the most severe social distancing measures.

In the meantime, China, Singapore and South Korea, the countries that were hit first and succeeded in controlling the first wave, appear to face different dynamics after easing of anti-COVID-19 measures.

South Korea appeared to have fully controlled local contagion, until 10 May (Hyonhee Shin, Josh Smith, “South Korea scrambles to contain nightclub coronavirus outbreak“, Reuters, 11 May 2020). In two days South Korea reported 69 new cases linked to nightclubs and bars in Seoul and races to test contact cases, still needing to trace more than 3000 people. Its borders are closed and entry is submitted to strict quarantines.

China seemed to fare quite well, despite struggling with clusters and imported cases notably in Heilongjiang (William Yang, “China tries to contain new coronavirus outbreak“, DW, 29 April 2020). Then, on 11 May, just above a months after the end of the lockdown, a new cluster arose in Wuhan, the original center of the epidemic, linked to asymptomatic cases (“China’s Wuhan reports first coronavirus cluster since lifting of lockdown“, Reuters, 11 May 2020). On 9 May, it was Northeastern Jilin province that reported a new small cluster, which triggered a lockdown for the city of Shulan (Ibid.).

Singapore knows what can be seen as a second wave, focused on migrant workers, with cases rising exponentially starting early April 2020 (James Crabtree, “How Singapore’s second wave is exposing economic inequalities“, New Statesman, 6 May 2020).

Meanwhile, history shows that for the 1918-1919 so-called “Spanish” Influenza pandemic, the second and third waves were more lethal than the first spring wave (Jeffery K. Taubenberger and David M Morens, “1918 Influenza: the mother of all pandemics,” Emerging infectious diseases vol. 12,1, 2006).

Thus, what are we to expect in the near future regarding this COVID-19 second wave?

Epidemiologists have modelled various types of scenarios to help policy-makers handle the pandemic and create responses that will mitigate, as much as possible, fatalities. This article looks at four such models and scenarios and highlight what they tell us about future waves of COVID-19. Comparing briefly the scenarios with the reality of the situation in China, Singapore and South Korea, we highlight the scenarios that look more likely and underline the need for further research focused on other factors.

Help us continue offering free
analysis for the COVID-19
Become a member
Donate any amount and
fund analysis on the COVID-19
Donate Now!

The waves as a result of our interactions with the COVID-19

It is now generally accepted that we shall have to live with the COVID-19. The pandemic, whatever the shape of the outbreaks, is expected to persist until immunisation is reached, assuming this is possible. Immunisation will result either from vaccination or from natural immunity. At best, according to our estimates, and considering the need to manufacture billions of doses immunisation will not happen before winter 2022 (see Helene Lavoix, The COVID-19 Pandemic, Surviving and Reconstructing, The Red Team Analysis Society, 24 March 2020). This timeframe does not take into account the time necessary for an immense mass vaccination campaign.

Actors handled the first outbreak of the COVID-19 or first wave as they could, considering that all countries were caught unprepared, with possibly the exception of South Korea. A range of measures were created and applied, including a stringent lockdown across the world, that allowed to handle the surprise and mitigate fatalities. The main objective of these measures was to stop the contagion while not seeing health systems break down. What we successfully did was not to end the epidemic but to change its course. We avoided an immediate possible worst case scenario (Helene Lavoix, Worst Case Baseline Scenarios for the COVID-19 Pandemic, The Red Team Analysis Society, 24 March 2020).

However, the price to pay was that activity stopped, with an immense cost to ways of life, including the economy.

Now, we are entering a new phase, where we shall start learning to live with the COVID-19. The fear is that once activity restarts, then the epidemic will spread and develop again, bringing about a second wave, with its corollary of death, sufferings and danger to see health systems break down. Political authorities are thus rushing to design sets of measures and policies that should allow us living with the COVID-19, instead of being frozen by the danger, until another kind of death takes us all.

The possibility of a second wave, and of next waves in general depend upon the interactions between the virus, and notably the epidemiology of the SARS-CoV-2,, and the responses and actions the various actors will design and implement.

We are thus both dependent for our activity upon the waves of COVID-19 while, in the same time, also contributing to create and shape them.

Second and recurring waves

The Imperial College COVID-19 Response Team March study

First and foremost, we have the influential study of the Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand (16 March 2020). Many governments used this report to build their first wave’s lockdown policies.

(A partir de ce point, traduction française automatique par intelligence artificielle.)

In this study, the objective is to minimise fatalities, which demands not overwhelming hospitals and notably the number of intensive care units bed requirements (ICU). The policy measures taken into account are as follows:

  • Case isolation in the home (CI),
  • Voluntary home quarantine (for 14 days – HQ),
  • Social distancing of those over 70 years of age (SDO),
  • Social distancing of entire population (similar to lockdown – SD),
  • Closure of schools and universities (PC).

The study, among other critical factors, considers the R0 (R-nought) or basic reproduction number of an infectious disease. This is a measure that represents “the expected number of secondary cases produced by a typical infected individual early in an epidemic” (O Diekmann; J.A.P. Heesterbeek and J.A.J. Metz (1990). “On the definition and the computation of the basic reproduction ratio R0 in models for infectious diseases in heterogeneous populations”, Journal of Mathematical Biology 28: 356–382). They “examine values between 2.0 and 2.6”, which is in the range of most estimates. They also take into account the acquired immunity against the SARS-CoV-2 and consider it to be similar to what is obtained against the seasonal influenza, i.e. re-infection cannot reoccur the next season.

With this model, the Imperial College COVID-19 Response Team finds that, for a R0=2.2, after the end of the first wave and once the social distancing of entire population measures are relaxed and school and universities re-open, assuming all other measures stay in place, a new wave starts. It triggers the need to start a new period of social distancing of entire population and school and university closure one month after the beginning of the relaxation.

As a whole, over two years, the full range of measures “is in force approximately 2/3 of the time” (p.12). In two years, we thus have, excluding the first wave, eleven waves of two months each, however the apex of each wave is lower. The second wave thus starts immediately once the lockdown stops, but starts being experienced as such one month after the exit strategy, when the need for SD is triggered.

Imperial College COVID-19 Response Team – 16 March study, p. 12 – “Figure 4: Illustration of adaptive triggering of suppression strategies in GB, for R0=2.2, a policy of all four interventions considered, an “on” trigger of 100 ICU cases in a week and an “off” trigger of 50 ICU cases.”

Although further monitoring will be needed, this seems to correspond approximately to the new clusters emerging in China and South Korea. Yet, we are still far in these two countries from the Imperial College estimated needs in ICU one month after exit from lockdown, as shown in the diagram above for example.

The Harvard T.H. Chan School of Public Health’s model

Scientists of the Harvard T.H. Chan School of Public Health created a model allowing notably for different sensitivity of the virus to seasonality (Stephen M. Kissler, et al. “Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period“, Science, 14 April 2020).

It obtained scenarios similar to those of the Imperial College, with recurring waves into 2022 “requiring social distancing measures to be in place between 25% (for wintertime R0 = 2 and seasonality…) and 75% (for wintertime R0 = 2.6 and no seasonality …) of that time”.

Obviously, the lower the R0 considered and the more important the seasonality factor, the shorter the social distancing period.

Here, as for the Imperial College’s model, the second wave would start immediately as social distancing measures are relaxed. In the Harvard model, in the U.S. case, new social distancing measures would be needed one month after the end of SD if the virus is not seasonal. If the virus is seasonal and if the first wave took place in Spring, as is more or less the case in the U.S., new social distancing measures would be needed 2,5 months after the end of SD.

The emergence of new clusters in South Korea and China in May would tend to indicate that the virus is not or not strongly seasonal. The Singapore case and the April wave anyway showed that heat and humidity do not appear to deter the virus and the disease.

Three possible scenarios for the CIDRAP

On 30 April 2020, the Centre for Infectious Disease Research and Policy (CIDRAP) of the University of Minnesota published “The future of the COVID-19 pandemic: lessons learned from pandemic influenza,” (Kristine Moore, MD, MPH, Marc Lipsitch, DPhil, John Barry, MA, and Michael Osterholm, PhD, MPH).

Pointing out useful similarities but also differences between influenza and the SARS-CoV-2, notably a higher viral transmissibility for the latter, the CIDRAP outlines three possible scenarios. These scenarios give the outlook of the future wave but are not precise enough to allow estimating when the second wave will start.

The first scenario of the CIDRAP is very similar to the scenario of the Imperial College and of Harvard T.H. Chan School of Public Health. According to this first scenario, “the first wave of COVID-19 in spring 2020 is followed by a series of repetitive smaller waves that occur through the summer and then consistently over a 1- to 2-year period, gradually diminishing sometime in 2021.” The strength and timing of waves may vary with the efficiency of the controlling measures taken as well as according to other demographic and geographic factors. This first scenario also expects that full SD measures may have to be implemented regularly.

CIDRAP’s second scenario is inspired by the pattern of the 1918-1919 Spanish Flu pandemic. “The first wave of COVID-19 in spring 2020 is followed by a larger wave in the fall or winter of 2020 and one or more smaller subsequent waves in 2021.” Thus, the main difference with the Imperial College and Harvard scenarios is first about intensity. The second wave is the most lethal. Second, it is about timing. The second wave would take place in the next fall or winter. Finally it is about the number of subsequent waves following the second one, creating two sub-scenarios: only one further wave or subsequent smaller waves.

Considering what is happening in China, Singapore and South Korea, the timing does not seem to correspond. The difference probably comes from the measures implemented for the COVID-19, which are likely to have “artificially” stopped the first wave, compared with the 1918 Influenza pandemic. However, the possibility of a more lethal second wave is serious enough to keep this scenario and further detail comparatively the 1918 pandemic and the COVID-19.

The third CIDRAP scenario is different from the previous models. It envisions that “the first wave of COVID-19 in spring 2020 is followed by a “slow burn” of ongoing transmission and case occurrence, but without a clear wave pattern.” In that case the most severe social distancing measures will not have to be reimplemented but “cases and deaths will continue to occur”.

This scenario does not fit what took place in Singapore. It may be, however, too early to discard it. It may also not be universal. In some countries, excess death and sufferings are not acceptable, while there is always the risk that contagion spreads again exponentially. Thus, even a few cases would trigger SD measures, as possibly in New Zealand, or in Shulan in China (e.g. Amy Gunia, “Why New Zealand’s Coronavirus Elimination Strategy Is Unlikely to Work in Most Other Places“, Time, 28 April 2020; Ibid.).

Mobility and Second wave

The most recent study, again by the Imperial College COVID-19 Response Team, focuses on Italy (Report 20: Using mobility to estimate the transmission intensity of COVID-19 in Italy: A subnational analysis with future scenarios, 4 May 2020).

It models scenarios for a relaxation of isolation measures on 4 May 2020, using increase in mobility as a proxy. A second wave is quasi in-built in their model as mobility is the parameter used to make “the time related reproduction number or effective reproduction number (Rt)” change. Thus, what the model tells us is the extent of infection and death in excess, i.e. the size of the wave.

In the first scenario modelled, mobility increases by 20% above pre-lockdown levels, and in the second, it increases by 40%. However, these scenarios do not account for other anti-COVID-19 measures such as school closures, hygiene, face masks, or testing and contact tracing. It only focuses on the mobility factor.

The first finding, unsurprisingly, is that the situation varies according to region. This could indicate that the way China or Germany, for example, handle the COVID-19 could be the way forward, at least as far as the mobility factor is concerned.

In scenario 1 (20% mobility) the number of excess death rises above 100 on approximately 8 June 2020 in Piedmont, 20 June in Veneto and 13 July in Tuscany, before to rise exponentially.

In scenario 2 (40% mobility) the number of excess death rises above 100 on approximately 28 May in Piedmont, 4 June in Veneto, 10 June in Tuscany, 22 June in Lombardy and 4 July in Emilia Romagna and Liguria, before to rise exponentially.

As the authors highlight, these scenarios must be seen as worst case scenarios, knowing that other measures will be implemented.

Thus, except in the third scenario of the CIDRAP, all epidemiological models suggest that we shall face a second wave. Most models consider also following recurring waves.

Now, a brief comparison with the dynamics of the epidemic in China, South Korea and Singapore tend to indicate that the models and scenarios anticipating recurring waves are the most likely. It could also indicate that models are pessimistic in terms of the timing of the second wave, except in the case of Singapore. Yet, in Singapore, other factors not included in the epidemiological models are also at work. Meanwhile, the size thus lethality of the second wave remains a high impact uncertainty that must be considered carefully.

Can we thus find other factors that could help improving assessments of the coming waves? These factors would make foresight even more actionable. They would thus contribute to the design of efficient policies. This is what we shall see with the next article.

Further Bibliographical references

Taubenberger, Jeffery K, and David M Morens. “1918 Influenza: the mother of all pandemics.” Emerging infectious diseases vol. 12,1 (2006): 15-22. doi:10.3201/eid1201.050979

Featured image: Image par Elias Sch. de Pixabay [Public Domain]

The Strange Case of Sweden in the COVID-19 Pandemic

Many countries hit by the pandemic are now exiting or about to exit the period of most stringent isolation measures. Indeed, they estimate they succeeded in controlling contagion. Meanwhile, they avoided the dreaded break down of their health-care system, which could have taken place if hospitals had been overwhelmed.

    In Europe, one country stands apart, Sweden. The oft-heard narrative runs as follows: Sweden appears to have decided for a policy of laissez-faire; it recommended but never imposed; it thus has hardly or no exit policy to design and implement, because there is not so much to exit from. Meanwhile, it does fare much better in its handling of the COVID-19, notably in economic terms, while the toll it pays in terms of casualties is far from terrible.

    Is this narrative correct? What are the facts? How can we explain the difference between “Sweden and the rest”? Can we already draw lessons from the Swedish case or is it truly too early in the pandemic to do so? Does that mean that all countries who implemented social distanciation and other measures were wrong to do so? Without falling into a caricatural black and white judgement, are there some lessons we could learn from the way Sweden handled this part of the pandemic outbreak? Is it reproductible in time and elsewhere?

    These are crucial questions for policy-makers as they are preparing the exit strategy from lockdown and as they need to provide security to their citizens. It could give them further elements to succeed in protecting citizens both from disease and from economic hardship.

    These are keys questions for businesses, corporate and financial actors, as they will lobby political authorities for their interests and as they also need to anticipate for the future of their activity.

    These are crucial questions for citizens, who need to be able to assess the way their political authorities succeed in their mission of protection of those who are ruled.

    This article addresses the way Sweden handled, so far, the COVID-19 pandemic and the “Swedish model” narrative. The aim is to assess in which way the Swedish strategy can be used as a model by others, not to judge the way Swedish authorities handled the COVID-19.

    First, the article focuses on the policies and measures Sweden took to face the COVID-19, the rationale for these measures and their actors. Second, it looks at current impacts of these measures, in terms of health and in economic terms. Finally, it wonders about the reality of the idea of an exceptional Swedish model. It looks first, assuming there is a model, to its replicability. Then it questions the very idea of a Swedish model.

    Help us continue offering free
    analysis for the COVID-19
    Become a member
    Donate any amount and
    fund analysis on the COVID-19
    Donate Now!

    Sweden faces the COVID-19

    Since the start of the COVID-19, the Public Health Agency of Sweden (Folkhälsomyndigheten) has had the upper hand on all decisions regarding the Swedish answer to the epidemic (Hans Bergstrom, “The Grim Truth About the “Swedish Model”“, Project Syndicate, 17 April 2020). Anders Tegnell, epidemiologist and head of the Department of Public Health Analysis and Data Development of the agency leads the effort (Ibid.).

    According to Hans Bergstrom, professor of political science at the University of Gothenburg, Tegnell’s strong and often erroneous convictions paved the way for Sweden strategies (Ibid.). Tegnell did not believe the Chinese outbreak could spread. Then he thought case tracing was a sufficient measure to control the COVID-19, as there was no sign of community transmission inside Sweden (Ibid.). Bergstrom (Ibid,) argues that “between the lines”, Tegnell seeks to progressively achieve herd immunity. Meanwhile, considering that the COVID-19 was there to last, Tegnell thought that policies that could be sustainable over time economically and psychologically had to be implemented (Ibid.).

