A movie and a thought experiment in strategic foresight
The 2021 “Dune” movie by Denis Villeneuve is a deep reflexion about the future of political and strategic power (Denis Villeneuve, Dune, 2021). This movie explores the deep connections between the source and exercise of strategic power and the state of the environment. It is both a faithful and creative adaptation of the first part of the Frank Herbert’s classic science fiction novel (Frank Herbert, Dune, 1965).
Formally, the story follows the adventures of young Paul Atreides, heir to the Duke of Caladan planet. The galactic emperor offers the governance of the planet Arrakis to his father, the Duke of Atreides.
Arrakis, also known as Dune, is an arid, desert planet, where the “Spice” is produced. It is the most important product in the universe because it allows space navigators to follow the folds of space. As such, it is a basic condition for inter-planetary exchanges, and is the material basis of the imperium.
The “regime change” implied by the arrival of the House of Atreides on Dune triggers a conflict with the Harkonnen family. That House provided the former governors and exploiters of the planet, while it is the historical bitter foe of the Atreides. The feud that follows the new appointment by the Emperor ends with the slaughter of the house Atreides. It forces the young Paul to join the “Fremen”, the indigenous people that live in the sand desert.
Power and environment
As it happens, the whole movie hinges about the way the exercise of power is rooted in the determinisms of natural environments (James C. Scott, Against the Grain, A Deep History of the Earliest States, 2017). For example, the Atreides government strives to master the “desert power”, while being originally a “sea power” government (“Sea Power”, Encyclopedia Britannica). Strategically adapting to these determinisms is a life and death issue for political authorities.
This transition from water abundance to extreme scarcity supports an important reflexion about depletion and power. So, “Dune” is about the “great depletion” of everything, especially of water and biodiversity. The film illustrates how depletion follows climate change as well as the forms of power that emerge from depletion.
Thinking the future of geopolitics on a warming planet
It follows that this movie is not “simply” Hollywood entertainment. It is also a massive “thought experiment” in communication of strategic foresight and early warning about the future of geopolitics. As such, it is exemplary of the way Hollywood continually absorbs the emerging issues of the U.S political and national security debate (Valantin, Hollywood, the Pentagon and Washington…, 2005). The “strategic warning dimension” of this movie is about the risks of political and military maladaptation to climate change and their scenarization.
In this case, the notion of communication of “strategic foresight and early warning” reveals the depth of its function. It installs the spectator as a witness of what could be the fate of humankind when, in a few months, its most basic life conditions are being taken into a spiral of fatal degradation, while unable to adapt.
The Great Shift
Power and its “natural environments”
“Dune” explores the way the Atreides governance shifts from peaceful seapower to “desert power” for war. At the beginning of the movie, the Atreides family rules upon planet Caladan.
It is a very humid planet with a vast ocean. The Atreides rules it through “sea power”. However, the transplantation of the Atreides on Dune forces them to change and to try to master “desert power”.
The movie depicts this ecological, political and strategic transition from a water cycle regime to another.
Climate and strategic transitions
Indeed, it shows the destabilization of a powerful government by a rapid “turnover” of the ecological conditions in which it is embedded. The passage from the water rich Caladan planet to the arid Dune planet allegorises the climate and political violent changes that numerous countries and their government are already undergoing.
Thus, it resonates with the current consequences of the shifting climate and water cycle on Earth. For example, a recent study establishes that the southern Siberian climate shifts rapidly into a new regime (N. Kharlamova et al.,“Present Climate Development in the Southern Siberia: a 55 year observations record”, IOP Conferences Series: Earth and Environmental Science, 2019).
This new regime accompanies the aridization of the steppe-parkland area and of the mosaic of birch-forests, while the summer season is dryer than 55 years ago. Those climate and ecological conditions are shifting very rapidly, while turning a normally humid region into one prone to mega fires.
As it happens, during the 2021 summer, Russia had to face once again historic megafires in Northern and southern Siberia. In the south-east of Nizhny Novgorod, in the depths of the deep Russian forest, a huge battle against the fire took place near the secret city of Rasov (“Russian army helicopters join battle against Siberian wildfires”, Reuters, 14 July 2021).
Starting during the Soviet Union era, Rasov has been the city where Soviet then Russian weapons nuclear were developed. Containing the huge wildfire there was thus of strategic importance, hence the use of civil security and military forces (“Russian planes seed clouds as raging wildfires near power plant”, Reuters, July 19, 2021).
From a “Burning World” to an “Arid World”
This example reveals how, on a (very) rapidly warming planet, some extreme weather events such as megafires are multiplying and expanding in a region where, in summer, the climate used to be mild and humid.
In other words, Siberia integrates the planetary archipelago of places where, each summer, there are surges of tsunamis of fire. Those emerge in North America, Russia, Africa, South Asia, and Europe. Each year, they break former records and spread wider, while becoming much more intense.
These fires define the parts of the world that are going to become a place apart, i.e the “Burning World” (Jean-Michel Valantin, “Adapting to the Burning World”, The Red Team Analysis Society, November 9, 2020). These mega wildfires are already pushing modern emergency services to the limits of their response capabilities (Ed Struzik, “The Age of Megafires: The World Hits a Climate Tipping Point”, Yale 360, September 17, 2020).
This means that the governance of the Drying and Burning world turns into a new political regime. In this “New World” a singular continuity between civil and military capabilities establishes itself.
This happens in order to manage the suit of “improbable” crises that becomes the new reality. Following this line of thought one may say that “Dune” exemplifies what happens during the the “post-Burning world”. That is to say when humanity settles into the “Arid World”.
However, “Dune” also raises the question of the real ability of government to adapt if bioclimatic conditions shift rapidly and radically. In the case of the Atreides family in spite of their awareness, the change from one planet to another is so rapid that it lethally weakens them.
Maladaptation as a strategic weakness
Indeed its members lack the time necessary to adapt to their new bioclimatic conditions and to turn it into a source of power. That is when their worst enemies, the blood thirsty and revengeful family Harkonnen defeats them through a sneak attack.
The Atreides are all slaughtered with the exception of the young heir Paul and his mother. They seek refuge in the desert. There, they will learn the ways and means of desert power with the “Fremen”, the indigenous nomadic warrior people.
Desert power rules
The movie lays down the basics of “desert power” for the spectator. In order to turn the desert into a base and a means of strategic power, it is necessary to understand it as a dominant and hostile environment.
Indeed, the defining features of the desert are the fundamental danger of aridity, and the impracticability of an infinite landscape of sand, dunes and rocks.
The presence of hostile semi-nomadic tribes and of giant sand-adapted predators (the “worms”) exacerbates those features. Thus, the desert puts de facto “under siege” the modern cities from where “migrant elites” try to rule.
Cities under siege
So, the movie shows how the urban world may poorly fare in regions where climate is quickly aridizing the environment. In the meantime, cities become literal strategic trap because of their exposition to “desert power”.
In other terms, while nowadays urban development is a massive driver of the “Great acceleration” of the current planetary change, cities are the main losers of the “desert power” emergence (J.R McNeil, Peter Engelke, The Great Acceleration, An Environmental History of The Anthropocene since 1945, Belknap Press, 2016).
So, “Dune” literally shows how desert power derives from the perspective of the strategic actors looking at the cities from the desert. Desert power comes from the ability to “follow the sand”, thus being semi-nomadic and able to live with very limited resources, especially water.
This tightly controlled sobriety confers a tremendous advantage upon those dependent on urban infrastructures and on complex technologies. Indeed, the latter have to carry the expensive and ponderous resources to project themselves in the desert. Thus, “desert power” is also the ability to develop long duration strategies in a world of very limited resources.
In other words, the movie, as well as the novel, proposes a scenario regarding possible ways for a polity to gain the strategic high ground in an arid world. This strategic approach entails self-discipline, hard sobriety and endurance in a time of rapidly changing climate and depleting resources.
Controlling Spice and depletion power
Finally, the ultimate strategic advantage of “desert power” is the weaponization of resources depletion and the threat to use it. Indeed, “Dune” is the only planet in the known universe where the desert sandworms produce “The Spice”.
This singular product allows space pilots to find their way through the “folds” of space. Thus, without spice, the galactic empire disappears. Each and every planet would be left to its own resources, cut off from the routes of the interstellar commonwealth.
From a “Dune” point of view, controlling the Spice is the same thing as dominating the Empire. However, Spice production is inherently a segment of the planetary ecology. So, organizing a shortage, or even the final depletion of the Spice through the ecological destruction of the planet is an extreme form of “desert power”.
In this acceptance, “desert power” becomes “depletion power” and the most formidable tool for deterrence and domination.
Weaponizing depletion
From this perspective, it is possible to change the depletion of basic resources by “channeling” it. In this regard, the movie is a thought experiment about the evolution of contemporary strategies based upon the weaponization of resource depletion.
It is the case, for example, of the “dam wars” waged by Turkey upon Syria and Iraq. Turkey is the upstream country of the Euphrates and Tigris rivers, which cross downstream Syria and Iraq. Those rivers, that define antique “Mesopotamia”, are the main sources of surface water in a largely water poor region.
Thus, the Turkish political authorities master the water cycle as a form of political power and influence. It is especially true of the water management of the Euphrates and Tigris rivers. One must keep in mind the vital role of these rivers. They are going through a region where access to their water is a vital necessity for entire countries.
Channeling aridisation
In the 1960s, the Turkish political authorities developed a strategic framework for the water management and development of southern Anatolia. This project is known as the Southeast Anatolia Project, or “Guneydogu Anadolu Projesi” (GAP). It was first thought about by Ataturk, founder of the Turkish Republic, during the twenties (“History of the South Eastern Anatolia project”, South Eastern Anatolia Project Administration, March 31, 2006).
This roadmap, central to the political thinking of the successive governments, has led to the construction of 14 dams on the Euphrates River. Throughout the years, the construction of eight dams on the Tigris River has been completing the roadmap. (Joost Jongerden, “Dams and Politics in Turkey: Utilizing Water, Developing Conflicts“, Middle East Policy Council, 2010).
Channeling water wars
This immense water project is used for the development of electricity production and for agricultural irrigation (South Eastern Anatolia Project Administration, ibid). In the meantime, Turkey uses its control of the upstream water. This has often led to very high levels of tensions with Syria and Iraq. It was also the case with the different Kurdish factions.
It was especially the case in 1975 and 1990, when water tensions almost led to open war between the downstream countries and the upstream country, because of the drastic decrease of the Euphrates flow during the building of a dam (Michael Klare, Resource Wars, 2002).
Furthermore, these infrastructures and their control are a tool in the long-standing conflict between Turkey and the Kurds. They literally “weaponize” rivers. This weaponization derives from control and reduction flow of water.
Since 1975, the reductions of the water flows of downstream Syria and Iraq may be respectively of 40% and 80%. (Connor Dilleen, “Turkey’s dam-building could create new Middle-East conflict”, The Maritime Executive, November 6, 2019). In other words, Turkey channels a “long depletion” to its neighbours. Thus, they impact the economic development and life conditions of the downstream regions and countries (Klare, ibid).
https://www.youtube.com/watch?v=bFpPwABc9cA
Since the U.S invasion of Iraq in 2003, and the start of the Syrian war in Syria, Turkey has been using its dams to lower the water flows of both those countries.
The Turkish water management is both a highly political tool of development and a strategic weapon. As it happens, it is also used to develop South Anatolia, a poor area with an important Kurdish population.
In other words, the Turkish authorities now have a real knowledge in wielding and using “(water) depletion power”. It has become a massive tool of international influence. As the whole Middle East is rapidly aridizing, the Turkish depletion power is all the more efficient.
For example, during the historic drought of the 2021 summer, the Turkish-backed Syrian national army (SNA) built three dams on the Kabhour river. By doing, so, they cut the water for the Kurdish downstream communities, while those were already hammered by the drought. As it happens, the Turkish military offensive in Syria accompanies the this “water depletion” offensive.
This weaponization of water depletion literally appears as a small scale and very precise use of “depletion power”. This development of a new environmental strategic management is the core of the “desert power” that the movie explores.
As it happens, “Dune-part I” allegorizes the political and strategic tendencies that are currently emerging on our warming and depleting planet. It is a thought experience that warns us about the way climate change drives an international redistribution of power between the countries that will be able to adapt… and the others.
This brief article is an updated warning about the threat created by the Omicron variant. It is assessed with 15, 22 and 23 December 2021 information. It concerns a series of indications related to the risks of hospitalisation, to vaccination and to incubation period for the Omicron variant.
Since the Omicron variant was identified, early studies are carried out as quickly as possible to allow us understanding the threat better and thus improving our answers.
This warning follows up on the previous one, issued on 18 December, and completes and updates it.
The early assessments that have been recently published and we use here are:
Other studies are to be expected. Monitoring must of course continue.
Collectively, the very high infectious power of Omicron continues making it a very serious threat to societies.
At individual level, the situation, compared with the Delta variant, may be slightly less dangerous, notably for vaccinated people and only as far as hospitalisations are concerned. Yet, the bad news regarding the booster dose also introduces some new concern. Reduced incubation period and the danger of not understanding how tests function must also be taken into account, especially before Christmas and New Year.
The two assessments on hospitalisation risks are for the UK, however, considering past waves, they are indications of what could happen elsewhere in the world. We should, however, consider notably previous immunity acquired within the population before applying British findings to other countries.
It should be stressed, furthermore, that these assessments are made on a small number of cases, thus a host of factors could lead to changes. Also, we still do not have any assessment of lethality. We do not know either – and cannot know – about both possible complications created by Omicron after the primary disease nor about the risks involved in terms of Long COVID. Cautiousness thus must remain the norm.
In a nutshell, the British findings are as follows:
Reduced rate of hospitalisation compared with Delta variant
Average estimates
“… the risk of hospital admission for an identified case with Omicron is reduced compared to a case of Delta… An individual with Omicron is estimated to be between 31 and 45% less likely to attend [Accident and Emergency] A&E compared to Delta, and 50 to 70% less likely to be admitted to hospital.”.