    Indeed, Tegnell interviewed in Nature, confirms this vision:

    “This is not a disease that can be stopped or eradicated, at least until a working vaccine is produced. We have to find long-term solutions that keeps the distribution of infections at a decent level. What every country is trying to do is to keep people apart, using the measures we have and the traditions we have to implement those measures. And that’s why we ended up doing slightly different things.

    Marta Paterlini, “‘Closing borders is ridiculous’: the epidemiologist behind Sweden’s controversial coronavirus strategy“, Nature, 21 April 2020

    Tegnell also stresses that none of the most severe measures implemented elsewhere, such as isolation, are grounded into scientific evidence, and that epidemiologists produced models that were too pessimistic (Paterlini, Ibid.).

    As a result, Sweden advised its citizens to practice social distancing and to work from home, but enforced little. Standing at bars is forbidden but restaurants are opened (Emergency Information from Swedish Authorities, “Ban on crowding in restaurants, cafés and bars“, Bekräftad information om coronaviruset, 25 March 2020).

    Entry ban applies primarily to foreign citizens attempting to enter Sweden from all countries, except those in the EEA and Switzerland from 17 March 2020 until 15 May, i.e. 30 days (The Swedish Police, Travel to and from Sweden affected until 15 May 2020).

    The exemplary Swedish sense of social responsibility and the unique Swedish values are touted as having allowed the policy to be successful. Sweden would be, deep down,

    “A model society based on values of social justice and human rationality, with a high level of trust between people and trustworthy authorities. This has its origins from the Social Democrat-introduced concept of “Folkhemmet,” or people’s home, where a welfare state cares for all with the proviso that everyone complies with a communal order.”

    Heba Habib, “With science and shared values, Sweden charts own pandemic course“, The Christian Science Monitor, 27 April 2020.

    As a result, people are believed to responsibly follow their government’s suggestions, which translates in successful policies. Hence, early April it was estimated that 50% of people worked from home, that usage of public transports had decreased by 50% and that streets in Stockholm were only 30% as busy as before the COVID-19 (“Sweden’s Outlier Response To COVID-19, And Its Results So Far“, PYMNTS.com 16 April 2020)

    Thus, until 24 April 2020, Sweden has had a far less constraining policy to control the COVID-19 than its neighbours or than most of the world, as shown in the table below listing the measures Sweden took compared with its Nordic neighbours.

    SwedenDenmarkNorway Finland
    All travels
    		14 March – including to Sweden16 March – all non residents banned to enter Norway16 March
    Travels outside EEA17 March until 15 May


    Quarantine from high risk regions
    		9 March27 February -all will be quarantined, save those coming back from Sweden and Finland16 March – all returnees must be residents or citizens only – 14 days quarantine
    Stay home for non essential functions
    		13 March19 March (prohibited to stay in cabins, home quarantine)16 March
    Gatherings of peopleGathering limited to 500 people – 30 March: gathering limited to 50 people18 March – No gathering above 10 people
    		16 March – No gathering above 10 people
    Secondary education closed
    		13 March12 March16 March
    Primary education closed
    		16 March12 March16 March
    Retails, restaurants, bars etc. closed 25 March – Standing at bars prohibited. Safety distance maintained elsewhere.18 March12 March -except establishment serving foods)16 March – only decrease of non critical activities
    Contaminated inner regions locked down


    		27 March – 15 April Uusimaa
    Measures taken to handle the COVID-19 Pandemic in Nordic Countries – Various official sources, according to countries

    In a 21 April’s interview, Tegnell acknowledged that most of the Swedish deaths came from care houses for elder people and that an investigation in the high number of deaths is needed (Ibid.). Yet, according to him, it is not the COVID-19 strategy that potentially failed here, but the social-care system (Jenny Anderson, “Sweden’s very different approach to Covid-19“, Quartz, 27 April 2020).

    Tegnell also does not believe much into asymptomatic contagion, or only at the margin, and decries closing borders, as the contagion now exists within European borders (Paterlini, Ibid.). However, he is also forgetting that Sweden is de facto protected by others’ closing borders and by others’ policies.

    As a whole, Tegnell is satisfied with the policy he designed and its results.

    However other top Swedish scientists contested this approach and 22 of them published an open letter in the Swedish newspaper Dagens Nyheter: “Public health authorities have failed – now politicians must intervene.” There they highlighted a dangerous failure of public-health authorities as deaths topped 1000. They asked political authorities to intervene and change policies.

    On April 15, 2020, the Swedish Parliament indeed “extended their agreement on temporary parliamentary procedure during the COVID-19 outbreak to last until at least April 29, 2020” (Library of Congress, Legal Monitor; Sveriges Riksdag, 15 April 2020).

    Yet policies did not change, up until 24-27 April 2020.

    Impacts… so far

    What are the impacts of the policies Sweden implemented regarding the COVID-19?

    Health results

    A peak?

    On 24 April 2020, there has been 17.567 cases identified and 2.152 deaths (John Hopkins CSSE: Tracking the COVID-19 (ex 2019-nCoV) spread in real-time). On 27 and 28 April, 11:30, there has been respectively 18.926 and 19621 cases identified and 2.274 and 2.355 deaths (Official Swedish data updates), but data for the last 7 days still need to be consolidated (Maddy Savage, “Coronavirus: Has Sweden got its science right?“, BBC News, 25 April 2020). So far hospitals have not been overwhelmed: 1.353 for 27 April, 1388 people for 28 April are in intensive care.

    As we monitor the situation after publication of the article, on 4 May 2020, we have 22.721 cases identified and 2.274 and 2.769 deaths (Official Swedish data updates). Interestingly, the figures for 24, 27 and 28 April are now revised and give respectively 18.100, 19.400 and 20.100 cumulative positive cases.

    Sweden, 28 April 2020 – Latest updates on the outbreak of coronavirus disease (covid-19). 
    The page is updated daily with number of cases at 14:00

    The Public Health Agency of Sweden suggested, first, that, in Stockholm, the epidemic peaked on 17 April 2020 (Reuters, “Swedish health agency says virus has peaked in Stockholm, no easing of restrictions yet“, 21 April 2020). Stockholm represents half of the confirmed cases in Sweden (Ibid.).

    Yet, by 27 April 2020, the number of daily cases still rises, with a strong increase between 21 and 24 April, then with lower rises. If the trends continues towards lower increases, then a peak may indeed have been reached.

    However as the new updated graph for 4 May 2020 (monitoring after publications) depicts, the revised data show an increase rather than a decrease. Furthermore, 29 April is the day with the highest number of positive cases since the start of the epidemic, i.e. 778 cases, followed by 24 April with 769 cases and 28 April with 750 cases. Thus the idea of a peak for Sweden needs to be questioned, and monitored considering also the variations in data.

    COVID-19 cases in Sweden – 27 April 2020
    COVID-19 cases in Sweden – 28 April 2020
    COVID-19 cases in Sweden – 4 May 2020 – Thus giving updated data for 26-29 April

    Meanwhile, as shown on the graphs below, and considering the uncertainties on data for the last seven days, the number of deaths reported has strongly fallen and the number of people in intensive care units has also fallen.

    COVID-19 fatalities in Sweden – 27 April 2020
    COVID-19 ICU in Sweden – 27 April 2020

    Thus do we have a peak or not? The reality of a peak is still unclear and only time will tell (John Hopkins data, see also official Swedish data updates). Nonetheless, as we shall see below, the 21 to 24 April period cancelled previous expectations of a peak.

    Comparisons

    Compared with its neighbours, even considering its larger population, Sweden has fared less well, as shown in the table below. Swedish rates are rather similar to those of the Netherlands, another country that initially had a laissez faire policy.

    24 April 2020SwedenDenmarkNorway FinlandNetherlands
    Population10 230 0005 806 0005 368 0005 518 00017 280 000
    Cases17 5678 4087 4444 39536 727
    %0,17172 %0,14482 %0,13867 %0,07965 %0,21254 %
    Fatality Rates2 1524031991774 304
    % / pop0,0210 %0,0069 %0,0037 %0,0032 %0,0249 %
    % / cases12,2502 %4,7931 %2,6733 %4,0273 %11,7189 %
    The COVID-19 in Nordic Countries – Data for 24 April 2020 – John Hopkins CSSE: Tracking the COVID-19
    Denmark COVID-19 daily cases up until 27 April 2020 (John Hopkins CSSE: Tracking the COVID-19)
    Norway COVID-19 daily cases up until 27 April 2020 (John Hopkins CSSE: Tracking the COVID-19)

    All the three other Nordic countries, notably Norway, seem to have clearly peaked. The Netherlands has also most probably peaked.

    Finland COVID-19 daily cases up until 27 April 2020 (John Hopkins CSSE: Tracking the COVID-19)
    Netherlands COVID-19 daily cases up until 27 April 2020 (John Hopkins CSSE: Tracking the COVID-19)

    In the case of Sweden, and as we shall further see below, there is ground to worry that Sweden’s peak is not so easy to achieve.

    Economic results

    Despite rather lax policies compared with most other countries, Sweden also faces economic damages.

    Indeed, Sweden also depends on others for its trade and activity. Thus, on 8 April, the economic research unit of BNP Paribas estimated that the country would be hard hit by the major slowdown in global trade, as exports account for 45.6% of Sweden’s GDP.

    Yet, some indicators, such as personal spending and unemployment’s increase were also better in Sweden than in Norway (Darren McCaffrey, “Analysis: Is Sweden right in its handling of COVID-19?“, Euronews, 22 April 2020).

    Nonetheless, on 24 April 2020, the Swedish finance minister stated that she expected the economy to shrink by 7%, more than she initially thought, and unemployment to reach 11% (Radio Sweden, “More restaurant corona inspections, economy expected to be hit harder, more infections in nursing homes“, 24 April 2020).

    So is there really ground for a model? Sweden did not fare as well as its neighbours in terms of protecting the health of its citizens. Yet, it also did not fare worse than, for example, the Netherlands, so far. But again, the Netherlands appears to have peaked. Meanwhile, the economic cost for Sweden is on a par with 14 April IMF forecasts for the Netherlands as the Dutch economy is expected to shrinking by 7.5% in 2020 (DutchNews.nl, “IMF sees Dutch economy shrinking 7.5% this year, unemployment to hit 6.5%” 14 April 2020).

    At first glance, and considering that we are still at the start of the pandemic, it is difficult to assess if we have or not a Swedish model. Let us thus now look at a potential replicability of the model, and then at the evolution of the last couple of days.

    A Swedish model?

    If there is a Swedish model, is it replicable?

    First, besides the role the cultural and socio-political values model plays, Sweden was also probably protected from even higher levels of contagion by a low population density, as shown on the comparative graph below, and despite variations according to areas.

    Population density (people per sq. km of land area) – Italy, Sweden, France, Spain, Denmark – Food and Agriculture Organization and World Bank population estimates.

    Second, Sweden did not have the same global exposure to the world as other nations such as Spain, Italy or France. Indeed, using World Bank statistics, in 2018, Sweden’s main partners, for exports, were Germany, Norway, Finland, Denmark and the United States, and for imports they were Germany, Netherlands, Norway, Denmark and United Kingdom. By comparison, France’s major partners for exports were Germany, the United States, Spain, Italy and Belgium, and for imports they were Germany, China, Italy, Belgium and Spain. Italy’s major partners were for exports Germany, France, the United States, Spain and the United Kingdom and, for imports, Germany, France, China, Netherlands and Spain.

    As a whole, Sweden receives far less travellers (tourism includes business trips) than other countries that were more quickly and more intensely hit by the COVID-19, as shown in chart below for Inbound tourism 2018 (UNWTO statistics).

    2018 Inbound Tourism for Sweden with comparisons – (UNWTO statistics)

    Thus, considering the specificities of Sweden, if there is a model, it can only be replicated in countries that benefit from the same conditions. Meanwhile, these specific factors also point out that rather than only a specifically designed model, we have here particular circumstances, as for every country, or more largely unit of analysis, interacting with a specific strategy.

    But is there truly a Swedish model?

    Now, we may also wonder if there is truly a Swedish model, considering the 21-24 April 2020 COVID-19 related data.

    Towards a change of policies? Not a different model but different dynamics?

    The Swedish government also noted the new rise of cases observed between 21 and 24 April (David Nikel, “Sweden Health Chief Admits ‘It’s Not Over’ As Coronavirus Cases Leap“, Forbes, 24 April 2020). The Swedish Public Health Agency acknowledged the increase. As reported by Forbes, Tegnell stated:

    “There have been more deaths than expected. It is definitely not over. We see that especially in the small rise in Stockholm again”

    David Nikel, “Sweden Health Chief Admits ‘It’s Not Over’ As Coronavirus Cases Leap“, Forbes, 24 April 2020.

    The disappointing results would be related to the Easter week-end.

    As a result, the Swedish Civil Contingencies Agency warned that people should not relax their responsible approaches (Ibid.). In the meantime the mayor of Stockholm threatened to close restaurants and bars if safe distancing was not respected (ibid.). Some of them were indeed shut by the local food safety board, while Springtime celebrations were cancelled (Radio Sweden, “Stockholm bars shut due to crowding, springtime celebrations cancelled, warning for long-term unemployment“, 27 April 2020).

    Thus, when confronted with an unexpected rise of cases, the Swedish authorities have to resort to the same policies as others. They have to reinforce social distanciation rules.

    If such rises happen again, then, considering the very recent decisions, it is possible that the authorities will need to continue on the path of more stringent measures.

    In that case, Sweden would just follow on the track of other countries. The “model” would actually rather be a longer initial phase, until more stringent measures become necessary.

    If the data are improve and then remain good, then Sweden may relax measures again. Thus, if there is a model, it may be one that promotes flexibility.

    Timing matters for preparedness

    Should COVID-19 cases rise strongly again, Sweden would then risk facing a shortage of intensive care units ICU), as happened elsewhere.

    It seems, however, that Sweden is well prepared in terms of ICU capacities. The ICU initial (pre-COVID-19) capacity of Sweden was 526 beds (Joacim Rocklov, “COVID-19 health care demand and mortality in Sweden in response to non-pharmaceutical (NPIs) mitigation and suppression scenarios“, MedRxiv, 7 April 2020).

    Rocklov estimated the ICU capacity could be doubled with preparedness, which is what seems to have taken place (Ibid., Anderson, Ibid.).

    On 26 and 27 April, COVID-19 patients in ICU would be respectively 558 and 543, thus hovering above the initial number of beds available for all pathologies (Svenska Intensivvårdsregistret). If the capacity has doubled as a result of preparedness, then Sweden is probably able to handle a substantial amount of new cases.

    Preparedness in terms of ICU capacities, assuming the doubling of the capacity is correct, could be seen as a successful element of the Swedish model, but it could also have been achieved with less fatalities.

    Towards homogenisation?

    Now, if the Swedish political authorities were to continue on the path towards more severe restrictions, because they do not succeed in truly achieving a peak, this evolution could take place just when other countries relax their policies.

    The countries exiting from severe isolation measures will then fear a return of the epidemic and a second wave. They will most certainly pay a very high attention to the possibility of imported cases, as China does. Thus the Swedish strategy of not believing in travel controls, added to an uncertain peak could threaten to backfire. As a result, the combination of factors could force Sweden to also change its travel policies. This is all the more likely that Sweden did contribute to the general European contagion as early a 7 February 2020, as shown in the fascinating Spanish study tracing the phylogenies of the virus in Europe (Francisco Díez-Fuertes, et al. “Phylodynamics of SARS-CoV-2 transmission in Spain“, bioRxiv, 20 April 2020). True enough, on 7 February most European countries were mocking those fearing a ridiculous small flu-like epidemic. Yet, since then, they appear to have learned.

    In that case, the uncertainty of the epidemic curve could play as a disadvantage for Sweden, or, to the least, would force Sweden towards homogenisation. The great political scientist Fred Halliday has shown the imperatives of homogenisation in international relations (Rethinking International Relations, 1994). Further research would be needed here to evaluate if the case of Sweden could give us indications that such dynamics towards homogenisation will be at work in the months and years to come, which is crucial to properly build scenarios.

    The model in this case would be different from what was initially expected. It would show the importance of timing, the possible danger of an uncertain epidemic curve as seen by others and a possible tendency towards homogeneity.