Imperial College London estimates are less optimistic, but still encouraging. Always comparing with Delta,
The estimates suggest that Omicron cases have, on average, a 20-25%reduced risk of any hospitalisation and an approximately 40-45% reduced risk of a hospitalisation resulting in a stay of one or more nights.
Report 50, Imperial College London, 22 December 2021
The length of stay in hospital also appears to be reduced, however, data are insufficient for any thorough assessment (ICL).
But how dangerous was and still is Delta?
According to the Scottish study,
“Risk of COVID-19 hospital admission was approximately doubled in those with the Delta VOC when compared to the Alpha VOC, with risk of admission particularly increased in those with five or more relevant comorbidities.”
Thus, if we have around 50% less risk of hospitalisation with Omicron than with Delta, which itself had a risk of hospitalisation that doubled (actually 1.85) compared with Alpha, we are back to a rate of hospitalisation similar to what we had with the Alpha variant. This means the third wave (see Towards a Covid-19 Fifth Wave), but we then need to look at immunity, both natural and related to vaccination. As a reminder there was hardly any vaccination for the third wave.
Previous immunity and Omicron hospitalisations
Imperial College London gives us a more detailed picture of hospitalisation rates for Omicron.
People with no previously acquired immunity
If you have not been vaccinated, nor been previously infected with the SRAS-CoV-2, the prospects are slightly better than with Delta, but not that much:
0-30% reduced risk of any hospitalisation [compared with Delta]
Report 50, Imperial College London, 22 December 2021
People with existing immunity
“… the estimated reduction in risk of hospitalisation due to previous infection is… around 55-70% reduction“.
Report 50, Imperial College London, 22 December 2021
Vaccination and Omicron
The (relatively) Good
The efficacy of the booster dose is confirmed by the studies.
“Vaccine efficacy analysis continues to show lower effectiveness for symptomatic Omicron disease. There is evidence that protection against symptomatic disease wanes after the second dose of vaccine, and then improves after the booster…. There are insufficient severe cases of Omicron as yet to analyse vaccine effectiveness against hospitalisation, but this is more likely to be sustained, particularly after a booster.”
There is however bad news that is broken out by the UK Health Security Agency and that confirms or explains Israel decision to recommend a 4th booster shot:
“…the latest data suggests this extra protection starts to wane more rapidly, being about 15 to 25% lower from 10 weeks after the booster dose.”
Thus, after a booster dose, one needs to wait 2 weeks before to be protected against Omicron, and this protection will start diminishing at an unknown rate 10 weeks after the shot, i.e. 2,5 months. As a whole, the booster dose only offers a full protection for 2 months.
The Intriguing
“Intriguingly” to use ICL words, and although researchers caution about not relying too much on these findings, it would seem that a two course vaccination with Astrazeneca protects better from infection with Omicron than a two course vaccination with Pfizer or Moderna.
“Hazard ratios for hospital attendance with Omicron for PF/MD are similar to those seen for Delta in those vaccination categories, while Omicron hazard ratios are generally lower than for Delta for the AZ vaccination categories. Given the limited samples sizes to date, we caution about over-interpreting these trends, but they are compatible with previous findings…”
Report 50, Imperial College London, 22 December 2021
Some elements on Omicron and incubation period
Incubation is the delay between the moment when an individual is infected and the time when s/he will show symptom – and most of the time become infectious thus dangerous to others.
With the initial strain of the SARS-CoV2, the picture was slightly more complex as people could become contagious before becoming symptomatic (see Dynamics of contagion and the COVID-19 Second Wave). In the very few studies we found on Delta, Omicron and incubation, there is no mention of this factor. Indeed, for example the Nov 2021 study on Delta specifies that
The incubation period was defined as the number of days between the single contact and the onset of symptoms.
The story of the Norwegian 2021 Christmas party cluster is worth narrating in full, as it highlights perfectly well the risks that not understanding tests and incubation entail
“The company Christmas party held on 26 November 2021 and that one of the attendees had returned from South Africa on 24 November 2021…. The closed event was held in a separate room (ca 145 m2) in a restaurant in Oslo from 18:00 to 22:30, after which the venue was opened to the public from 22:30 to 03:00. A pre-party had been arranged for the Christmas party attendees at a separate venue, after which they were transported by private buses to the restaurant. Although there were no restrictions in place for events at the time in Norway, all attendees of the party were reported to be fully vaccinated and had been asked by the organiser to perform a rapid antigen self-test….”
On 1st December the attendee having been in South Africa tested positive. Out of the 117 people attending the Christmas party, 110 accepted to be surveyed. Out of the 110 attendees, by 13 December, 66 were confirmed cases and 15 probable cases. Hence, the attack rate of Omicron was estimated to be 81/110 = 78%. The average age of the attendees was 38 years old.
Thus, to summarise, 117 people think they are very careful and all healthy, and, as a result gather happily at an event. Then, reality strikes, 81 of them are finally infected with Omicron within three weeks.
On the bright side, none of these people needed hospitalisation by 13 December 2021. Of course, this does not mean that they did not then lead to chains of contamination that triggered hospitalisation. This does not mean either that all similar contaminations would never imply hospitalisation.
Tests only protect others … when they are positive
What does the above story highlights?
Tests only protect others … when they are positive. If you test positive, then you know you are infectious and can contaminate others. Thus you isolate, and start caring about yourself. It is absolutely critical to use tests to identify and then limit contamination as early as possible.
However, if you test is negative, then this only means that at the time of testing you were not infectious. But you can very well be in one hour, two hours or six or whenever until the end of the longest possible incubation period. Ideally, if you want to be really sure and really protect others, you would need to permanently test yourself. The device we would need would be more akin to heart monitoring than to COVID tests.
Omicron and incubation
Omicron possible incubation period
Out of Norway’s study, we have first elements regarding the incubation for Omicron.
The incubation period for symptomatic cases ranged from 0 to 8 days with a median of 3 days (interquartile range: 3−4).
The incubation period for Delta was estimated to be 4,3 days and for prior variants (original, Alpha, Beta, etc.) to be 5 days.
Finally, we found that the mean incubation period was shorter for Delta compared to non-Delta infections (4.3 and 5.0 days, respectively)…. We calculated the incubation period to be shorter for Delta (mean (SD) = 4.3 (2.4) days; median (IQR)= 4 (3-5)), compared to non-Delta infections (mean (SD) = 5.0 (2.4) days; median (IQR)= 5 (3-7)) (P < 0.001). Among non-Delta infections, the mean (SD) incubation time was 5.0 (2.3) days for Alpha, median (IQR)= 5 (3-7); 5.1 (2.7) for Beta/Gamma median (IQR)= 5 (3-7); and 5.1 (2.5) for non-VOC median (IQR)= 5 (3-7).
As the time for incubation is reduced, then it is much more difficult to stop contamination. Indeed, the human process that have been implemented will likely be slower than the spread of the infection.
The good news may be that if the longest length of the incubation period is confirmed to remain at 8 days and if there are no outliers, then possible quarantines can also be shortened. This is probably what we see happening, for example in England and probably in France. However, note that the scientific data upon which to ground this decision are still very sparse. The necessity to keep the various flows of a country going are also a major consideration in the decision regarding length of isolation period.
At the individual level, as long as there is no certainty regarding the length of the incubation period, even if you are authorised to end your isolation period, it would be safer for your loved ones and in general for people you will meet, if you were wearing a N95/FFP2 face mask and anyway reducing as much as possible contacts.
This brief article is a warning assessed over 15 to 18 December 2021 about the very serious, indeed “major, imminent threat” created by the Omicron variant (Neil Ferguson in Emily Head, Dr Sabine L. van Elsland, “Omicron largely evades immunity from past infection or two vaccine doses“, ICL News, 17 December 2021).
Since the Omicron variant was identified, we have been waiting for further assessments regarding this variant of concern (VoC).
Two such early assessments have been recently published:
European Centre for Disease Prevention and Control, Assessment of the further emergence and potential impact of the SARS-CoV-2 Omicron variant of concern in the context of ongoing transmission of the Delta variant of concern in the EU/EEA, 18th update – 15 December 2021. ECDC: Stockholm; 2021.
Neil Ferguson, Azra Ghani, et al., “Report 49 – Growth, population distribution and immune escape of Omicron in England”, Imperial College London, 17 December 2021 – with a Summary by Emily Head, Dr Sabine L. van Elsland, “Omicron largely evades immunity …“, Ibid,).
Other studies are to be expected, however the probability of the situation being imminently very serious is high enough to deliver a warning. Monitoring must of course continue.
Summarised current findings
Imperial College London assessments are for the UK, however, considering past waves, they are excellent indications of what could happen elsewhere in the world.
In a nutshell, Imperial College London findings are as follows:
The very high infectious power of Omicron is confirmed
“The proportion of Omicron among all COVID cases was doubling every 2 days up to December 11th… Reproduction number (R) of Omicron was above 3 over the period studied”.
Summary News, Imperial College London 17 Dec 2021.
Younger people seem to be more vulnerable than with previous variants
“The distribution of Omicron by age, region and ethnicity currently differs markedly from Delta, with 18–29-year-olds… having significantly higher rates of infection with Omicron relative to Delta. … the researchers note that given its immune evasion, the age distribution of Omicron infection in the coming weeks may continue to differ from that of Delta.”
“Risk of reinfection with the Omicron variant is 5.4 times greater than that of the Delta variant… protection against reinfection by Omicron afforded by past infection may be as low as 19%.”
Summary News, Imperial College London 17 Dec 2021.
Vaccination induced immunity strongly or mildly degraded
Vaccination (initial full scheme/two doses) does not offer protection, while the third dose/booster protects less than with the Delta variant.
“Depending on the estimates used for vaccine effectiveness against symptomatic infection from the Delta variant, this translates into vaccine effectiveness estimates against symptomatic Omicron infection of between 0% and 20% after two doses, and between 55% and 80% after a booster dose.”
Summary News, Imperial College London 17 Dec 2021.
Note, that as a result of these, the very idea of herd immunity disappears or must be revised, as we warned on 27 January 2021 (see COVID-19 Vaccinations, Hope or Mirage?).
Severity
It may be too early to completely assess the severity of the variant, however, so far, severity does not appear to have been lowered compared with Delta:
The study finds no evidence of Omicron having lower severity than Delta,
Summary News, Imperial College London 17 Dec 2021.
ECDC warning assessment
Therefore this study reinforces the alerts of the ECDC, very briefly summarised as:
“…We therefore assess the probability of further spread of the Omicron variant in the EU/EEA as VERY HIGH” .
“…We therefore assess the impact of the spread of the Omicron VOC as VERY HIGH.
“…the overall level of risk to public health associated with the further emergence and spread of the SARS-CoV-2 Omicron VOC in the EU/EEA is assessed as VERY HIGH.“
ECDC 18th Update
Responses and recommendations
Recommandations are full vaccination plus booster/third dose plus full non pharmaceutical interventions (NPI: “use of face masks, reduced contacts between groups of individuals in social or work settings, teleworking, expanded testing and strong contact tracing”- ECDC, and also disinfection of hands and possibly materials etc.).
“Rapid reintroduction and strengthening of NPIs is necessary”
“Vaccination remains a key component of the multi-layered approach needed to reduce the impact of the Omicron VOC, while also addressing the ongoing circulation of the Delta VOC.”
ECDC 18th Update
The ECDC stops shorts of highlighting the possible need for renewed lockdown, and prefers to stress the importance of testing and contact tracing, isolation, increase in health capacities and genomic surveillance.
Long COVID could be the next battle we have to fight and win in our struggle against the COVID-19 pandemic.
Thus, in this article, we seek to assess Long COVID in the framework of the fifth wave of the COVID-19 pandemic. This will also give us possible indications regarding how Long COVID could develop in the future, beyond the current wave. Our aim is to obtain an idea of the current and coming impact of long COVID. This early assessment will, in turn, contribute to the development of responses and strategies to answer this aspect of the pandemic, which has been so far rather ignored.
First, we explain our methodology. Doing so, we uncover some incoherence among the few serious available data on long COVID. We suggest ways to overcome them for our purpose, strategic foresight and early warning. Then we present the result of our evaluation as three short scenarios for Long COVID and the fifth wave: “Coming back to our senses“, “Optimism“, and “The price of ignorance“.
The first article of this series on Long COVID reviews current knowledge up to end of November 2021 (Helene Lavoix, “Long COVID and the Fifth Wave – The Hidden Pandemic“, The Red Team Analysis Society, 22 November 2021). It lays the foundation for our understanding of the disease. We also use when needed what was established in our other articles on the fifth wave of the pandemic (Helene Lavoix, “The Fifth Wave of the COVID-19 Pandemic and Lethality“, 9 November 2021, and “Towards a Covid-19 Fifth Wave“, 27 October 2021, The Red Team Analysis Society).
Estimating Long COVID for the fifth wave
Objective and limitations
Objective
As highlighted in the introduction, our objective is to get an idea of the current and coming impact of Long COVID.
We need a global estimate of people experiencing Long COVID each day. We also need to know how many of these people, each day, can carry out or not their activities. Furthermore, as our aim is foresight and strategy for preparedness and response, we need to be able to make forecasts, however tentative. Therefore, we use what has so far been understood of Long COVID, that appears to depend notably on infections, and thus we consider the factors favouring or constraining the pandemic in terms of contagion (see “Towards a Covid-19 Fifth Wave“).
With these estimates, we should start being able to envision collective global impacts.
Limitations
Considering the high level of uncertainty and the numerous approximations and estimates upon which we have to rely, what we shall get are mainly possible rough trends and indications (for an explanation of what are “indications”, see our seminal “Horizon Scanning and Monitoring for Warning: Definition and Practice“, The Red Team Analysis Society, revised ed., 2019).
Moreover, a major approximation that we carry out is to apply rates specific to the UK to the whole world. However, as the UK survey is the only national and historical data on Long COVID available, we do not have much choice. As explained below, we shall also, here, encounter a major problem, incoherence in data.
Hopefully, as countries start taking Long COVID into account, better assessments will become possible.
Methodology
Estimated daily cases of Long COVID
Bearing in mind the limitations faced, we apply Chen Chen et al. (Ibid.) global pooled prevalence rate, 43%, on world daily cases of infection. This gives us an estimated daily number of Long COVID.