    Trial by pandemic

    If ever the COVID-19 evolution went wrong, and if Sweden had to abandon its touted “cultural” model, then it would be the very belief-system underpinning its socio-political organisation that would be questioned.

    Trust in political authorities could be impaired, which would twice hurt the Swedish polity. First, as for any political system, the legitimacy of political authorities would diminish. Second, because trust in the system is so crucial to Sweden values, these very values could be shaken. To measure the difference, imagine a system where the constructed shared historical values led to diffidence towards central political authorities, as in the U.S..

    However, this “trial by pandemic” is not exclusively a threat for Sweden. Each and every polity has to face it. How each will handle it, how each will be able to reinvent its system to overcome the threat will most probably deeply change each society and the international system.

    It is probably too early in the pandemic to conclude with certainty about the success of the Swedish measures in handling the pandemic. However, looking at the Swedish case helped us understanding better how societies handle the COVID-19 pandemic. It also highlighted that there is no such a thing as a Swedish model that could be an easy recipe to follow by all in our global struggle against the COVID-19.

    Further bibliography

    Francisco Díez-Fuertes, María Iglesias Caballero, Sara Monzón, Pilar Jiménez, Sarai Varona, Isabel Cuesta, Ángel Zaballos, Michael M Thomson, Mercedes Jiménez, Javier García Pérez, Francisco Pozo, Mayte Pérez-Olmeda, José Alcamí, Inmaculada Casas, “Phylodynamics of SARS-CoV-2 transmission in Spain” bioRxiv 2020.04.20.050039; doi: https://doi.org/10.1101/2020.04.20.050039

    Paul W Franks, “Covid 19 coronavirus: Sweden thinks we’re underestimating how many people have had virus“, The New Zealand Herald, 24 April 2020.

    Featured image: Kurious (pixabay.com)

    The COVID-19 Shaping the World – The Red (Team) Analysis Weekly – 23 April 2020

    This is the 23 April 2020 issue of our weekly scan for political and geopolitical risks (open access).

    Editorial: The COVID-19 has already deeply reshaped the world.

    Imagine the headlines and the social networks buzz on the oil prices amazing rout, if we were not in a time of pandemic! It would certainly not be as it is now. Of course, both the COVID-19 and the oil quasi irrelevance are linked, but the imagination exercise points out how much our perceptions and interests have changed over the course of less than two months.

    Yet, this “shaping the world” by the COVID-19 is likely far from being finished.

    Now, we also face a fight back by those who want the world of globalisation – the world of the last 20 years – to return, expressed, among others, through favouring “herd immunity”, hyping a Swedish success in resisting isolation and lockdown, and a return of the narrative according to which “the COVID-19 is hardly more lethal than seasonal flu”.

    This is mixed with a serious risk to see the U.S. collapse. But, are we certain this is “just” the U.S.? Or could it be the Western liberal democracy model that could collapse? And is this “just” this model that could end, or are we facing the collapse of the modern state system?

    Furthermore, these threats are also mixed with a serious risk to see war coming to the fore. War and pandemic should not fare well together. But then, we are living extraordinary and bizarre times, with cascading and complex impacts. And animosity is running high, notably against China. And China has also to face the very likely end of the bounty that was delocalisation, as countries want to recover their industrial and economic sovereignty.

    And these are only some of the major uncertainties we face.

      Help us continue offering free
      analysis for the COVID-19
      Become a member
      Donate any amount and fund analysis on the COVID-19 Donate Now!

      Using horizon scanning, each week, we collect weak – and less weak – signals. These point to new, emerging, escalating or stabilising problems. As a result, they indicate how trends or dynamics evolve.

      The Scan

      The 23 April 2020 scan→

      Horizon scanning, weak signals and biases

      We call signals weak, because it is still difficult to discern them among a vast array of events. However, our biases often alter our capacity to measure the strength of the signal. As a result, the perception of strength will vary according to the awareness of the actor. At worst, biases may be so strong that they completely block the very identification of the signal.

      In the field of strategic foresight and warning, risk management and future studies, it is the job of good analysts to scan the horizon. As a result, they can perceive signals. Analysts then evaluate the strength of these signals according to specific risks and dynamics. Finally, they deliver their findings to users. These users can be other analysts, officers or decision-makers.

      You can read a more detailed explanation in one of our cornerstone articles: Horizon Scanning and Monitoring for Warning: Definition and Practice.

      The sections of the scan

      Each section of the scan focuses on signals related to a specific theme:

      • world (international politics and geopolitics);
      • economy;
      • science including AI, QIS, technology and weapons, ;
      • analysis, strategy and futures;
      • the Covid-19 pandemic;
      • energy and environment.

      However, in a complex world, categories are merely a convenient way to present information, when facts and events interact across boundaries.

      The information collected (crowdsourced) does not mean endorsement.

      Featured image: Milky Way above SPECULOOS / The Search for habitable Planets – EClipsing ULtra-cOOl Stars (SPECULOOS) is searching for Earth-like planets around tiny, dim stars in front of a panorama of the Milky Way. Credit: ESO/P. Horálek.

      The COVID-19 and the U.S.-China competition (1)

      What is “great powers competition” in a time of global confinement?

        As we write this article, half of the human species is or has been confined in homes or apartments, in cities and slums. In China, for example, confinement is a massive political and social undertaking. All around the world hundreds of millions of people are living “inside”. Since its start, the epidemic spread from the wet market of Wuhan to South Korea and other Asian countries, India, Europe, Africa, Latin America and the U.S. and Canada. In April 2020, more than 3 billion people are confined (Hélène Lavoix, “COVID 19- Worst case baseline scenarios, March 13 2020 and COVID 19 scenarios- Making sense of antiviral treatment”, The Red (Team) Analysis, April 8 2020).

        https://www.youtube.com/watch?v=xKPWngYf2Wk

        The rapid spread of the virus triggers contrasted answers from the U.S. federal state and from the different levels of political authorities. Consequently, the U.S. economy is on a free fall trajectory, while social cohesion is under tremendous sanitary and financial pressure. In one week, 6.6 million American people filed for unemployment (Catherine Thorbecke, “6.6 million more Americans file for unemployment amid financial crisis”, ABC News, 9 April 2020).

        This situation begs a series of questions about the geopolitical and strategic consequences of the Chinese confinement and of the U.S. reactions to the COVID-19 for the China-U.S. relationships. Indeed, their interactions are extremely deep, notably because of the economic interdependence that links these two giants, without uniting them.

        Help us continue offering free
        analysis for the COVID-19
        Become a member
        Donate any amount and
        fund analysis on the COVID-19
        Donate Now!

        Chimerica versus COVID-19

        This relation is so dense that Niall Ferguson calls it “Chimerica”. This expression translates the quasi-intimate process of hybridation between these two mammoth national economies (Niall Ferguson, Xiang Xu, “Making Chimerica Great again”, Wiley one line Library, 21 December 2018). This process emerges both from the installation of thousands of U.S. industries and corporations in China and from the mammoth trade relation between the two countries.

        This relation is also the driver of the fantastic trade imbalance between China and the U.S. As such, it is at the core of the trade war launched by President Donald Trump against China in 2018 (Jean-Michel Valantin, “The Midwest floods, the trade war and the pandemic swine flu: the agricultural and food super storm is here“, The Red (Team) Analysis Society, September 3, 2019).

        https://www.youtube.com/watch?v=CQeLXumqG30

        In other terms, the present and future of “Chimerica” is fundamentally related to the consequences of the “global confinement” triggered by the global pandemic of COVID-19.

        In this new series, we are going to evaluate and anticipate the way the COVID-19 is deeply redefining the U.S.-China interdependency. That is to say, we shall assess the potential types of partnerships or conflicts it could unleash.

        In this first article, we shall see how the COVID-19 triggers the equivalent of a geo economic warfare on Chimerica.

        From China’s lockdown to global confinement

        At the start of 2020, after a few weeks of tragic hesitation, the Chinese political authorities reacted very strongly in the face of the COVID-19 epidemic. They locked down entire cities and provinces, with Wuhan and Hubei province in the first place.

        The Chinese Central power cancelled the New Years festivities, and prolonged the official holidays, before confining hundred of millions of Chinese people. This decision intended to decrease the demographic density in working places in Chinese urban areas and especially to stop the dissemination through the travels of massive numbers of people in order to break the contamination chain (Hélène Lavoix, “Why the COVID 19 is NOT a Black Swan event”, The Red (Team) Analysis Society, March 6, 2020).

        For example, on 23 January 2020, the Chinese national authorities decided to impose a complete lockdown on the 11 million people city of Wuhan. This drastic measure aimed at containing the spread of the COVID-19 outbreak, probably originating from the wet market of the city, throughout the country. An immediate consequence of China’s urban confinement was a massive decrease in economic activity (Associated Press, “China reports Jan-Feb economic activity worse than expected”, US News, 16 mars 2020).

        https://www.youtube.com/watch?v=870N8Qaie4Y

        Three weeks later, the epidemic being a matter of national emergency, measures of partial and total lockdown were vigorously enforced in numerous provinces and cities. This meant that 500 million Chinese citizens were living through confinement measures. This represented almost 7% of the whole of humanity.

        From a strictly analytical point of view, this was, so far, a unique feat of social engineering. However, the international spread of the virus started before the confinement.

        Towards international confinement

        Pandemic

        As a result, the pandemic blazed throughout the globalized world, from China to the rest of Asia and Eurasia. The virus expanded everywhere, from South Korea and Asia, to Italy, France, Great Britain and Europe, to Australia and New Zealand, Africa, Latin America, the U.S. and Canada. Thus, during February and March 2020, the COVID-19 became the first global human pandemic of the 21st century.

        Half of the human species is confined (Hélène Lavoix, “COVID 19-Worst case baseline scenarios”, ibid). The geopolitical consequences of this sanitary initially domestic crisis were developing at a gigantic scale.

        From China to Chimerica

        This dire sanitary-economic situation begs the question of what the confinement of both China and the U.S. means for Chimerica?

        De facto, the Chinese economic reality is inseparable of the U.S.-China relationship. Indeed, if the U.S. industrial output represents “only” 16,6% of the world production, while China’s industrial output weighs 28%, it is the result of the installation of large segments of the U.S. industrial base in China and in Asia since the 1980s (Felix Richer, “China is the world’s manufacturing power”, Statista, Feb 18, 2020).

        Chimerica results from the export of China-based products at very low costs to the U.S. consumer base.

        Chimerica and China’s growth

        Chimerica

        From this point of view, Chimerica literally “is” the different dimensions of the fantastic trade imbalance between the two countries. Since 1986, this imbalance went from zero to more than 336 billion dollars in 2017 and 378 billion dollars in 2018 (Office of the United States Trade representative, “The People’s Republic of China – U.S-China Trade facts“).

        One notes that, since 2002 when China joined the World Trade Organization, this imbalance has been growing and accelerating. The Chinese GDP follows the same dynamic. As it happens, according to the IMF, in 2001, China’s GDP corresponded to 13% of the U.S. GDP. It represented 25% of the U.S. GDP in 2007 and 60% in 2016. In 2016, the IMF was projecting a growth of the 2023 Chinese GDP that would make it equivalent to 88% of the U.S. GDP.

        In other terms, Chimerica is at the core of the Chinese growth, as well as the heart of the U.S. economy (Niall Ferguson, Xiang Xu, ibid).

        The COVID-19 slows down China’s economy…

        The coercive measures of forcibly enforced urban lockdown and quarantine drastically slowed the Chinese economy down. They did so by diminishing the industrial and trade activity throughout the country. As a result, the import-export global relationship of China with Asia, and the rest of the world also slowed down.

        Thus, as China accounts for a mammoth 28% of the world industrial output, its slowing down impacts the global industrial output. The Caixin/Markit China manufacturing PMI, as well as IMF studies, reveal that, in January and February 2020, China’s industrial production suffered a historic contraction. China’s industrial production was 25% lower than during the same period in 2019. In the meantime, retail sales also suffered a massive 35% drop (Huileng Tan, “China’s factory activity slumps in February in weakest reading on record, private survey shows”, in “A private survey shows shows China’s manufacturing activity expanded slightly in March”, CNBC, updated 1 March 2020).

        Impacting America

        From this point of view, the confinement of China and its industrial and economic consequence literally rippled through and down the China-U.S. production, trade, finance, and logistical arteries. Moreover, the confinement of part of America is rapidly affects the consuming habits of the U.S. population (Lucia Mutikani, “U.S consumer prices post largest drop in five years amid coronavirus disruptions”, Reuters, April 10, 2020).

        https://www.youtube.com/watch?v=ZD-HP_7cgaQ

        Confinement as a geo-economic warfare

        Oil as indication

        However, “Chimerica” is also the core driver of the world economy. The viral crisis is reinforcing the slowing down trade. It is already translating through the fall of oil Chinese imports and on the oil prices, amid the Russia-Saudi Arabia-Mexico initial oil production dispute (Gillian Rich, “Oil prices mixed after OPEC+ surrenders to Mexico on massive deal”, Investors Business Daily, 10 April 2020). As of 12 April 2020, oil prices are at historic lows, between 22$ and 24$. One must remember that, at the worst of the 2008 crisis, oil prices slumped “only” at 40$.

        However, oil is the material and energetic driver of the world economy and finance. This dizzying fall of the oil prices is expressing a global deceleration of production and transport activities. It also means a mammoth loss of petro-dollars that thus cannot be injected in international transactions.

        Chimerica as an economic battlefield

        So, the consequences of the COVID-19 are triggering the equivalent of a geo-economic warfare on the hybrid U.S.-China economy. However, since 2018, this US-China hybrid economy was already under pressure because of the U.S.-China trade war.

        The combination of both the pandemic and the trade war turns Chimerica into an inside-out economic battlefield. As the virus and confinement policies spread through the road of globalization, the whole world is decreasing its interactions with China.

        https://www.youtube.com/watch?v=GBV8NeBQaIU

        Pandemic as a geo-economic warfare

        Actually, we may wonder if those safety measures are triggering a situation with consequences similar to a worldwide geo-economic conflict. Theorised since 1990, a “geoeconomic war” is thought as a way to inflict a country the same kind of damages that could be wrought by military means. This approach concerns infrastructures as well as the financial dimensions of life quality. The idea is to use economics as weapon systems (Edward Luttwak, “From Geopolitics to Geoeconomics”, The National Interest, 1990 and Robert D. Blackwill and Jennifer M. Harris, War by other Means, Geoeconomics and Statecraft, 2016)).

        Thus, in a very strange and surprising way, the COVID 19 crisis appears as a new kind of economic disruptive force. As it happens,, this unwanted offensive strikes China, and the U.S., thus Chimerica.

        However this battlefield deploys itself on numerous fronts. First, let us see what happens on the savage American front.

        Featured image: Image par Gerd Altmann de Pixabay [Public Domain]

        The Red (Team) Analysis Weekly – 9 April 2020 – COVID-19 Cognitive Overload?

        This is the 9 April 2020 issue of our weekly scan for political and geopolitical risks (open access). Again, a very large part is devoted to the COVID-19. Read the scan below, after the editorial, quite long this week.

        Editorial

        First, this week’s scan features the excellent article “Stretching the International Order to Its Breaking Point” by Thomas Wright, Senior fellow at the Brookings Institution in The Atlantic. The highlight for the article reads:

        “The greatest error that geopolitical analysts can make may be believing that the crisis will be over in three to four months.”

        It is not only geopolitical analysts that are making this error, but, apparently, an increasingly large majority of people, whatever their position and role in the system.

          As we progress here, at The Red (Team) Analysis Society, with the building of scenarios for the COVID-19, the idea of a crisis with a rapid end looks more and more improbable, not to say impossible. The COVID-19 is a pandemic, caused by a highly contagious, dangerous virus about which we know extremely little. It is highly improbable it disappears as if by magic, because it is inconvenient to human beings.

          The sketch Wright paints for the future is highly interesting and is definitely a must read.