For the past, we use real statistical data of daily cases of infection or more precisely daily COVID-19 tested positive cases, an approximative indication for the number of infection (Our World in Data using COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University). Note that even for past data, figures change every day, as corrections to datasets are made. Sometimes, important number of cases of infections are added a posteriori, more than one month later. This adds again another measure of uncertainty.
For the future, using our article “Towards a Covid-19 Fifth Wave“, we make three hypotheses or scenarios for the possible shape of the wave of daily global infections, as detailed below at the start of each scenario.
For all of these scenarios, we consider that the prevalence of Long COVID linked to the Omicron variant is the same as what we was observed with previous variants (WHO, “Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern” – 26 November 2021). We must, however, underline that this is an unknown. The Omicron variant could lead to more, less, none or far more cases of Long COVID. The intensity and various characteristics of Long COVID resulting from Omicron – or other future Variants of Concern (VoC) – could also change. The new symptoms could only be a couple of weeks of tiredness, or on the other end of the spectrum a far more severe Long COVID. This should be monitored. Even with monitoring, it will take months and even potentially years before we start having an idea of the impact of variant Omicron or other VoC on Long COVID.
Daily number of Long COVID according to length of Long COVID
The next step was meant to be, initially, relatively simple to realise. It would prove far more difficult to handle than planned.
Finding the rates of Long COVID according to duration
The idea, originally, was to “simply” apply the proportion of Long COVID according to duration to the estimated daily number of people that would experience Long COVID and that we had obtained with the previous step.
The proportion of long COVID per length of illness was to be given by the historical monthly datasets of the United Kingdom Office for National Statistics (UK ONS – Tables 1 – Estimates of the prevalence of self-reported long COVID and associated activity limitation, using UK Coronavirus (COVID-19) Infection Survey data- Monthly datasets). The evolution of that rate, since March 2021, is shown on the graph below, which depicts the evolution of Long COVID throughout time in the UK.
Duration of Long COVID since first (suspected) coronavirus infection (Source: UK ONS – Tables 1 – Estimates of the prevalence of self-reported long COVID and associated activity limitation, using UK Coronavirus (COVID-19) Infection Survey data.- Monthly datasets )
For example, on a given month, the lightest brown segment represents new cases of long COVID as a new wave starts, waxes then wanes. The following month, part of these new cases have moved to the next category (Long COVID lasting between 12 and 26 weeks) and thus are depicted as a segment of a slightly darker brown. The new “entrance” in a segment joins the Long COVID cases of previous months still in this category, while some Long COVID cases end and other Long COVID cases move to the next category (26 to 39 weeks). Thus, each month, Long COVID cases move from one column to the next, going each time one category up.
However, we could not just take the percentage resulting directly from the monthly British tables. Indeed the number of cases and the proportions for one month concern all these people who experiment Long COVID for a given month (or for the period under investigation). However, as explained in the previous paragraph, each segment, in fact, links to a different period of time as far as the triggering event, infection, is concerned. For example, the 31 October 2021 result concerns people who were infected after 1 November 2020 (Long COVID lasting more than 52 weeks), and people who were infected between 8 November 2020 and 31 January 2021 for these Long COVID lasting between 39 and 52 weeks, and people who were infected at other periods for each other segment.
As we want to be able to move forward in our assessment, starting from the infections, we cannot take the British tables directly. We have first to recreate tables according to the time of infection and then to deduce a tentative rate for each length of Long COVID we shall then apply to our daily number of Long COVID.
Uncovering problematic incoherence
• Long COVID lasting more than one year: when the number of Long COVID exceeds the number of detected positive cases
We started with the longest Long COVID, the real estimates of UK long COVID that last over 52 weeks. These Long COVID correspond to people who were infected, knowingly or not, at least 52 weeks before the survey. Thus, for example, people declaring a Long COVID that lasted more than 52 weeks on 6 March 2021 had to be infected before 7 March 2020, i.e. at the very beginning of the pandemic.
However, when we compiled the different statistics, we found a surprising result. If we use the UK historical series for Long COVID, as well as the reported official statistics for COVID positive cases, we see, as shown on the curves below, that until August 2021, the number of Long COVID that lasted more than one year (the brown curve) is superior to the cumulated number of people that had tested positive to COVID (the yellow curve). We thus have more people with long COVID than people who were detected as infected. This incoherence continues up until August 2021.
Comparing declared long COVID longer than 52 weeks, infections and estimated long COVID prevalence (Sources: in text)
This statistical incoherence may stem from erroneous declarations (people badly estimated the start of their infection) and from largely unreported cases of infections, as people were infected, noticed it or not, did not report it and nonetheless developed long COVID. These two reasons are not mutually exclusive. We may, in any case, infer that a large part of asymptomatic cases were unreported and that they nonetheless developed long COVID.
With time, as more tests were done and as people probably became used to report their long COVID, biases were reduced. Yet, we remain with an enormous number of long COVID lasting more than 52 weeks, even for the last two monthly reports.
Furthermore, in the light of the British survey, the prevalence found by Chen Chen et al. (43%) cannot work for Long COVID lasting for more than a year. Indeed Chen Chen et al. (ibid) only looked at “prevalence for 30, 60, 90, and 120 days after index date”, i.e. 4 to 17,2 weeks. Thus, three and a half segments of the British survey are not included in Chen Chen et al. meta review. We can still, tentatively use Chen Chen et al. global pooled rate of prevalence, but only out of absence of alternative. In that case – a 43% prevalence for long COVID – the last UK figures would mean that all declared Long COVID will last for more than 52 weeks. Could this be true? It would be imperative to know.
• Potential meaning and consequences
If the numbers given by the British survey are representative, then we could have different explanations allowing to overcome the apparent incoherence.
The British figures could mean that a very large number of people infected with the SARS-CoV2 never completely recover, even if initially they do not feel any symptoms. This is the worst case scenario, because as infections spread, then cases of Long COVID of more than one year would also strongly increase.
Alternatively, the figures could also mean that those people who had a very long Long COVID initially were the most fragile, or the most predisposed to get Long COVID, and thus that their Long COVID lasted longer. With time, as infections rise, these people who are susceptible to get a very long Long COVID could become proportionally less numerous. In that case, the rate for a duration superior to 52 weeks will continue to fall, and maybe stabilise.
Actually, fundamentally, we do not know.
In this light, the British approach makes sense. By looking at the proportion of Long COVID compared to the overall UK population, the UK statisticians overcome the obstacle of detection of asymptomatic cases, as well as the challenge of variations in tests’ policies. However, they also make it difficult, if not impossible to anticipate. Thus, they have good indications to manage the present, but they cannot prepare for the future.
• Ways forward to handle this case in the framework of strategic foresight and early warning
In terms of foresight, this means it will truly be very difficult to estimate how many people could develop a Long COVID of more than 52 weeks in the future, starting from the identified number of infections.
As we want to be able to anticipate, considering the dearth of data, we can make the hypothesis that the final result for the last experimental statistics given by the UK (31 October 2021) is somewhat representative, despite biases probably remaining. This could be, in terms of rates, a kind of worst case scenario.
To give an idea of the immense uncertainty we face, we present below two curves, showing two estimates for Long COVID superior to 52 weeks (the brown dotted line): the first estimate was done with the UK statistics for 2 October 2021 and the second with the statistics for 31 October 2021.
Wild differences: two estimates for the number of long COVID longer than 52 weeks from 2 October and 31 October 2021 statistics of UK ONS survey (Sources: in text)
As is obvious from these two curves, the results are varying wildly as we go, for end of May 2022, from more than 3,75 million of Long COVID lasting for more than a year to around 1,5 million.
If we make a similar calculation for each of the minimal duration for Long COVID as resulting from the British survey, we see that the curves all vary as shown on the figures below. The Long COVID curves follow more or less the curve of infections, in a flattened way, but without simple linear consistency of rates. As a result, it is difficult to discern simple trends, and our knowledge is so far too limited to create a more coherent model. Much research still needs to be done.
Declared long COVID per length of long COVID, and corresponding infections and estimated long COVID prevalence (from UK ONS statistics for 31 October 2021)
In such difficult cases for anticipation, notably as far as the long COVID cases superior to 52 weeks are concerned considering the potential numbers involved, we need to use scenarios added to early warning and to adjust scenarios as knowledge increases.
Here, we shall only focus on one scenario. We shall consider that the Long COVID rates per duration of Long COVID all correspond to the recalculated rates for the 31 October 2021 UK survey (latest data available at the time of writing).
These rates will be applied to the global daily rate of Long COVID (even though we know that the meta review by Chen Chen et al. does not cover 3,5 segments), for each of the corresponding length of Long COVID. For Long COVID longer than 52 weeks we shall conservatively consider that the length of the illness is only these 52 weeks. Again, this is a major approximation. Here also, scenarios would be needed to consider various lengths of this type of Long COVID that could be, for example, 1 year (this scenario), 2 years, or for ever (a HIV type of scenario).
Once more, we want to stress that, even for the scenario selected here, the result will, obviously, only be roughly indicative.
All these steps being done, we now have a rough indication of people suffering of Long COVID daily in the world.
Severity of long COVID
Finally, we need to know the impact of Long COVID on daily activities. In other words, each day, we want to roughly estimate how many people with Long COVID will be completely unable to carry out their activities, will be somehow limited in their activity and will not be limited at all.
Always using the UK ONS monthly survey, as far as the limitation of activity is concerned, rates vary little over months, as shown in the graph below. We shall take the latest rates, i.e. those for 31 October 2021, for our assessment. This time we can be slightly more confident in our assessment, apart from the fact that we apply British conditions to the whole world, when, most probably, the rates vary immensely according to countries.
Estimated number of people living in private households with self-reported long COVID by subsequent activity limitation (Source: UK ONS – Tables 9 – Estimates of the prevalence of self-reported long COVID and associated activity limitation, using UK Coronavirus (COVID-19) Infection Survey data.- Monthly datasets )
Three Scenarios for Long COVID and the Fifth Wave
Resulting from our model*, we now have a rough daily number of people suffering from Long COVID estimated globally up until end of February 2022, furthermore sorted according to activity limitation. Using our earlier work on contagion (“Towards a Covid-19 Fifth Wave“), we created three scenarios to envision three possible shape for the fifth wave.**
We present these results first side by side to allow for comparison, then one scenario after the other. We detail more the narratives for scenario 2 and 3 than for scenario 1.
Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic: 3 scenarios (be careful the scale changes according to scenario).
What we see, first, is that Long COVID hardly follows waves. Rather, the waves can be observed but are transformed into ondulations towards higher numbers of daily Long COVID. Only the second scenario seems to show a stabilisation at a very high level. The last scenario would lead us towards a staggering 140 millions people suffering of Long COVID each day.
Similarly a relatively large and slowly rising share of the world population is limited in its daily activity, either slightly or a lot, a share that accelerates in the third scenario.
Scenario 1: Coming back to our senses
The first scenario considers that the global fifth wave of infection will follow a pattern similar to the second wave.
Borders have been more reopened than for the third and fourth wave, and non-pharmaceutical interventions as well as cautiousness have also been relaxed, considering notably an erroneous understanding of current vaccination and willingness to go back to a pre-pandemic world. Nonetheless, as infections rise, measures are reintroduced. The new Omicron variant is finally found as being highly infectious, as suspected initially; the “increased risk of reinfection” is also confirmed with time (WHO, “Classification of Omicron (B.1.1.529): SARS-CoV-2 Variant of Concern” – 26 November 2021; Juliet R.C. Pulliam et al., “Increased risk of SARS-CoV-2 reinfection associated with emergence of the Omicron variant in South Africa“, medRxiv [not yet peer-reviewed], 2 Dec 2021, 2021.11.11.21266068; doi).
The pattern of the fifth wave thus “looks” like the second wave, at a slightly higher level because of temporary complacency and because of the Omicron variant.
Scenario 1: Coming back to our senses – Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic
Daily, towards the end of December 2021, 110 million people in the world suffer of Long COVID. It is especially hard for those 21 million people and their families who cannot at all assume their daily activities.
The costs on individuals, families, companies, sectors and countries that started appearing previously do not relent. On the contrary, they go on and increase.
Scenario 2: Optimism
This is the most optimistic scenario. The pattern of the fifth wave looks like the pattern of the fourth wave.
The factors that could lead to this scenario would be vaccination that become more widespread worldwide while it reduces somehow infection. We also have a very positive impact on infections of the third dose or booster dose in those countries that had so far largely driven infections and lethality (Tal Patalon et al., “Odds of Testing Positive for SARS-CoV-2 Following Receipt of 3 vs 2 Doses of the BNT162b2 mRNA Vaccine“, JAMA Intern Med. Published online November 30, 2021, doi:10.1001/jamainternmed.2021.7382). Finally, the Omicron variant, despite being very infectious, has led to reinstate more reason and common sense in various policies and behaviour. As a result, we are in a situation that is more similar to what was done during the fourth wave.
The fifth wave in scenario 2 looks very much like the fourth. It is only very slightly stronger to account for the Omicron variant.
Scenario 2: Optimism – Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic
Daily, towards the end of December 2021, the number of people in the world who suffer of Long COVID seems to stabilise and even to become very slightly lower around 107 million cases. This number remains enormous, but, at least, it does not increase anymore. Life remains especially hard for those 20 million people and their families, who cannot at all assume their daily activities.
The costs on individuals, families, companies, sectors and countries that started appearing previously go on. However, the stabilisation, even at a high level allows for a modicum of adaptation. True enough, those sectors that have been disrupted will not really be able to go back immediately to what they were before the pandemic, but the alternative solutions that were imagined could be sufficient. Of course, this means that these solutions will have to last at least a couple of months more.
Scenario 3: The price of ignorance
This scenario is probably the most worrying. The pattern of the fifth wave for the infections would look like the first wave: global infections would rise to reach a new and higher plateau.