          The second point I would like to make for this scan, considering the signals collected, is the incredible sheer mass of texts, articles, posts, etc. produced on the COVID-19. It is not only the COVID-19 cases that grow exponentially, but also publications about it. Thus, we are also faced with the dangers of a huge information overload. It is impossible to keep track of all the articles. It is impossible to even skim through them to sort out quality articles from rubbish, serious articles from fake news, scientific analysis from mere opinion. We certainly cannot rely on Google or search engines, as their algorithms rarely privileges quality and relevance. Google, for example, in its ranking, puts a high premium on page-speed and commercial stuff. But are these truly important criteria to find truly crucial articles on key uncertainties regarding the COVID-19?

          The COVID-19 information overload will accelerate the need for closure, which is already enhanced by the stress and the crisis. The need for closure is the imperious need to get answers, any answer, immediately. It rises notably with time-pressure, critical when going through duress and crisis, and with environmental noise, which includes information overload (for more on the need for closure, cognitive biases in general and strategies to mitigate them, see our online course 1 – Geopolitical Risks and Crisis Anticipation: Analytical Model – module 2). Of course, when faced with a pandemic, jumping to decisions and responses is not a very good idea. On the contrary, one needs to think peacefully and to use evidenced-based analysis, and to wait, when necessary, until proper analysis and science-based findings become available. Thus one needs to have a low need for closure.

          Now, the very means we have to obtain analysis and scientific articles, the web, because of the massive amount of texts on the COVID-19, creates an information and cognitive overload that, in turn, generates need for closure thus stops the capacity to think. Thus, to be able to know, we impair our ability to think.

          Disaster looms.

          Actors will probably fall back on classical means to obtain information: the system as it exists (which includes also the pre-COVID-19 Google, Bing and others algorithms). But, this directs us to ask a very inconvenient question.What led us all to first an outbreak of a completely unknown disease, then to an epidemic then to a pandemic, with all the unpreparedness that is everywhere increasingly documented is this very system. Hence, is that system the best to select the relevant and reliable information we need to face and overcome the pandemic?

          If not the system then what? Could part of the system be salvaged and should other parts be abandoned? Here our topic is selection of quality and relevant analysis, but should these questions be also extended to the whole system?

          The Scan

          Using horizon scanning, each week, we collect weak – and less weak – signals. These point to new, emerging, escalating or stabilising problems. As a result, they indicate how trends or dynamics evolve.

          The 9 April 2020 scan→

          Help us continue offering free
          analysis for the COVID-19
          Become a member
          Donate any amount and fund analysis on the COVID-19 Donate Now!

          Horizon scanning, weak signals and biases

          We call signals weak, because it is still difficult to discern them among a vast array of events. However, our biases often alter our capacity to measure the strength of the signal. As a result, the perception of strength will vary according to the awareness of the actor. At worst, biases may be so strong that they completely block the very identification of the signal.

          In the field of strategic foresight and warning, risk management and future studies, it is the job of good analysts to scan the horizon. As a result, they can perceive signals. Analysts then evaluate the strength of these signals according to specific risks and dynamics. Finally, they deliver their findings to users. These users can be other analysts, officers or decision-makers.

          You can read a more detailed explanation in one of our cornerstone articles: Horizon Scanning and Monitoring for Warning: Definition and Practice.

          The sections of the scan

          Each section of the scan focuses on signals related to a specific theme:

          • world (international politics and geopolitics);
          • economy;
          • science including AI, QIS, technology and weapons, ;
          • analysis, strategy and futures;
          • the Covid-19 pandemic;
          • energy and environment.

          However, in a complex world, categories are merely a convenient way to present information, when facts and events interact across boundaries.

          The information collected (crowdsourced) does not mean endorsement.

          Featured image: Milky Way above SPECULOOS / The Search for habitable Planets – EClipsing ULtra-cOOl Stars (SPECULOOS) is searching for Earth-like planets around tiny, dim stars in front of a panorama of the Milky Way. Credit: ESO/P. Horálek.

          The COVID-19, Immunity and Isolation Exit Strategy

          One of the critical and key uncertainty about the COVID-19, among so many, is the immunity a patient may have after recovery from the COVID-19. In other words, can someone who recovered from the COVID-19 catch the disease again and infect other people again?

            As long as we have neither vaccine nor fully efficient antiviral treatment, specific acquired immunity, i.e. the immunity developed as the body fights then recovers from the disease, is one of the key variables at the center of the few solutions we have to handle the pandemic. Because, as we saw, we shall not be able to use vaccination for immunisation before at the very best winter 2022, and considering the uncertainty considering treatments against the SARS-CoV-2, specific acquired immunity becomes even more important.

            This immunity is also key to determine exit strategies to isolation and lockdown. Indeed, one of the components of the exit strategy that may be designed is to allow people who have developed an acquired immunity to return to normal life (e.g. Ran Balicer, “Coronavirus: Two Things Must Happen Before Initiating Exit Strategy“, Haaretz, 2 April 2020).

            Thus what do we know or not, so far, about this immunity? How can we handle the uncertainty? Finally, what does that imply for an exit strategy? This is what we shall see in this article.

            Help us continue offering free
            analysis for the COVID-19
            Become a member
            Donate any amount and
            fund analysis on the COVID-19
            Donate Now!

            Many questions and few answers, yet.

            In a nutshell and schematically, when a pathogen such as the SARS-CoV-2 enters the body, the immune system develops a range of reactions to fight against the intruder and attacker (for a very interesting clear, detailed biological and medical explanation see, for example, “Features of an Immune Response“, in Immune System Research, National Institute of Allergy and Infectious Diseases). The creation of antibodies is one of these responses. Antibodies will attack the intruder. If the immune system is victorious against the SARS-CoV-2, then the patient recovers. His or her body keeps traces of war that took place. The patient will now also have an acquired immunity (e.g. Encyclopaedia Britannica, “Immune System“).

            However, as Morgane Bomsel, virologist and immunologist underlines:

            “The question is to know if it [the acquired immunity] will be protective of nor, and how long it will last” (La question est de savoir si elle va être protectrice ou pas, et combien de temps elle va durer) .

            in Camille Gaubert, Interview with Morgane Bomsel, “Covid-19 : l’immunisation pourrait, chez certains, ne pas protéger d’une deuxième infection“, Sciences et Avenir, 1 April 2020)

            Protective acquired immunity after recovery from the COVID-19?

            First, thus, one needs to find the various components of the acquired immunity in the body. For example, antibodies need to be present in such a quantity that they are sufficient to prevent infection again (Wu, IBId., Callow, K A et al., ibid.). Such antibodies were detected in a patient with mild-to-moderate symptoms “before symptomatic recovery. These immunological changes persisted for at least 7 d following full resolution of symptoms” (Thevarajan, I., Nguyen, T.H.O., Koutsakos, M. et al., “Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19“, Nat Med; 2020).

            Then, Linlin Bao, et al., in a not yet peer-reviewed article, showed on rhesus macaques that those could not be reinfected, “after the symptoms were alleviated and the specific antibody tested positively”, at 5 days post-infection (“Reinfection could not occur in SARS-CoV-2 infected rhesus macaques“, bioRxiv, 14, March 2020.

            On 27 March 2020, the Helmholtz Centre for Infection Research (HZI) in Germany announced the start of a much larger study, on 100.000 individuals. The donors’ “blood will be regularly tested for antibodies against the Covid-19 pathogen. The study will provide a more accurate picture of immunity and pandemic development.” The center goes on highlighting that following this study, one may imagine giving a kind of immunity certificate to people who developed an immunity, which would allow them to return to normal life (Ibid.). The tests should start in April 2020 and first results should be available at the end of the same month (Veronika Hackenbroch, “Large Antibody Study to Determine Germans’ Immunity to Covid-19“, der Spiegel, 27 March 2020). Improvements in the test procedure – thus reliability of the study – should take place between end of May 2020 and end of June 2020 (Ibid,).

            Thus, it would seem, according to what we now know, that we indeed obtain a protective acquired immunity. Utmost caution, however, must still be exerted waiting for other studies’ results, such as the German study.

            Furthermore, we must also account for the possibility, that, for some individuals, a different immune response develops. In two other coronaviruses, the SARS and the MERS, for some people, the antibodies facilitated infection rather than preventing it Camille Gaubert, Interview with Morgane Bomsel, “Covid-19 : l’immunisation pourrait, chez certains, ne pas protéger d’une deuxième infection“, Sciences et Avenir, 1 April 2020). Favourable results for experiments in vitro gave opposite, negative results in vivo experiments (ibid.). If such were the case for the SARS-CoV-2, however, possible negative impacts of antibodies could then be blocked with adequate treatment (ibid.). However, this would be again more pharmaceutical efforts to endeavour.

            The possible existence of such individuals that would then possibly be more fragile after infection needs to be thoroughly deepen and then checked before general measures are applied to the population.

            Length of the protective acquired immunity

            However, antibodies remain in the body, for a while (e.g. interviews with virologists and immunologists in Katherine J. Wu, “What Scientists Know About Immunity to the Novel Coronavirus“, Smithsonian Magazine, 30 march 2020; Callow, K A et al. “The time course of the immune response to experimental coronavirus infection of man.” Epidemiology and infection vol. 105,2 1990; Gaubert, Ibid.).

            But how long is this while? This is the first unknown we face. Antibodies usually diminish with time then disappear (Wu, ibid.). Thus, how long do we keep these antibodies? For how long will the acquired immunity be protective?

            Then, another related question is about the immune memory: will antibodies be able to remember the attacker well enough to generate the proper response (Wu, Ibid.)?

            Thus, to summarise, for our purpose the key question is: for how long will the acquired immunity be protective?

            Currently, although we do not know with certainty, most scientists seem to consider as likely hypothesis that, in general, patients who have recovered from the COVID-19 will be sufficiently immunised, for a while.

            The possible length of the naturally acquired immunity considered varies.

            Indeed, our knowledge of the SARS-CoV-2 is extremely recent. It started with recorded data mainly in January 2020. Thus at the beginning of April 2020, we cannot know with certainty the possible length of the immunity beyond 2 to 3 months. This is one more reason why monitoring what is happening in China, where the first patients recovered, is so important.

            Various hypotheses are considered.

            If the SARS-CoV-2 is similar to the coronavirus giving the common cold, then some scientists state that the immunity could last “years” (Interview with Angela Rasmussen, a virologist at Columbia University in Brian Resnick, “The 9 most important unanswered questions about Covid-19“, Vox, 20 March 2020). However, other results, obtained with the coronavirus 229E, show a more complex picture, as some individuals could also, in experiment, become reinfected a year later (Callow, K A et al. “The time course of the immune response to experimental coronavirus infection of man”, Epidemiology and infection, vol. 105,2, 1990).

            If the coronavirus behaves as the seasonal flu, the hypothesis the Imperial College COVID-19 Response Team used, then re-infection is considered as “highly unlikely in the same or following season” (Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020, p. 4). However, the seasonal flu is not a coronavirus.

            Other uncertainties

            The condition and age of the patient, as well as genetics, may also impact the response of the immune system (Wu, Ibid.).

            Finally, mutations may occur as the virus duplicates itself, leading to new strains the body cannot recognise, as with the seasonal flu (Wu, Ibid.). This is however less likely for coronaviruses than for flu viruses (Ibid.). But coronaviruses can also “trade segments of their genetic code with each other”, which allows them to trick the immune system. (Ibid.). In that case, the acquired immunity would be useless. Note that this would also be true for a vaccine.

            Virologists and immunologists most probably have other much more specific questions to which they need to find answers.

            Thus, with such a new disease, we are still faced with many uncertainties. How can we handle them?

            Impacts on the architecture of scenarios

            Again, scenarios are a crucial tool to handle these uncertainties.

            Our scenario structure is currently as follows. The main scenario we consider as most likely is that we shall have to wait for a vaccine until winter 2022 (at best) (see Hélène Lavoix, The COVID-19 Pandemic – Surviving and Reconstructing, The Red (Team) Analysis Society, 24 March 2020, last updated 3 April 2020). Then we need to account for the possibility to see the emergence of treatments impacting the disease (see Hélène Lavoix, Covid-19 – Scenarios – Making Sense of Antiviral Treatment, The Red (Team) Analysis Society, 30 March 2020).

            Now, ideally, we would need to have another epidemiological layer of models and scenarios that vary to include various possibilities for the acquired immune response. We would build the next layer of our scenarios out of these.

            Until such detailed epidemiological models are available, if ever, we need to handle the variable “immunity” as correctly as possible, through different sub-scenarios useful for our purpose. The best way at this stage is to consider a first batch of sub-scenarios where a fully protective immunity is developed upon recovery and to have this immunity vary according to time.

            Considering that the detailed epidemiological model that many governments use is the model the Imperial College COVID-19 response team developed (Ibid.), it is interesting for our purpose to look at a scenario that is less optimistic than the “same season and next one” immunity they used, for example less than one year, one that is the Imperial College scenario and one that is more optimistic, for example, an immunity that lasts from one and a half to two years.

            That said, the Imperial College’s model shows that “temporary suppression” (with social distancing of the entire population, case isolation, household quarantine and school and university closure) is the only way forward not to overwhelm the health system and to prevent massive fatalities. It also shows that because this suppression is successful, then only a small number of individuals will develop immunity. Hence, for a collective approach focused necessarily on health, fatalities and not overwhelming the health system, variations on the acquired immunity, because they play on small numbers, may not be a key variable.

            Things are, however, more challenging for the second objective all polities must fulfil, i.e. ensuring the fundamental security a society needs to survive as well as not to break down (see The COVID-19 Pandemic – Surviving and Reconstructing, and Summary of previous findings in Covid-19 – Scenarios – Making Sense of Antiviral Treatment). Indeed, critical functions must continue, and, as much as possible, a new economy must start emerging. As a reminder, the first objective is to reduce as much as possible the fatalities resulting from the disease (see Summary of previous findings, ibid.).

            Hence the need for sub-scenarios that consider acquired immunity and its length.

            Finally, to make sure we cover the whole range of possible futures, we may create a “complex immunity” scenario that would actually cover all other cases. This scenario would, for example, include a situation where the acquired immunity varies so much according to diverse criteria that it becomes difficult, rapidly, to create adequate understanding and thus policies. It could also be used if our knowledge is so uncertain and the involved risks are so high that similarly, no policy can be created easily. With time, or according to the decision-makers for whom the actionable scenarios are created, this “cluster scenario” would need to be developed adequately.

            This “complex scenario” would be the least favourable.

            Immunity and exit strategy

            We must highlight first that the theories and models created to handle the exit of the “suppression/isolation” period need to account for the immunity uncertainty.

            Thus, considering the high cost in lives and sufferings, as well as the impacts across domains, we must consider all scenarios. We cannot consider only the most likely and most preferable scenario. Actually, we need either to make sure that policies will be correct across scenarios or that they are flexible enough to switch in a timely way from one scenario to another. In that case, this demands precise monitoring and warning that will allow to steer policies, again in a timely manner. This flexibility should also allow to fully integrate new understanding and new results on the length and protection of the acquired immunity, as they become known.

            Policies also need to be correct at both individual and collective level, considering the high stakes in terms of legitimacy for political authorities. For example, the policies should try to consider the possibility of individual variations in terms of acquired immunity.

            In terms of exit strategy, for example, the current assumption, considering the early results (see above) is that people who were positive to the COVID-19 and recovered, now have a protective immunity to the SARS-CoV-2. However, it does not seem that the length of the immunity is, so far, taken into account.

            The challenge thus becomes, in terms of handling of the pandemic and exit of the isolation/suppression phase to identify who has antibodies. If we wanted to also make sure the length of the immunity is considered, then we would need to make sure that a possible fading of the immunity can be identified.

            The answer to this need will be in the serological tests, which are currently developed worldwide (Chad Terhune, Allison Martell, Julie Steenhuysen, “U.S. companies, labs rush to produce blood test for coronavirus immunity“, Reuters, 25 March 2020; Gretchen Vogel, “New blood tests for antibodies could show true scale of coronavirus pandemic“, Science, 19 March 2020; Hugo Jalinière, “Les tests de sérologie, clé du déconfinement“, Sciences et Avenir, 30 mars 2020; Lauren Chadwick, “Coronavirus: Antibody tests ‘will be crucial’ in determining when to lift lockdowns“, Euronews, 6 April 2020; for a list of commercially developed tests all categories, not only serological, see Find, Covid-19 Diagnostics resource centre).