This scenario is grounded in a change of priorities, with the primary concern, worldwide, given to the return of an economic system similar or as similar as possible to what existed before the pandemic. Vaccination strongly lowers the number of severe forms of COVID-19 necessitating hospitalisation, as well as mortality. Thus, those cases of COVID-19 that remain, despite the daily load of deaths and sufferings, are deemed as acceptable for the sake of conserving the existing socio-politico-economic system. In most countries, policies and behaviour aim thus, as much as possible, to ignore the still continuing pandemic. Thus, infections rise, but do not trigger the type of responses that would be necessary to stop global contagion.
The arrival of the Omicron variant, past a few first weeks of return to caution, does not change policies and behaviour. Under pressure from the UN bodies and various actors, hinderance to travels and the few closure of borders that had been temporarily reinstated are abandoned. This is done even before we can assess with certainty the severity of the forms of COVID-19 triggered by the Omicron variant and definitely before any link or absence thereof to Long COVID can be made and understood. This is done even though the strong infectious power of the Omicron variant is confirmed.
As a result, the fifth wave looks like the first, but at a much higher level. In our timeframe (four months), it does not stop rising. Probably, it would continue going up and up until new more adequate policies are designed, or until the SARS-CoV-2 and the COVID-19 disappear or become benign.
Scenario 3: The price of ignorance – Estimates of number of people suffering of long COVID each day in the world until the end of the fifth wave of the COVID-19 pandemic
The number of people in the world who, daily, suffer of long COVID seems to never stop rising. It does increase less steeply than infections, but it reaches new heights every day, up to almost 140 million cases at the end of February 2022. Life remains especially hard for those 26 million people and their families who cannot at all assume their daily activities.
The costs on individuals, families, companies, sectors and countries that started appearing previously continue to rise. The disruptions that were partly stemming from Long COVID intensify. As Long COVID is not monitored and has been rising without awareness and care, disruptions erupt haphazardly and pile up. Production, logistics, services are hit and new solutions must be found. Cascading effects cannot always be stopped. On the contrary, domino effects increase as more and more people become prey to Long Covid.
Consommation also takes a toll. Indeed, people struggling and suffering, as well as their families, not only have less disposable income but also revise their priorities and are less encline to consume (e.g. Patrick W. Watson “The “Long COVID” Economy“, Forbes, 14 June 2021 using a commentary by David R. Kotok, “M2 Velocity, Fed & Years Life Lost (YLL)“, Cumberland Advisors, 27 April 2021).
China, which now fully benefits from its insistence on a zero COVID policy, is almost free, relatively, of the dire effects of long COVID (e.g. Helene Lavoix, “How China Could Win the War against the Covid-19 Pandemic“, The Red Team Analysis Society, 18 January 2021). Those countries like Australia or New Zealand who also kept their borders closed for a long time reap benefit of their cautious policy.
In the harsh context of great-power struggle and competition that is taking place internationally, China, unburdened by Long COVID, enjoys a very large relative advantage, directly and indirectly as it can showcase its foresight and acumen. On the other hand, Europe and the U.S. now must carry the ever increasing weight of Long COVID. At worst and on the long run, if Europe and the U.S. do not act and thus if they continue letting infections spread and Long COVID rule, China will have won the international contest simply by default of its adversaries.
Conclusion
Despite the many uncertainties and limitations highlighted, it is clear that the real impact of the COVID-19 pandemic definitely and imperatively must take into account Long COVID. The more the world in general, a country in particular, faces infections, the higher its burden in terms of sufferings, economic and financial cost, and disruptions. For countries, to these already immense burdens we must add loss of power, absolute and relative.
Further research would be needed to estimate more finely possible impacts, including through comparisons with previous pandemics. How resilient are the various systems within which we live, when confronted to this kind of grinding weight?
Long COVID is fundamentally disruptive, including because of the dearth of data and the absence of understanding we face. Data must be gathered, knowledge must be accumulated, treatments must be found and, waiting for these, solutions must be imagined. Policies considering Long COVID must be designed and implemented.
The price to pay to live with the COVID-19 without considering Long COVID may well be far too high to pay.
**Considering the dearth of knowledge and data on long COVID, the number of estimates and approximations, without forgetting the incoherence uncovered, we do not give probabilities for each of these scenarios, which are, at this stage, merely indications aiming at framing the issue.
In our precedent article, we saw that current conflicts are integrating climate related tensions. This process is literally transforming certain conflicts into “proto-climate wars” (Jean-Michel Valantin, “What are Climate Wars ?”, The Red Team Analysis Society, 2 November 2021). This transformation follows the way the chain of consequences of climate change influences the definition of the goals of war.
The same process most probably applies to internal tensions. Hence, we have to wonder if the interactions between climate change and domestic tension may lead to civil wars?
Civil war
In order to answer this question, we have to define what is a civil war. We propose to define it as a war that happens within the borders of a given country, between different but domestic armed parties fighting the state (Encyclopedia Britannica).
According to Max Weber, a state is the “legitimate monopoly of violence” (“Politics as vocation“, 1919). So, a civil war both signals its weakness and worsens it. However, this weakening may very well turn a civil war into a “disagregation war”, when and where the opposite parties keep on fighting, while war becomes its own finality (Harald Welzer, Climate wars: what people will be killed for in the 21st century, 2012).
Thus, a civil war implies a profound breaking down of the social, institutional and political order. As it happens, in certain areas and periods, climate change is already exerting effects on societies analogous to those of civil war.
So, we shall use the start of the Syrian war as a case study. First, we shall see how and why there was such social vulnerability in the face of the 2006-2011 long drought.
Then, we shall see how climate change and political tensions interacted in the Middle East and Syria during the Arab spring and the start of Syrian civil war in 2011.
Finally, we shall study how this led to the weakening of the Syrian State as a monopoly of violence.
First contact
Syria’s fragility
There are several studies about the links between climate change and the Syrian civil war. Several researchers identify the way the historic long drought of 2006-2010 destroyed the Syrian rural fabric (Werrell and Femia, The Arab Spring and Climate Change, 2013).
It led to a massive rural exodus of poor and destitute populations in badly prepared and managed cities. In this context, the ultra-rapid development of urban inequalities did create a vast reservoir of disaffiliated young people. Those were to become the first reservoirs of the insurgencies.
Building vulnerabilities
However, the very lack of resiliency of this semi-arid country, even in the face of a historical drought, is surprising. As it happens, the reasons for this vulnerability to drought takes root in the agricultural policy of the Assad regime since the 1990s (Aden W. Hassan et alii, “The impact of food and agricultural policies on groundwater use in Syria”, Journal of Hydrology, 29 March 2014).
At that time, the regime forcibly developed cotton cultivation for export to the international market. Cotton cultivation is very water intensive. So, the number of wells doubled between 1998 and 2006, thus overexploiting the quite limited Syrian water supply (Asan, ibid).
So, Syria was already suffering from an acute lack of water when the 2006 long drought started. Faced with this disaster, the Syrian state and its political authorities were basically impotent.
This crisis was even more profound that it took place in the larger climate-politics nexus of the 2011 Arab Springs.
The Arab Spring climate-bread-political nexus
The whole “Arab spring” process took place in the context of a general increase of commodity prices started a few years before. The impact on wheat was especially notable, particularly in 2007-2008, when, as corn and rice, wheat saw its price increasing by 100% (Michael Klare, “Entering a Resource-Shock World“, TomDispatch, April 21, 2013).