            Assuming that the tests are reliable, we nonetheless find again the familiar problem of quantities. The ongoing “war for face masks” is very likely to be again reproduced, this time, with tests. Masks as well as serological tests become crucial stakes to fulfil the two objectives of societies faced with the COVID-19 pandemic. Those who will be able to develop and secure for their populations as much and as many of the necessary tools – including smart strategies – to both survive and ensure the fundamentals of security, will survive best. Furthermore, they are also likely to be earlier and better able to interact again with each other.

            To account for the length of the immunity, if the tests which are developed cannot detect early enough a fading of immunity, then testing many times subjects may become necessary. However, here the problem of test quantity – and test operationalisation – increases. Continuing imperatively protective gestures as well as a generalisation of face masks is thus likely to be necessary to compensate for insufficient serological testing.

            With the next articles we shall continue exploring the factors which are key to build the general architecture of our scenarios.

            Some detailed references and bibliography

            Callow, K A et al. “The time course of the immune response to experimental coronavirus infection of man.” Epidemiology and infection vol. 105,2 (1990): 435-46. doi:10.1017/s0950268800048019

            Linlin Bao, Wei Deng, Hong Gao, Chong Xiao, Jiayi Liu, Jing Xue, Qi Lv, Jiangning Liu, Pin Yu, Yanfeng Xu, Feifei Qi, Yajin Qu, Fengdi Li, Zhiguang Xiang, Haisheng Yu, Shuran Gong, Mingya Liu, Guanpeng Wang, Shunyi Wang, Zhiqi Song, Wenjie Zhao, Yunlin Han, Linna Zhao, Xing Liu, Qiang Wei, Chuan Qin, “Reinfection could not occur in SARS-CoV-2 infected rhesus macaques“, bioRxiv, 14, March 2020, 2020.03.13.990226; doi: https://doi.org/10.1101/2020.03.13.990226

            Thevarajan, I., Nguyen, T.H.O., Koutsakos, M. et al. Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med (2020).https://doi.org/10.1038/s41591-020-0819-2

            Shi, Y., Wang, Y., Shao, C. et al. COVID-19 infection: the perspectives on immune responses. Cell Death Differ (2020). https://doi.org/10.1038/s41418-020-0530-3

            Featured image: Image par Gerd Altmann de Pixabay

            COVID-19 Antiviral Treatments and Scenarios

            The world is now struggling to know how to face the COVID-19 pandemic. We want to know how long the pandemic will last. Actually, what we want to know is when the pandemic will end and when life will be able to resume normally.

              As we explained in the opening article for this series, to be able to answer these questions, considering the very high number of uncertainties involved, we need to use scenarios. Our aim is to contribute to the creation of robust scenarios in our field, political science and international relations. We are thus concerned with the future of polities, i.e. the futures of organised societies. Nonetheless, to be able to do so, we obviously have to take into account what other sciences, those primarily concerned with diseases and pandemics, find out.

              For now we are trying to establish both the general structure for our scenario tree and the timeframe. Thus we study main critical factors that will allow us to articulate our scenarios.

              In this article, we first briefly summarise the points made in previous articles. We then turn to the antiviral prophylaxis and treatment as a second key critical factor.

              Summary of previous findings

              Objectives of societies faced with a pandemic

              Because we have collectively and individually “chosen” not to accept the baseline worst case scenario, then our main aim is now survival for each individual, and for each polity, society or country. Fundamentally, as long as the pandemic continues, thus as long as the baseline worst case scenario could become a reality, each polity will need to fulfil simultaneously two objectives.

              First objective

              Our analysis of the coronavirus/
              Covid-19 pandemic is available for free.
              Please consider becoming a member of the Red (Team) Analysis Society
              to support independent and in-depth analysis or
              Fund Analysis on the COVID-19 with a donation

              The first objective is to reduce as much as possible the fatalities resulting from the disease. This implies reducing the number of infected people and caring for those who are ill. This means, in turn, not overwhelming the care system.

              Should we fail, then, not only the dreaded scenario we seek to avoid would take place, but, at worst, all other fatalities and deaths we succeeded to prevent over centuries could come back. The excess deaths (compared with the pre-pandemic time) would be dramatic. It would also seriously impaire the capacity of a society to ensure its security and, at term its survival.

              Second objective

              The second objective is to continue having a society that ensures fundamental security.

              Simultaneous objectives

              The two aims must be fulfilled at the same time.

              Indeed, if fundamental security is not ensured, then the system will rapidly collapse. Neither caring for diseased people, nor containment measures will be possible anymore. The pandemic will run its course as with the worst case scenario, but the situation will be even worse. If we do not stop the pandemic, then death and disease will take their toll and damage the capacity of society to ensure its security. Society will be fragilised, and in turn will less be able to handle the pandemic, increasing fatalities. We risk here to fall into a vicious circle.

              Fund Analysis on the COVID-19

              Immunisation and vaccine as a first key critical factor

              We explained in the previous article, that immunisation through vaccination is a first critical factor around which we can organise the architecture of our scenarios. We also assessed – with many uncertainties remaining – that we could not expect such immunisation to take place before winter 2022-2023. This gives us a first broad likely scenario upon which we can concentrate. Within this scenario that we shall use as framework, we need to understand the futures of our systems as they face the COVID-19 over the next two to three years.

              Become a member

              Actually, another implicit scenario at the same level of analysis should also be made explicit. This scenario is, however, uncontrollable, according to the current and expected stage of knowledge. The virus, could lose either its infectious power or its lethality or a strong immunity could also develop naturally among human beings. In that case, the pandemic would end much earlier. This scenario being less likely and also obviously less threatening, considering limited resources, we shall not, right now, examine it. Nonetheless the factors influencing the probability of this scenario must be monitored.

              Antiviral prophylaxis and treatment – a second key critical factor

              Antiviral prophylaxis and treatment are a second critical factor for our scenarios architecture. Indeed, we try to reduce fatality. Thus, if we have a cure for the disease, the possibility of the worst case baseline scenario disappears.

              To date, 30 March 2020, there is no known antiviral treatment against the SARS-CoV-2, i.e. certain and having gone through all the usual testing process.

              Thus, some of the key questions we must ask are as follows. Is it possible to see a treatment discovered and developed? Which types of effects this treatment could have on the disease and on the pandemic? When could this treatment become available?

              Here, we face a supplementary challenge as controversies, debates, power and ego-struggles have entered the field. Meanwhile, notably out of fear, panic, or lack of trust in governments, these debates and struggles have been transformed and relayed as rumours, fake news, and conspiracy theories.

              As far as we are concerned, we shall rely on scientific papers and focus on looking for elements which are key for our aim, contributing to establish valid scenarios. We shall also keep the issue of the timeframe in mind.

              Possible candidate antiviral treatments from existing and known drugs

              The Chloroquine hope and debate

              Since mid-February and increasingly so as the pandemic spread, the efficiency of chloroquine, either as Chloroquine phosphate or as one of Chloroquine’s derivate, hydroxychloroquine, to treat patients infected with the SARS-CoV-2, has become a hot topic in scientific and lay publications (see a non-exhaustive bibliography below). Some promote it as the Graal that will save us all from the disease. Others just underline that the necessary clinical tests allowing to assert and measure its efficiency – as well as the ideal posology according to the stage of the disease – have not yet been completed. Meanwhile, conspiracy theories abound.

              Hope from a Chinese publication

              In a nutshell, the issue is relatively simple. On 19 February 2020, as an e-publication, Gao J, Tian Z, Yang X, published a letter for advanced publication titled “Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in
              clinical studies” in the journal BioScience Trends. There, they notably stated that

              “The drug is recommended to be included in the next version of the Guidelines for the Prevention, Diagnosis, and Treatment of Pneumonia Caused by COVID-19 issued by the National Health Commission of the People’s Republic of China for treatment of COVID-19 infection in larger populations in the future.”

              They also underlined that

              “results from more than 100 patients have demonstrated that chloroquine phosphate is superior to the control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, promoting a virus negative conversion, and shortening the disease course according to the news briefing”.

              The need for further trials

              Now, those who urge caution do so because they would like to have access to all these trials and to be able to replicate and enlarge them.

              Consequently, up to 30 March 2020, at least 17 studies (out of 22 trials) have started, or are planned, to carry out further testing of the efficiency of hydroxychloroquine on patients with COVID-19. They are taking place from South Korea to the U.S. through Thailand, Brazil and the EU. They address various stages of the clinical trials studying a drug. One of these studies only has been completed, in Shanghai. Its results have been published in the Journal of Zhejiang University (Medical Sciences, 3 March 2020). It was carried out only on 30 patients.

              Disappointing results on a small sample

              We should note that the results of the Shanghai’s trial show no impact of hydroxychloroquine on patients, compared with the control group. Even worse, although on such a small group conclusions are only tentative, one patient under hydroxychloroquine developed to a severe condition (ibid).

              Fund Analysis on the COVID-19
              Select options
              A French microbiologist promotes the treatment

              Meanwhile, some French immunologists and specialists in microbiology headed by the Director of the State Institut Hospitalo-Universitaire Méditerranée (IHM) Infection Didier Raoult promoted the early use of Chloroquine (Philippe Colson , et al., “Chloroquine and hydroxychloroquine as available weapons to fight COVID-19”, International Journal of Antimicrobial Agents, 26 February 2020). Furthermore, the same team tested Chloroquine with Azythromycine on 26 patients, 16 others being used as control group (Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial). On 22 March 2020, they decided to start applying hydroxychloroquine massively to infected people in Marseille, adding furthermore Azythromycine.

              Out of the 17 studies mentioned earlier, three of them test the combination of Hydroxychloroquine and Azythromycin.

              Further need to be careful

              Meanwhile, scientists, including from the IHM, have warned about the difference between in vitro successful experiments and in vivo ones. For example, Franck Touret et Xavier de Lamballerie in “Of chloroquine and COVID-19” (Antiviral Research 177 (2020) 104762) pointed out various negative possible impacts in previous attempts at using Chloroquine on other types of viruses. Notably, “in a nonhuman primate model of CHIKV infection”, the use of Chloroquine was shown to delay the cellular immune response (Ibid.). Even though every virus is different, these earlier trials on other viruses highlight the need for caution.

              An indication from outside the medical world

              To this, we should add an indication coming from outside the world of clinical tests. If China considers “the apparent efficacy” of Chloroquine since 19 February, it has nonetheless continued its lockdown, travel bans and quarantine policy on the country. Indeed, for example, lockdown on Wuhan will be partially lifted only on 8 April 2020 (BBC News, “Coronavirus: Wuhan to ease lockdown as world battles pandemic“, 24 March 2020). Furthermore, China is rightly being extra careful with not allowing new imported cases to spread (BBC News, “Coronavirus travel: China bars foreign visitors as imported cases rise“, 27 March 2020). It is paying particular attention to all cases, in case a new wave of COVID-19 would hit the country (Ibid).

              Should Chloroquine – possibly added to Azythromycine – be such a miracle drug, then China would not be so afraid of seeing a new epidemic outbreak. Thus, if we take Chinese policies and behaviour as indication, Chloroquine could hopefully alleviate sufferings, but not critically change the disease behaviour.

              The results of the clinical trials will tell.

              Other candidate treatments

              Meanwhile, China and other countries are testing other drugs and molecules, such as arbidol, remdesivir, favipiravir, lopinavir and ritonavir, also with immunomodulator interferon beta-1b and others (Liying Dong, Shasha Hu, Jianjun Gao, Discovering drugs to treat coronavirus disease 2019 (COVID-19), Drug Discov Ther. 2020;14(1):58-60. doi: 10.5582/ddt.2020.01012; Lindsey R. Baden, M.D., and Eric J. Rubin, M.D., Ph.D., Covid-19 — The Search for Effective Therapy, NEJM, 18 March 2020; Camille Gaubert, “Coronavirus : lancement d’un essai clinique sur 3.200 patients atteints de Covid-19“, Sciences et Avenir, 12 March 2020; John Cahill, “Potential COVID-19 therapeutics currently in development“, European Pharmaceutical Review, 26 March).

              Major ongoing trials

              Among all these candidates the WHO has selected four treatments as most promising for a very large trial: the “experimental antiviral compound called remdesivir; the malaria medications chloroquine and hydroxychloroquine; a combination of two HIV drugs, lopinavir and ritonavir; and that same combination plus interferon-beta” (Kai Kupferschmidt, Jon Cohen, “WHO launches global megatrial of the four most promising coronavirus treatments“, Science, 22 March 2020). The WHO solidarity trial is expected to run from March 2020 to March 2021 (ISRCTN registry).

              The French INSERM coordinates a European corresponding trial called DISCOVERY on 3200 patients. It started on 22 March. Fifteen days after the inclusion of each patient, the analysis of treatment efficacy and safety will be evaluated.

              We should also count the Institut Hospitalo-Universitaire Méditerranée 22 March beginning of treatment of patients with Chloroquine and Azythromycine also as a trial. Indeed, it differs from SOLIDARITY and DISCOVERY because it adds Azithromycine. This point could be important if we consider the pre-test done, as Azythromycine seemed to have a critical role to play (Ibid.).

              As highlighted above, according to the database Clinicaltrials.gov of the U.S. government, 22 trials are currently taking place on various drugs.

              Discovering new treatments or uncovering less common treatments

              This type of scenario is quite similar, in terms of process, to what we saw with vaccines. We must first discover or unearth one or more molecules that may positively impact the development of the disease, yet without adverse effects.

              Artificial Intelligence, Automation, and supercomputers against the SARS-CoV-2

              As existing and known drugs and treatments are tried, researchers are also also busy trying to unearth or discover molecules that could help fight the SARS-CoV-2.

              For example the Institut Pasteur of Lille – France (EN version) tests molecules on the virus thanks to robots in a specially confined laboratory. As a result, researchers can greatly speed the rhythm of tests. Thousands are carried out daily. Meanwhile, the combination of molecules by pairs for testing is also automated (website).

              DeepMind, or rather DeepMind Technologies Limited, the famous artificial intelligence / deep learning lab. Alphabet Inc. (Google) bought, joined the efforts to fight the SARS-CoV-2 ( Computational predictions of protein structures associated with COVID-19, 5 March 2020 – for more on artificial intelligence and deep learning see our related series). It used the latest version of their AlphaFold system to “release structure predictions of several under-studied proteins associated with SARS-CoV-2”. Should these deep learning predictions then be confirmed through experiments, then they will have contributed to a better knowledge of the virus and possibly to the development of new drugs.

              Researchers at the U.S. Oak Ridge National Lab (Department of Energy) use Summit, the most powerful supercomputer to date, “to run through a database of existing drug compounds to see which combinations might prevent cell infection of COVID-19” (Brandi Vincent, “Researchers at Oak Ridge National Lab Tap into Supercomputing to Help Combat Coronavirus“, Nextgov.com, 11 March 2020). Researchers could simulate 8,000 compounds and select 77 that have “the potential to impair COVID-19’s ability to dock with and infect host cells” (Dave Turek, “US Dept of Energy Brings the World’s Most Powerful Supercomputer, the IBM POWER9-based Summit, Into the Fight Against COVID-19“, IBM News Room, nd). It took them a couple of days instead of “months on a normal computer” (Ibid.).

              https://youtu.be/IRtBKUeAly4

              As we pointed out in our series on supercomputers and computing power, these are increasingly key factors for the present and the future. In this case, supercomputers could be critical in the fight against this pandemic.

              Other efforts using supercomputing power, such as a NSF programme or the European program Exscalate4CoV are at work (Oliver Peckham, “Global Supercomputing Is Mobilizing Against COVID-19“, 12 March 2020, HPC Wire). For example,

              “E4C is operating through Exscalate, a supercomputing platform that uses a chemical library of over 500 billion molecules to conduct pathogen research. Specifically, E4C is aiming to identify candidate molecules for drugs, help design a biochemical and cellular screening test, identify key genomic regions in COVID-19 and more”. 

              Oliver Peckham, “Global Supercomputing Is Mobilizing Against COVID-19“, 12 March 2020, HPC Wire

              We could also imagine that companies and start-ups in the quantum information science field, who highlighted the importance of quantum computing and simulation in the field of chemistry, for example, or material science, would be actively contributing to the fight against the COVID-19 (e.g. Foreseeing the Future Quantum-Artificial Intelligence World and Geopolitics; Quantum Optimization and the Future of Government). A similar point could be made regarding logistics necessary to survive the pandemics, working from the Volkswagen Group research with D-Wave (Quantum Optimization, Ibid.). Yet, up to 30 March 2020, no open source information regarding the participation of the “quantum world” in the fight against the COVID-19 seems to be available.

              When could such a new treatment become available?

              There is no way to know how close we are to the discovery of the right molecule or combination of molecules.

              Once it is discovered, the new potential drug will have to go through the whole process of trial and development, including clinical trials (e.g. EU Drug Discovery and Development, U.S. Biopharmaceutical Research & Development).

              Classically – i.e. when we are not in an emergency mode – this process takes 10 to 15 years (Drug discovery, Ibid.) as shown in the picture below.

              EU Drug Discovery and Development, p.11.

              Then, even if we are lucky and manage to shorten the process – to how long? – we shall still need to manufacture the drug and then deliver it.

              First, this explains why the current focus is on known drugs. Second, this highlights that totally new drugs may not help us on the short and even medium term.

              This reminds us that major world pandemics, in the past, lasted not months, but years. Meanwhile, outbreaks happened across centuries. If ever, for antiviral treatments, hope is only in the discovery of a totally new medicine, then then waiting (actively) for a vaccine moved from being a pessimistic scenario to being an optimistic scenario.

              Key elements to look for in an anti SARS-CoV-2 treatment and to inject in scenarios

              Because an antiviral treatment can mix different drugs, posologies and approaches, sub-scenarios will need to include main elements impacting epidemiological models. To identify them, we used the model of the Imperial College COVID-19 Response Team in Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020. As a result, we shall also get the indicators we need to monitor candidate treatments.

              We assume that, once a treatment is found, epidemiologists will relatively rapidly run their models and publish results. In turn, this will allow us updating our scenarios as well as their likelihoods.

              The key elements to which we need to pay attention are as follows.

              Impact on infectiousness

              For example, the treatment could be given prophylactically to everyone, or to the contact cases of an infected person. In turn, the treatment could also lower the cases of asymptomatic or very mild symptomatic infections.

              Impact on immunity

              The impact of treatment on immunity after recovery from infection, on the short term and on the long-term needs to be evaluated.

              Impact on severity of disease

              If the treatment is given to symptomatic cases, we shall monitor if the treatment lowers the amount of patients developing severe, critical and fatal disease. This could twice decrease the pressure on the health system. Indeed, we would have less patients needing stays in hospitals. Furthermore, the duration of the stay in hospital could also diminish. Currently, the Imperial College COVID-19 Response Team estimates that we have:

              “A total duration of stay in hospital of 8 days if critical care is not required and 16 days (with 10 days in ICU) if critical care is required. With 30% of hospitalised cases requiring critical care, we obtain an overall mean duration of hospitalisation of 10.4 days…”

              Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020

              Manufacturing and supply

              Again, as for vaccine, the manufacturing of doses and their availability per country will need to be envisioned in detailed scenarios. Supply tensions are likely to emerge. As a result, we may possibly face international tensions. Should the quantity of the new drug be insufficient per country, then it would be interesting if epidemiological models were run according to possible supply.

              New treatment(s) against the SARS-CoV-2 could offer any combination of the proprieties above. Ideally, epidemiological models or those built on them would also account for the feedbacks between non-pharmaceutical interventions, new treatments beneficial impacts and drug availability.

              With the next articles, we shall continue to explore the factors that determine the architecture of our scenarios.

              Bibliography

              Tara Haelle, “Chloroquine Use For COVID-19 Shows No Benefit In First Small—But Limited—Controlled Trial“, Forbes, 25 marche 2020.

              Tony Y. Hu, Matthew Frieman & Joy Wolfram, “Insights from nanomedicine into chloroquine efficacy against COVID-19“, Nature, 23 March 2020.

              Xueting Yao, Fei Ye, Miao Zhang, Cheng Cui, Baoying Huang, Peihua Niu, Xu Liu, Li Zhao, Erdan Dong, Chunli Song, Siyan Zhan, Roujian Lu, Haiyan Li, Wenjie Tan, Dongyang Liu, In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clinical Infectious Diseases, , ciaa237, https://doi.org/10.1093/cid/ciaa237

              Adam Rogers, Chloroquine May Fight Covid-19—and Silicon Valley’s Into It, Wire, 19 March 2020.

              Liu, J., Cao, R., Xu, M. et al. Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro. Nature, Cell Discov 6, 16 (2020), 18 March 2020. https://doi.org/10.1038/s41421-020-0156-0

              Philippe Colson, Jean-Marc Rolain, Jean-Christophe Lagier, Philippe Brouqui, Didier Raoult, “Chloroquine and hydroxychloroquine as available weapons to fight COVID-19“, International Journal of Antimicrobial Agents (2020), doi: https://doi.org/10.1016/j.ijantimicag.2020.105932

              Gautret et al. (2020) Hydroxychloroquine and azithromycin as a treatment of COVID‐19: results of an open‐label non‐randomized clinical trial. International Journal of Antimicrobial Agents – In Press 17 March 2020 – DOI : 10.1016/j.ijantimicag.2020.105949.

              Guangdong Provincial Department of Science and Technology and Guangdong Provincial Health Committee Multi-center Collaborative Group on Chloroquine Phosphate for New Coronavirus Pneumonia, “Expert Consensus on Chloroquine Phosphate for New Coronavirus Pneumonia” [J]. Chinese Journal of Tuberculosis and Respiratory Medicine, 2020,43 (03 ): 185-188. DOI: 10.3760 / cma.j.issn.1001-0939.2020.03.009

              Featured image: Image by Darko Stojanovic from Pixabay 

              The COVID-19 Pandemic, Surviving and Reconstructing

              The COVID-19 pandemic is now a global fact. It still involves many uncertainties. At present and in the near future, we need to handle the ongoing pandemic as a global catastrophic crisis with complex cascading impacts. We also need to start thinking about reconstruction. We are here concerned with reconstruction that will allow polities to fully function again, i.e. not to be in emergency mode. That may go from norms to socio-political systems, through ways to produce goods and services. It may be elements of these systems, or larger parts of them.

                In this article, we explain first that we have tools to plan ahead properly and constructively even considering the condition of utter uncertainty. We must not allow the unpreparedness disaster that is also striking us to go on. Unpreparedness, resulting from lack of anticipation, must also stop.

                We then turn to the real issue we need to consider: surviving and reconstructing. We thus outline our research question and our scope. We explain that we are coming back to the fundamentals of politics (and not politician politics). We start outlining how both surviving and reconstructing are intertwined. As a result, we paint a sketch of what is ahead and what we need to further research.

                Help us continue offering open access/free articles on the COVID-19
                Donation – Fund Analysis for the War against COVID-19

                Finally, we start the construction of a structure for our set of scenarios that will outline the possible futures. We underline that two factors are critical and will determine our future: vaccine and antiviral prophylaxis and treatment. Here we focus on the first of this factor, vaccine. We do not only look at the discovery of the right vaccine for the COVID-19 but also at the various stages of the immunization process. As a result, we obtain a first estimate that mass campaigns of vaccination may start earliest around winter 2022-2023 (all vaccine candidates). The next article focuses on antiviral prophylaxis and treatment.

                Fund Analysis on the COVID-19
                Select options

                Considering the very large scope of the task ahead, this article is the first of a series of articles focusing on strategic foresight and anticipation to survive at best the COVID-19 and then reconstruct.

                Tools to stop unpreparedness

                To be able to achieve the goals of surviving (across domains) and reconstructing, we need to deploy and use, at the same time, monitoring for warning and strategic foresight. And this is NOT an option but a crucial necessity.

                Monitoring for adequate models and to struggle against deadly biases

                Monitoring must take place in two areas. First, we must monitor what is happening in science, across many disciplines. Then, we must also consider what is happening on the ground. This monitoring will allow revising a knowledge that is everyday checked, changed, and improved.

                With the result of our monitoring, we shall need to update all our models, including those implicit models we use everyday and which are active, unknowingly, in our heads. Indeed, if we do not do that, these inner models will become cognitive biases. And cognitive biases, when survival is at stake, can be deadly.

                This part is extremely challenging because we know that human beings are naturally bad at updating the inner models that allow them to understand the world (e.g. Heuer, Richards J. Jr., Psychology of Intelligence Analysis, Center for the Study of Intelligence, Central Intelligence Agency, 1999 – more in our online course 1 – Module 3).

                For example, as shown by Anderson et al., if we are presented with a new problem and do not have a lot of information about it, our brain creates a first very approximative model. That model makes sense of whatever data we have (Craig A. Anderson, Mark R. Lepper, and Lee Ross, Perseverance of Social Theories: The Role of Explanation in the Persistence of Discredited Information, Journal of Personality and Social Psychology 1980, Vol. 39, No.6, 1037-1049).

                Then, once this model is created, it becomes very difficult to change it. Effort is necessary to do so. In other words, most people, will stick to their initial model, even though new facts and evidence arise. It is not that they lie or that they show bad will, although this, of course, may also happen. It is that those people had first to make sense of a new problem with insufficient information. As they receive new information, their model has become inadequate but it still filters their understanding (Craig A. Anderson et al. ibid.).

                Unfortunately, the COVID-19 pandemic exactly corresponds to the worst possible case to generate this kind of cognitive bias. We have the emergence of a new virus, then a completely new pandemic situation, with completely novel cascading impacts. We are thus in the perfect situation to see outdated inner cognitive models wreck havoc on a situation that is already catastrophic.

                Thus, we absolutely need to apply all methodologies that help us overcome the use of outdated models. Explicit modelling and methodologies of strategic foresight and warning including monitoring are crucial here.

                We must all learn to handle uncertainty

                Strategic foresight and notably scenarios, furthermore, can help us handling uncertainties when they remain.

                Indeed, modeling and scenario-building are the methodological tools epidemiologists use (e.g. for a recent and very influential study, Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020). And we, as social scientists, risk managers and decision-makers, must also follow suit and use this approach.

                Meanwhile, the range of responses we deploy must also, ideally, be as quick and flexible as possible. This is challenging, but this is possible.

                Even small businesses can do it. One way forward, in terms of capabilities, could be to mutualise some parts of the work, for example within chambers of commerce, or professional associations.

                Even individuals can and should do it. Indeed, in a pandemic, they are those who are first on the front line. The need to care and protect first and foremost the medical staff is constantly highlighted. This is, of course, indispensable. Each profession that participates in activities crucial for survival is key.

                Yet, alongside them as professional groups, those who fight on the front line are each and every individual, their body and their understanding of the situation. They are those who will stop or not the contagion. And they are those who will win against the virus or not.

                Framing our issue – surviving then reconstructing

                Rediscovering survival matters

                We have moved from a normal type of life and system to an emergency one, where only survival matters.

                The reasons for this move, despite the many conspiracy theories and denials of all sorts spreading, is grounded in the risks entailed by what we called crude worst case baseline scenarios. This is the epidemiological approach where overall possible fatalities are estimated, before scenarios to handle the pandemic start being modelled (e.g. Imperial College COVID-19 Response Team, Impact of non-pharmaceutical interventions (NPIs) to reduce COVID19 mortality and healthcare demand, 16 March 2020). We thus shall not come back to this point here.

                Thus, we have become aware again of the importance of survival as prime motivation. We are living the essence of what politics is really about: human beings are organised in society to survive, and the fundamental mission of political authorities is to ensure their survival and security (e.g. What is Political Risk? and related bibliography). Most people had forgotten these essentials, but the pandemic reminded us powerfully and pitilessly of these fundamentals.

                If you think about it, what we are all living through is absolutely extra-ordinary. Country after country, in a couple of days, according to cases, we went from a business as usual state (for those who were not paying attention to the world) to complete confinement, end of economic supremacy, closed borders, end of freedom, end of “fun”. And 168 countries face, one after the other, the same ordeal in a couple of months. And we see it and communicate about it across vast distances. This is completely new too.

                Destruction and reconstruction

                Meanwhile, and as a result, the usual pre-COVID-19 system is being destroyed.

                The scope, magnitude and depth of the destruction will depend upon how long the COVID-19 state of emergency system will last, upon the lethality and the amount of sufferings the pandemic will inflict on the population. It will also depend, relatedly, on the way the pandemic and the COVID-19 emergency system are handled and the resilience of the pre-COVID system.

                The reconstruction, in turn, will depend upon what “part” of the pre-COVID-19 world as a socio-ideological and political system has been destroyed and how this destruction was carried out. It will be determined by the amount of damages and sheer destructions the pandemic directly caused. The state of the various actors at the end of the pandemic, i.e strength, capabilities, intentions, trauma etc., will also, and as strongly, influence reconstruction.

                The case of face mask shortages

                For example, what the populations and their ruling authorities live, the intractable hurdles and fear they face, will remain as a burning mark in their memories. Those will certainly strongly shape their future decisions and actions.

                For instance, the whole of Europe and the U.S. face an incredible shortage of face masks (e.g. Yanqiu Rachel Zhou, “The global effort to tackle the coronavirus face mask shortage“, The Conversation, 17 March 2020; Keith Bradsher and Liz Alderman, “The World Needs Masks. China Makes Them — But Has Been Hoarding Them“, 13 March 2020, updated 16 March, The New York Times).

                This results from past mismanagement and from intense outsourcing of face mask manufacturing capabilities, notably to China that produces half of them (Ibid.; Fabien Magnenou, “Coronavirus : pourquoi la France manque-t-elle de masques de protection respiratoire ?“, France Info, 19 March 2020).

                Consequently, the non-producers must wait on others’, and notably China, good will and benevolence and gifts. They must wait until exports become available again.

                Thus, new production capabilities must be recreated from scratch, in a hurry, thanks to imagination, courage and good will, while the know-how must be reinvented. Adequate materials may lack. At the beginning, the resulting products may not be as safe as needed (e.g. Juliette Garnier, “Coronavirus : mobilisation générale pour fabriquer des masques en tissu“, Le Monde, 17 March 2020).

                In the meantime, the contagion spreads and people die. On the bright side, innovation and new ways to produce will emerge from this struggle for face masks.

                Yet, the stress and the fatalities and the fear will certainly not be forgotten in our lifetime and maybe for generations. As a result, it is very likely that major outsourcing to China or elsewhere is over, especially for goods that could be of critical importance.

                To come back to our main question, we are thus faced with a twin task. We must foresee the near future to be able to survive while, in the same time, identifying various scenarios of destruction and nascent reconstruction. Then, building from and upon this first layer, we must foresee possible ways to reconstruct.

                Looking for a first structure for our set of scenarios

                On the importance of time

                As a preamble, we need to stress a supplementary challenge we face when building the architecture of our set of scenarios for the COVID-19 pandemic.

                We need to introduce a relatively precise timeframe. Indeed, the length of time during which the pandemic will last, as well as the timing and duration of measures taken does matter. This is obvious when looking at epidemiological studies, which will be one of the main materials upon which we shall build (e.g. Imperial College COVID-19 Response Team, Ibid.; Joseph T Wu et al. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study, The Lancet, 31 January 2020).

                Key critical factors: vaccine and antiviral prophylaxis and treatment

                The first factor that determines all the others is the existence – or rather in our case the non-existence – of vaccine and/or antiviral prophylaxis and treatment. Once either vaccine or treatment or both are viable, then a second key question is their availability in sufficient quantity where they are needed. Finally, we have the operationalisation of mass vaccination and/or treatment. These elements are absolutely critical.*

                Indeed, once a vaccine will have become widely available and will have immunised the population, then the pandemic will end. In the case of treatments, we shall have potentially more variations and shades, but, fundamentally, the way the factor operates will likely be similar. We shall refine this statement after analysis.

                The scientific effort to identify possible vaccines candidates and antiviral prophylaxis and treatment is considerable. This could take place thanks notably to very early Chinese efforts to “sequence the genetic material of Sars-CoV-2” and willingness to share it as quickly as possible (e.g. Wu, F., Zhao, S., Yu, B. et al. A new coronavirus associated with human respiratory disease in China. Nature 579, 265–269 (2020), 3 February 2020; updated GenBank “SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) Sequences“; Laura Spinney, “When will a coronavirus vaccine be ready?“, The Guardian, 13 March 2020).

                We should, however, note – for the next pandemic – that time has been lost those last years and notably since the SARS 2003 epidemic. Indeed, “medication against coronaviruses” were not included in the progress made over the last 25 years in antiviral medication (interview of Matthias Götte, a biochemist and viral researcher from Hamburg in Kerstin Kullmann und Veronika Hackenbroch, “The Urgent Search for a Cure for COVID-19“, Der Spiegel, 13 March 2020).

                Vaccine

                Discovery matters

                Various companies, universities and research laboratories would currently be exploring between 15 (Pang et al., Feb 2020, see table on vaccines) and 35 vaccine candidates of various types (Laura Spinney, Ibid.). They are all in the early stages of the overall process (Ibid.; John Hodgson, “The pandemic pipeline“, Nature, 20 March 2020). By 15 April, more than 70 vaccine candidates would be explored, five being at the preliminary trials’ stage (Christine Soares, “The lifeline pipeline“, Reuters, 13 April 2020).

                For example, human trials have already started for U.S. Moderna Therapeutics’ candidate vaccine (Michelle Roberts, “Coronavirus: US volunteers test first vaccine“, BBC, 17 March 2020). In that case the animal trials have even been skipped (Ibid.). Other human trials will start in April 2020 (Spinney, Ibid.). French Sanofi is also working on a candidate vaccine (see below).

                Hodgson states that another candidate vaccine, developed by Singapore, would be at the manufacturing stage (Hodgson, Ibid.). This is probably an editing mistake, because after verification, the vaccine, developed with the Company Arcturus has not yet entered clinical trials. They expect to start phase 1 of clinical trials “in the third quarter of the year” and to complete it at the end of 2020 or beginning of 2021 (Joyce Teo, “Countries, including Singapore, in race to develop vaccine“, Straits Times, 25 March 2020). Thus, Singapore and Arcturus are nowhere near the manufacturing stage. However, Arcturus suggests that their manufacturing process will be quicker than for other vaccines (Arcturus website ibid.).

                Chinese CanSino Biologics Inc. has also started conducting first phase clinical trial, which should last until December 2020 (China embarks on clinical trial for virus vaccine, The Star, 22 March 2020).

                Manufacturing vaccin doses matters too

                In general, scientific studies estimate that we are at best between 10 and 18 months away from a vaccine (e.g. interviews in Spinney, Ibid.; Helen Stillwell, “SARS-CoV-2 – The vaccine landscape“, Virology Blog; 11 March 2020; Roy M Anderson et al., “How will country-based mitigation measures influence the course of the COVID-19 epidemic?” – The Lancet – Published online March 09, 2020). These studies however rarely mention which phase of the vaccination process is included in these 10 to 18 months.

                The director of the U.S. National Institute of Allergy and Infectious Diseases (N.I.A.I.D.) assesses that “the earliest it [a vaccine] would be deployable is in a year to a year and a half,” which would tend to imply that it has been manufactured by then (Carolyn Kormann, “How Long Will It Take to Develop a Coronavirus Vaccine?“, The New Yorker, 8 March 2020).

                For its part, the global head of vaccine research and development of Sanofi estimates that, at best “a vaccine could be fully ready for licensure in a year and a half.” (Ibid.) In that case, this means that the time to manufacture doses is not included in the year and a half. This may sound logical as without the composition of the vaccine, it may be hard to assess the time needed to produce it and in which quantities.

                As far as estimates of manufactured doses are concerned, the firm Inovio, for example has as target 1 million doses by the end of 2020 (Tarryn Mento, “Inovio Pharamaceuticals Fast-Tracking Human Trials, Working On 1 Million Doses Of Coronavirus Vaccine“, KPBS, 20 March 2020). This is only a target as its production capability by end of January 2020 was 100.000 doses a year (Jon Cohen, “Scientists are moving at record speed to create new coronavirus vaccines—but they may come too late“, Science, Jan. 27, 2020).

                Moderna could produce at best 100 million doses a year, but would use all its production capability for it (Cohen, ibid.). For another candidate vaccine, “the Queensland team says it could make 200,000 doses in 6 months” (Cohen, Ibid,).

                Sanofi, for the U.S., “has the established capacity and infrastructure to make up to 600 million doses in two existing facilities based in New York and Pennsylvania, without compromising the supply of vaccines for other illnesses, including influenza” (Sanofi, “Sanofi Mobilizes to Develop a Vaccine against COVID-19“, 23 march 2020). Meanwhile, on 23 March 2020, Sanofi confirmed its timeline: “We estimate that we will have a vaccine candidate available for in vitro testing within six months and potentially enter clinical trials within a year and a half” (Sanofi, “Sanofi’s Response in the Fight against COVID-19“, 23 march 2020).

                In he meantime, the 2017 created Coalition for Epidemic Preparedness Innovation (CEPI) is building up its capacity to produce “multiple millions of doses available within 12–18 months” (Hodgson, Ibid.).

                China vaccines manufacturers also now have massive capabilities to produce vaccines. In 2018, Yaming Zheng et al. estimated that China produced annually 700 million vaccine doses (The landscape of vaccines in China: history, classification, supply, and price. BMC Infect Dis).

                Global estimates of future production of vaccine doses remain quite elusive and will need to be handled through scenarios, waiting for further research.

                How long could the emergency or survival period last? A first estimate

                This first open source brief review gives us the guidelines to conduct further in-depth study and to define the monitoring that will need to take place. Indeed, we now have the material to identify at least a first batch of indicators to monitor to follow the situation on the ground.

                Meanwhile, each uncertainty related to the “vaccine factor” will create a sub-branch in our scenario tree. In other words, in the following paragraphs, each time I’ll make an assumption and use a word such as “imagine” or “if”, this means that we are dealing with sub-branches and sub-scenarios.

                Waiting for a finalised architecture for our scenario tree, we can already roughly outline a very optimistic scenario. This is a scenario where at least one current candidate vaccine goes successfully through all the trials, in 12 months. This brings us, for the start of the manufacturing process to March 2021.

                Here, we must remember that Singapore and those using a technology similar to Arcturus could produce more quickly the vaccines. However, the clinical trials must be successful first.

                Now, a 2018 presentation by the chair of RA WG at Vaccines Europe (a specialised vaccines group within the European Federation of Pharmaceutical Industries and Associations (EFPIA), the professional association of the pharmaceutical industry in Europe) gives 24 months for the overall vaccine manufacturing process, up to distribution (slide 6 – see below).

                2018 presentation by Michel Stoffel, chair of RA WG at Vaccines Europe

                Let us imagine – but further sub-scenarios will be necessary here actually – that efforts will be made and succeed at speeding up this process and reduce it to 20 months. This brings us to November 2022. And then a mass vaccination campaign must start. We shall leave this part aside for now, but it is nonetheless important to underline that a mass immunization campaign is not a small endeavour (e.g. WHO “Aide Mémoire – To ensure the efficiency and safety of mass immunization campaigns with injectable vaccines“)

                Here, we must wonder about the number of doses that need to be injected for immunization. We must wonder about the length of the immunization. If ever the SARS-CoV-2 mutates and changes every year, as with the flu, or if it does not, we have different scenarios in front of us.

                In the best of case, we can imagine that only one dose needs to be injected, and that immunization will last for years. We may also assume that herd immunity can be reached with only 70% of the population receiving the vaccine (a crude estimate of what is considered as necessary for the influenza, see, Kenneth A.McLean, Shoshanna ​Goldin, Claudia Nannei, Erin Sparrow, Guido Torelli, “The 2015 global production capacity of seasonal and pandemic influenza vaccine“,Vaccine, Volume 34, Issue 45, 26 October 2016, pp. 5410-5413; “Community Protection“, table in Paul E.M. Fine, … W. John Edmunds, in Plotkin’s Vaccines (Seventh Edition), 2018).

                In these conditions, as a crude approximation, we may need a production of 70% x 7,7 billion = 5,39 billion doses to immunize the world against the SARS-CoV-2.

                Various scenarios of collaboration and possible international tensions related to this production may thus also need to be built.

                In any case the evolution of the vaccine process must be closely anticipated and monitored for action as no nation and no government will be there able to afford a situation looking like what happened with face masks.

                As a conclusion, a first crude estimate of a best case scenario for the vaccine suggests that we shall have to wait until winter 2022-2023. This assessment includes many unknowns that we must handle through scenarios, monitoring and ongoing revision. Furthermore, completely unpredictable events, can also occur, such as a mutation of the virus towards less lethality for example, to be optimistic.

                We have progressed into building the overall structure of our scenario tree. We also have a timeframe. Meanwhile, this timeframe also tells us that we cannot sit and wait for a vaccine. At this very early stage of our work, the years ahead for the surviving system or surviving stage, will likely need to include a vast array of imaginative solutions, mixing isolation and lock down, new ways of organisation and production, improved personal protection, new technological capabilities such as artificial intelligence, and, critically, antiviral prophylaxis and treatment.

                We shall look next at main potential antiviral treatment including the chloroquine that generates so much hope (e.g. Zhonghua Jie He He Hu Xi Za Zhi. 2020 Mar 12;43(3):185-188. doi: 10.3760/cma.j.issn.1001-0939.2020.03.009 “Expert consensus on chloroquine phosphate for the treatment of novel coronavirus pneumonia”; Jianjun Gao, Zhenxue Tian, Xu Yang, “Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies“, BioScience Trends, 2020, Volume 14, Issue 1, Pages 72-73, Released March 16, 2020, [Advance publication] Released February 19, 2020).

                *For vaccines, the 2017 created Coalition for Epidemic Preparedness Innovation (CEPI) identifies five steps: Discovery, Development /licensure, Manufacture, Delivery/stockpiling, Last mile.

                Further detailed bibliography

                Anderson, Roy M, Hans Heesterbeek, Don Klinkenberg, T Déirdre Hollingsworth, “How will country-based mitigation measures influence the course of the COVID-19 epidemic?” – The Lancet – Published online March 09, 2020

                Pang J, Wang MX, Ang IYH, Tan, SHX, Lewis RF, Chen, JI, Gutierrez RA, Gwee SXW, Chua PEY, Yan Q, Ng XY, Yap RKS, Tan HY, Teo YY, Tan CC, Cook AR, Yap JCH, Hsu LY, “Potential Rapid Diagnostics, Vaccine Therapeutics for 2019 Novel Coronavirus (2019-nCoV): A Systematic Review,” J. Clin. Med. (2020) 9(3), doi: 10.3390/jcm9030623 (received 13 February 2020 ).

                Wu, F., Zhao, S., Yu, B. et al. A new coronavirus associated with human respiratory disease in China. Nature 579, 265–269 (2020), 3 February 2020. https://doi.org/10.1038/s41586-020-2008-3.

                Thevarajan, I., Nguyen, T.H.O., Koutsakos, M. et al. Breadth of concomitant immune responses prior to patient recovery: a case report of non-severe COVID-19. Nat Med (2020). https://doi.org/10.1038/s41591-020-0819-2

                Zheng, Y., Rodewald, L., Yang, J. et al. The landscape of vaccines in China: history, classification, supply, and price. BMC Infect Dis18, 502 (2018). https://doi.org/10.1186/s12879-018-3422-0

                Featured image: Image by Gerd Altmann from Pixabay, Public Domain

                Worst Case Baseline Scenarios for the COVID-19 Pandemic

                On 11 March Chancellor Merkel warned that the SARS-CoV-2 – the virus for the COVID-19 – could infect between 60 and 70% of Germany’s population (DW, “Coronavirus: Germany’s Angela Merkel urges ‘solidarity and reason‘”, 11 March 2020). She was accused to spread panic (Ibid.). Chancellor Merkel’s point was to highlight the very real danger Germans faced.

                In this article, we explain why, indeed, as stressed by Chancellor Merkel, a pandemic such as the COVD-19 is something serious. We do so by establishing a crude baseline worst case scenario that helps us assessing the magnitude of the threat. The seriousness of the danger then determines why political authorities must consider the pandemic and why they need to take such drastic measures as complete lockdown of countries. Most importantly the severity of the threat determines actions and then real impacts. Meanwhile, we also explain how the rate Chancellor Merkel used was calculated.

                A threat to life primes any other concern

                Since the start of the pandemic, then still an outbreak, many commentators permanently try to minimize the possible extent of the threat. Rather than getting rational assessments and scenarios with acknowledgment of uncertainty and proper probability, we hear and read a vast array of comments and opinions most of them aimed at being positive, minimising problems, putting the economy first, while also often mocking others. As we pointed out earlier, this most probably stems also from the various interests of actors, added to many cognitive biases (see The Coronavirus COVID-19 Epidemic Outbreak is Not Only about a New Virus and The New Coronavirus COVID-19 Mystery – Fact-Checking).

                Help us continue offering open access/free articles on the COVID-19
                Donation – Fund Analysis for the War against COVID-19

                Nonetheless, we must remember that the fundamental mission of political authorities is to ensure the security of those they rules (see What is Political Risk?). Meanwhile, and as fundamentally, individuals want to survive. Thus, when a very direct threat to life, such as a virus and its related disease, emerges and spreads, then, very rapidly, all other matters loose importance. Actually, the rapidity of the understanding of the magnitude of the threat will also determine the measures taken and the very actualisation of the threat.

                Thus, the problem is to evaluate the potential direct threat to life, at individual and collective level.

                How to evaluate the potential direct threat to life?

                Uncertainty and being careful with what we know through the Chinese experience

                Because the virus is new, and as all serious scientific actors dealing with the SARS-CoV-2 and the COVID-19 permanently stress, much is still unknown about both the virus and the disease.

                Fund Analysis on the COVID-19
                Select options

                Furthermore, most of what we know about the illness and its spread comes from China. It thus includes the way the Chinese handled the epidemic. Our current knowledge thus contains elements about the virus and the disease that can be universally applied, as well as, possibly, idiosyncrasies. We should not forget that China deployed gigantic means to face the epidemic (Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) – 16-24 February 2020). These means and actions influenced the way the disease “behaved”.

                They may also have influenced the virus itself. Indeed, and even though further research is needed, in an early study, Xiaolu Tang, Changcheng Wu, et al. found, studying the genomes of the SARS-CoV-2, that

                “… these viruses evolved into two major types (designated L and S) … Whereas the L type was more prevalent in the early stages of the outbreak in Wuhan, the frequency of the L type decreased after early January 2020. Human intervention may have placed more severe selective pressure on the L type, which might be more aggressive and spread more quickly. On the other hand, the S type, which is evolutionarily older and less aggressive, might have increased in relative frequency due to relatively weaker selective pressure.”

                Xiaolu Tang, Changcheng Wu, Xiang Li, Yuhe Song, Xinmin Yao, Xinkai Wu, Yuange Duan, Hong Zhang, Yirong Wang, Zhaohui Qian, Jie Cui, Jian Lu, “On the origin and continuing evolution of SARS-CoV-2“, National Science Review, 03 March 2020, https://doi.org/10.1093/nsr/nwaa036

                Thus, we must be very careful when applying the “Chinese” experience elsewhere. We must work at distinguishing variables and at understanding the processes and dynamics at hand. This is nothing knew in science, as comparative approaches are, for example, detailed in John Stuart Mills’ A System of Logic (1843) with the method of agreement, of difference and combinations thereof (e.g. Encyclopaedia Britannica).

                Using a crude baseline “worst case” scenario

                We are thus faced with a lethal threat incorporating many unknowns, even after two and a half months, which, by the way, in scientific terms is an extraordinarily short time. Now, humanity has known throughout history many epidemics and pandemics, and is thus aware of the possible catastrophe a disease spreading entails. But what is meant by a possible catastrophe?

                Scientific communications and articles, as well as political ones, most of the time, shy away from giving absolute numbers.This is probably partly for fear to create a panic, out of humility because we do not really know, and out of anxiety at being later targeted as having been wrong. However, then, it becomes truly hard to understand the threat.

                To know the risks we face, to be able to better understand what could happen, what is a catastrophe, then we need to be able to get an idea of the threat one can represent. The threat must mean something. This implies having at least a crude worst case baseline scenario in terms of fatalities. In other words, we need to have an idea of what would be likely to happen if we were not acting. The aim here is not to get something precise and accurate, but to have an imperfect idea of the possible magnitude of the cost in human lives terms.

                A crude estimate of the lethal power of the COVID-19 threat

                To be able to get a crude worst case baseline scenario, we need to have first a possible figure for the number of people that could be infected, if nothing at all were done. Of course, each country and each actor is already doing a lot. Thus, as highlighted, this crude baseline worst case will explain why various authorities are fighting against the pandemic. It will indicate the magnitude of the threat and thus of the responses.

                We shall follow here epidemiologist Roy M. Anderson et al., who explains that

                “A simple calculation gives the fraction likely to be infected without mitigation. This fraction is roughly 1–1/R0.”

                Roy M Anderson, Hans Heesterbeek, Don Klinkenberg, T Déirdre Hollingsworth, “How will country-based mitigation measures influence the course of the COVID-19 epidemic?” – The Lancet – Published online March 09, 2020

                As we explained, R0 (R-nought) or basic reproduction number of an infectious disease is a measure that represents “the expected number of secondary cases produced by a typical infected individual early in an epidemic” (O Diekmann; J.A.P. Heesterbeek and J.A.J. Metz (1990). “On the definition and the computation of the basic reproduction ratio R0 in models for infectious diseases in heterogeneous populations”, Journal of Mathematical Biology 28: 356–382).

                This is most probably the calculation that is behind Chancellor Merkel’s figure for the rate of Germans the SARS-CoV-2 will probably infect (Ibid.).

                We now have a range of possibles R0 for the COVID-19. The R0 have been estimated to be between 1.6 and 3.8 (see The New Coronavirus COVID-19 Mystery – Fact-Checking). Of course, the R0 evolves with time and actions, but we are only looking for a rough estimate. Anderson et al. use a R0 = 2.6 for their crude estimate, which corresponds to 61.54%, and is within the 60% to 70% range given by Chancellor Merkel.

                Using these R0, we thus have the following worst case baseline scenarios table, for the world, with an estimated population of 7.7 billion people:

                R0 1,6

                		2,2


                		2,6


                		3,8


                % of infected population: 1–1/R0 37,50 %


                		54,54 %


                		61,54 %


                		73,68 %


                Estimated case fatality rate 0,3 % 1 % 2,2 % 3,18 % 0,3 % 1 % 2,2 % 3,18 % 0,3 % 1 % 2,2 % 3,18 % 0,3 % 1 % 2,2 % 3,18 %
                Infected population in million 2887,5 4200,0 4738,5 5673,7
                Estimated deaths in million 8,7 28,9 63,5 91,8 12,6 42,0 92,4 133,6 14,2 47,4 104,2 150,7 17,0 56,7 124,8 180,4

                Thus, at worst, considering what is known of the SARS-CoV-2 and estimated by 12 March 2020, assuming no action had been taken, we could have had to face between 8.7 and 180.4 million direct deaths worldwide.

                It is important here to stress that the estimates are for direct deaths. Indeed, if we consider the Italian tragic situation, the case-fatality rate is much higher and reached a staggering 6.7% on 12 March 2020. Pr. Ricciardi gives various possible causes for the much higher CFR in Italy, ranging from ways to establish statistics to impacts of overwhelmed hospitals on death rate ( “Coronavirus, contagiati e morti: cosa succederà in Usa, Francia e Germania. Parla Ricciardi (Oms-Salute)“). The latter notably can be seen as indirect and cascading – yet very real – causes of death. They are thus not included in the crude estimate calculated here.

                COVID-19 Worst Case Baseline Crude Estimate –
                World potential deaths if nothing had been done – The first four columns correspond to estimates for a R0 = to 1.6 thus 37.5% of the population infected. The next four to estimates for a R0 = to 2.2 thus 54.54%% of the population infected, etc. – Within each group of four columns, the first corresponds to a CFR = 0.3%, the second to a CFR = 1% then a CRF = 2,2%, and finally a CFR= 3,8%

                If we consider that the fatalities for World War II were between 70 and 85 million, then, at worst, the COVID-19 could have been more than twice as deadly.

                You can do the math for each country. For China, for example, the potential fatalities could have meant between 1.6 and 32.4 million deaths; for the U.S. between 0.4 and 7.6 million deaths.

                Assuming China has indeed completely overcome the threat and is not infected again by other countries as they become prey to the epidemic, the possible global fatalities are now lower. The baseline threat is nonetheless still there for other countries. And some risk remain also for China.

                Those figures are indeed just crude estimates, but the very high possible impact justifies the immense efforts made. It justifies that each and every person takes the pandemic seriously.

                And here, the sufferings of the 13.8% that will probably have severe disease and the 6.1% that will be in critical conditions is not taken into account (Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) – 16-24 February 2020, p.12.). If we apply the same calculation, in the case of a R0 = 2.6, thus of 61.5 % of the population being infected, this means that, without any action 653.9 million people would be at risk to suffer severely and 289 million would be in critical condition.

                The staggering difference between the rough calculation above and the reality, in China, of the detected cases – 80945 on 13 March 2020 – then fatalities – 3180 – is both a tribute to the success of the mammoth Chinese efforts (WHO report, ibid.) and a twin warning. First, the difference between real and estimated figures stresses that rough worst case estimates are nothing more than a crude evaluation of the danger faced. Second, and maybe most importantly, the difference between actual figures and estimated ones also underlines that gigantic efforts may not be an option but an imperative necessity.

                Featured image: John Hopkins CSSE: Tracking the COVID-19 (ex 2019-nCoV) spread in real-time – map for 13 March 2020 – 17:43 CET.

                A short summary FAQ

                Can we create worst case scenarios for the COVID-19 pandemic?

                Yes, definitely, we can. We can use estimates of scientific measurements to assess worst cases for the COVID-19 pandemic. This is actually necessary to know the extent of the threat, the risk and thus decide about the magnitude of the answers.

                What could be the number of deaths caused by the COVID-19?

                Worldwide, at worst, considering what is known of the SARS-CoV-2 and estimated by 12 March 2020, assuming no action had been taken, we could have had to face between 8.7 and 180.4 million direct deaths.
                This means the COVID-19 could have been more than twice as deadly as World War II.

                Why the COVID-19 is NOT a Black Swan Event

                As the COVID-19 spreads throughout the world, its cascading and multiple impacts deepen. As a result, fear spreads. Meanwhile, finance and business firms now started promoting the idea that the COVID-19 epidemic was a “black swan event”.

                  For example, Goldman Sachs, in its Top of Mind, issue 86 (February 28, 2020) featured an article titled “2020’s Black Swan: coronavirus.” It is “the event that no one expected”. This, by the way, as we shall explain below is not what a black swan event is. Similarly, as the idea spreads throughout the corporate world, we read that “Sequoia Capital, one of the world’s top venture capital firms, sent a note to the founders and CEOs of its companies on Friday 6 March 2020 describing the coronavirus as “the black swan of 2020″ and urging them to brace for coming economic shocks” (Reuters 6 March 2020: Latest on the spread of coronavirus around the world).

                  The only problem with characterising the COVID-19 epidemic as a black swan event is that it is untrue. At best it shows ignorance. This statement also underlines the complete incapacity or unwillingness of a large part of the corporate world, and of society more generally, to consider the future and plan ahead.

                  This article explains why the COVID-19 is NOT a black swan event.

                  What is a black swan event

                  The idea of a “black swan event” was popularised in 2007 by Nassim Nicholas Taleb bestseller The Black Swan: the impact of the highly improbable (see Helene Lavoix, “Taleb’s Black Swans: The End of Foresight?“, The Red Team Analysis Society, 21 January 2013, and “Useful Rules for Strategic Foresight and Risk Management from Taleb’s The Black Swan“, The Red Team Analysis Society, 28 January 2013).

                  Taled defines them “as unpredictable (outliers), with an extreme impact and which are, after the fact, revised as explainable and predictable”.

                  scenario building, scenario, strategic foresight, online course, risk management, future
                  Embrace Uncertainty: Anticipate, Foresee and Warn!
                  Practically develop and enhance, step by step, your anticipatory analytical skills to tackle complex geopolitical, national and global security and political issues. Online course 1: from process to analytical modeling – Online course 2: scenario-building

                  Actually, in a nutshell Taleb with The Black Swan denounces the problem and risks of induction, building upon David Hume and Karl Popper. Extremely briefly, an inductive reasoning runs as follows: all the swans observed are white, thus all swans are white… which is proven wrong when one black swan is spotted. Hence the danger of this reasoning.

                  If we follow Taleb, a “black swan” is an event that cannot be foreseen because there is neither knowledge about it nor methodology to anticipate it. Black Swan events are intrinsically unknowable.

                  Thus was the COVID-19 epidemic intrinsically unknowable and unpredictable?

                  Did we have knowledge to foresee the COVID-19 epidemic?

                  Help us continue offering open access/free articles on the COVID-19
                  Donation – Fund Analysis for the War against COVID-19

                  First, we know, considering for example the SARS epidemic, that coronaviruses exist and can lead to epidemic.

                  True enough the very specific strand of virus named COVID-19 was probably impossible to predict, but the emergence and spread of an epidemic of a coronavirus type was possible to foresee. Actually, such an emergence is almost certain. And the emergence of other epidemics of the same type and of other types is certain too. The problem is a problem of onset, of monitoring and then of handling of the outbreak.

                  Fund Analysis on the COVID-19
                  Select options
                  COVID-19, epidemics, scenario, risk analysis, strategic foresight, warning, threat anticipation
                  Consider Coronavirus risks: commissioned reports
                  Listed firms are urged to factor coronavirus risks in their financial disclosures (US SEC urged ,19 Feb; UK FRC, 18 Feb 20). All companies should consider the future likely impacts of the COVID-19 outbreak on their activity.
                  Contact us for commissioned reports helping you to plan ahead and fulfil your obligations. Also contact Dr Helene Lavoix directly.

                  Indeed, and second, since at least 2006, epidemiologists and serious people interested in national security and anticipation have summarised the issue for pandemics and epidemics with the catchphrase: “the question is not if but when”. They have been worried about it and they have fought to see epidemics and pandemics and their emergence and spread put on various national and global agenda. I can witness to this having worked with such a community of interest within the U.S. system.

                  Finally, since at least 2000, we know that biodiversity has effects on the emergence and spread of disease (e.g. Ostfeld. and Keesing, “Biodiversity and Disease Risk: the Case of Lyme Disease“, 2000). Since then, there has been scientific debate to understand how both relate. Thus, a conservative appraisal would be that biodiversity has both positive and negative impacts on the emergence and spread of disease, according to mechanisms we still do not understand very well (e.g. Angela D. Luis, et al. “Species diversity concurrently dilutes and amplifies transmission in a zoonotic host–pathogen system through competing mechanisms“, PNAS, 2018). Biodiversity is notably operative in the spill over of infectious diseases from animals to humans (Ibid.).

                  Considering the staggering rate of biodiversity loss, and our imperfect knowledge, then first this factor should have been considered. Second, the precautionary principle would have demanded that scenarios be crafted. As a result, actors would have taken into account the whole range of possibles for the future.

                  Thus, we had enough knowledge to consider the possibility to see epidemics and pandemics emerge and spread at all time. Hence the current epidemic was not intrinsically unknowable. Hence it is not a black swan event.

                  You may then argue that uncertainty is still part of our knowledge thus that we could not do anything to foresee the COVID-19 epidemic because of this uncertainty.

                  Thus, do we have methodologies and ways that allow to handle uncertainty? Can we foresee despite uncertainty?

                  Did we have methodological tools to foresee new types of epidemics

                  In serious strategic foresight, strategic warning, futurism and risk management – I mean people who are seriously and systematically applying proper methodologies to anticipate – we do have ways to handle these types of possible surprises.

                  Scenarios, for example, are a perfect way to handle issues presenting various types of uncertainties (e.g. Scenarios and our online course 2: Geopolitical Risks and Crisis Anticipation: Scenario building, where, by the way, a whole unit is devoted to Back Swan and Wild Card events).

                  Then, we have something that is called wild card scenarios and which aim at handling difficult cases (James Dewar, “The Importance of “Wild Card” Scenarios,” Elina Hiltunen, “Was It a Wild Card or Just Our Blindness to Gradual Change?” 2006). If we assume that an epidemic has a low probability of occurence – which we can debate considering biodiversity as well as climate change, then we can at worst consider the emergence of an epidemic as a wild card. Indeed, “a wild card is a future development or event with a relatively low probability of occurrence but a likely high impact on the conduct of business,” BIPE Conseil / Copenhagen Institute for Futures Studies / Institute for the Future: Wild Cards: A Multinational Perspective, (Institute for the Future, 1992), p. v). The idea was then popularised with John L. Petersen, Out of the Blue, Wild Cards and Other Big Surprises, (The Arlington Institute, 1997, 2nd ed. Lanham: Madison Books, 1999).

                  Thus we could have anticipated the COVID-19 epidemic at worst through such an approach.

                  As a result, if we had enough knowledge to anticipate the emergence and spread of a new global epidemic of a coronavirus type, and if we had the methodology to anticipate such an event, furthermore considering remaining uncertainties, then the current COVID-19 epidemic is NOT a black swan event.

                  The truth is that the corporate world and especially the financial world do not seriously anticipate events beyond one day, one week and at the very best three months. When they do anticipate, they are blinded by quantitative tools, as already denounced by Taleb (Ibid.). Meanwhile they think in silos. In general, despite of course exception, recruitment is done by people who have no clue about global risks and methodology to handle such risks. Recruiters privilege the wrong skills, using keywords and criteria rather than real understanding. Outside research and scientific circles, most of the time, basics of qualitative research and understanding, built over centuries, are now discarded. In most sectors, nepotism reigns. Fear of not pleasing the hierarchy or “the market” rule. Finally, there is also most probably a large part of wishful thinking and ego that stops such a successful crowd to properly and honestly consider the future.

                  Thus, no, the COVID-19 epidemic is NOT a Black Swan event. Thinking so will only allow people and firms who failed to shed any responsibility for their error.

                  On the other hand, is the COVID-19 epidemic a strategic surprise and a warning failure? Yes, definitely for many actors (although not for all). If we recognise this, then it will also be a way to humbly understand why part of the world was not prepared for the epidemic and why proper strategic foresight systems to anticipate it were not operational. And, so far, we are rather lucky as the case-fatality rate, although far superior to the influenza, seem to remain relatively low (see WHO and The New Coronavirus COVID-19 (ex 2019-nCoV) Mystery – Fact-Checking).

                  Recognising errors and mistakes is the only way to progress. It will be the only way to do better, when the next epidemic will emerge.

                  Bibliography

                  BIPE Conseil / Copenhagen Institute for Futures Studies / Institute for the Future: Wild Cards: A Multinational Perspective, (Institute for the Future, 1992), p. v).

                  Dewar, James A., “The Importance of “Wild Card” Scenarios,” Discussion Paper, RAND. – download pdf.

                  Hiltunen, Elina, “Was It a Wild Card or Just Our Blindness to Gradual Change?” Journal of Futures Studies, Vol. 11, No. 2, November 2006, pp. 61-74

                  Lavoix, Helene, “Taleb’s Black Swans: The End of Foresight?“, The Red Team Analysis Society, 21 January 2013

                  Lavoix, Helene, “Useful Rules for Strategic Foresight and Risk Management from Taleb’s The Black Swan“, The Red Team Analysis Society, 28 January 2013.

                  Luis, Angela D., Amy J. Kuenzi, James N. Mills. “Species diversity concurrently dilutes and amplifies transmission in a zoonotic host–pathogen system through competing mechanisms”. Proceedings of the National Academy of Sciences, 2018; 201807106 DOI: 10.1073/pnas.1807106115

                  Ostfeld, R.S. and Keesing, F. (2000), Biodiversity and Disease Risk: the Case of Lyme Disease. Conservation Biology, 14: 722-728. doi:10.1046/j.1523-1739.2000.99014.x

                  Petersen, John L., Out of the Blue, Wild Cards and Other Big Surprises, (The Arlington Institute, 1997, 2nd ed. Lanham: Madison Books, 1999)

                  EN
                  FR ZH EN