Consequently, food and, in particular, bread, the most important element (besides water) of the biological and social daily life for dozens of millions of poor Arab families and people in a dozen countries, cost more. This means: too much.
The world cereal market was under pressure because of three convergent factors. Those were a brutal spike of oil prices, a diversion from food to biofuel crops and financial speculation on commodities. It started an “epidemic” of food riots all around the third world (Michael Klare, “A Planet at the Brink“, TomDispatch, February 24, 2009).
Things grew even worse in 2010-2011, because of a series of extreme climate events on major areas of cereal production. There were giant droughts in Russia and China, and immense flooding in Australia. Russia decided immediately to withdraw what was left of its crops from the world market. Price spikes were the immediate market answer (Klare, 2013).
Thus, the bread prices heightened the Syrian social tensions, that were already embedded in the consequences of climate change.
Oil and Financial shock
However, in the same timeline as the drought, the Syrian oil output decreased dramatically because of geological depletion. The subsequent financial loss deprived the Syrian political authorities of their capabilities to answer the basic needs of the rapidly expanding very poor cities (Mathieu Auzanneau, Pétrole, Le Déclin est Proche, Le Seuil, 2021).
The state, the Syrian civil war and geophysics
In order to apprehend the central role that the “state of the Syrian state” plays in this crisis, we have to remember that, according to major political thinkers such as Thomas Hobbes (The Leviathan, 1651), Max Weber (Politics as Vocation, 1919) and Norbert Elias (The Civilizing process, vol.II, State Formation and Civilization, 1982), the state concentrates the monopoly of legitimate violence and a great capital of legitimacy, i.e. the right to rule as recognised by the population protected by the state.
In other terms, the legitimacy of the state is deeply rooted in its capacity to forbid other actors the use of violence. When the State is efficient, it is thus able to protect people from the violence of invasion, civil war, disaster or widespread crime (Norbert Elias, ibid).
Agriculture as a climate change attractor
So, in 2011, the Syrian State faces the interactions between unsustainable agriculture, extreme drought and oil depletion. Sadly, it is unable to protect the Syrian people and social cohesion. The Assad regime is unable to manage this crisis (Jason Burke, The New Threat, The Past, Present and Future of Islamic Militancy, 2017).
It is in this context that, in 2011, different insurgencies emerge during the “Arab Spring”. As in Tunisia and Egypt, those movements contest both the living conditions as well as the legitimacy of the political authorities. As soon as July 2011, the Assad governed state starts to fight them.
In other words, if there is no direct and immediate causality between the Syrian civil war and climate change, there are deep connections between the economic and social vulnerabilities and the profound and sustainable shock that the long drought inflicts on the country. Those conditions are profoundly destabilising and weaken the authority and capabilities of the state.
The result is a set of volatile social, economic and political conditions that fuel contestation while destabilising and delegitimising institutions ((Acemoglu and Robinson, Why nations fail, 2012).
As it happens, these geophysical and social interactions have to be understood as an integrated process. Indeed, in an arid country, in order to remain sustainable, the uses of water for agricultural, human, and urban needs are basically dependent on the limited availability specific to this resource.
However, the water cycle is basically embedded within the dynamics of the climate (AssessmentJohann Rockstrom and al., “Planetary boundaries: Exploring the safe operating space for humanity”, Ecology and Society, 2009). Consequently, the uses of water literally attract the dynamics of climate change inside the very fabric of the Syrian society.
So, it appears that climate change may very well inter-plays with the fabric of national and domestic tensions leading to a civil war. This means that this process may emerge in other countries when similar dynamics appear.
Thus, it is not specific to Syria or other “non-western” countries. So, we may wonder if this lethal combination could emerge in a great power ?
Featured image: The Euphrates River flows through Lake Assad in Syria in this photograph from the International Space Station as it orbited 263 miles above. NASA, 22 April 2021. Public Domain.
Strategic foresight and early warning are grounded in the idea of preventing surprise and more specifically strategic surprise. However, if we move away from the general idea of “strategic surprise” and try to be specific, i.e. if we try to apply the concept to a specific threat or issue we try to anticipate, then the exercise becomes remarkably difficult.
President Franklin Delano Roosevelt delivers his “Day of Infamy” speech to Congress on December 8, 1941, after Pearl Harbour surprise attack – Public Domain
The “surprise” part of the concept is relatively easily understood and envisioned. When we imagine a threat or danger occurring, we can identify and explain easily the many reasons why this event could happen unexpectedly and find us unprepared. However, understanding, assessing, and estimating these incriminated causes, then remedying them, is more complex. This is indeed the raison d’être of strategic foresight and warning and risk management, and the topic of many studies.
The strategic dimension, for its part, is more elusive and far less intuitive. For example, if you were asked to specify in one or two sentences the strategic-level impacts of the use of nano-drones for hostile action, or of the global exponential increase of long COVID, or of the global or regional shrinking of the pollinators’ population and had to answer the question immediately, would you be able to do it? This is actually a very difficult exercise.
D-day allied assault routes, from Center for Military History, US Army, Public domain, from Wikimedia Commons.
Try to carry out this exercise for any issue or problem that matters to you. Can you do it very quickly? Was it easier? Probably, if you have already thought about the question and researched it, if it is one of your area of specialisation and expertise, then the chances are that you will be able to answer easily. Yet are you really sure you are truly addressing the strategic dimension of the question? Or are you merely thinking – and wrongly so – that strategy is about the long term?
If the issue is about a threat that is obviously strategic, such as a war between Iran and Israel, or between China and the U.S., then it is easier to answer the question.
Yet, even in those cases, some strategic implications can easily be forgotten. But what would be your answer and how easily could you give it if the danger or the threat imagined relates to an entirely new area, as is most likely to happen if you try anticipating and getting ready for the future. How difficult would you find the endeavour if the danger of concern does not belong obviously to the more classical geo-strategic realm, for example an aspect of a pandemic? Would you even think about looking at the strategic aspect of the potential surprise?
This article focuses on the strategic component of the idea of strategic surprise. It underlines some of the major challenges that make it difficult to answer the “strategic-level impact question” and suggest practical ways forward (summarised in the conclusion). The aim of this article is modest and only hopes to contribute to facilitate debates on strategic impact and significance. Those debates will remain, and are necessary to obtain the best possible strategies.
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Thanks: I am very grateful to all those, throughout workshops, who have made this article possible, through rich and enlightening discussions, as well as with their comments and suggestions.
Bibliographic References
Balasevicius, T., Major, ‘Adapting Military Organizations to Meet Future Shock,’ Canadian Army Journal Vol. 12.2 (Summer 2009) 8-24.
Barfield, Ashley, John Bergstrom and Susana Ferreira, “An Economic Valuation of Pollination Services in Georgia,” Selected Paper prepared for presentation at the Southern Agricultural Economics Association Annual Meeting, Birmingham, AL, February 4-7, 2012.
Greene, Brian W., “Rethinking Strategic Surprise: Defence Planning Under “Bounded Uncertainty,” Technical Memorandum DRDC CORA TM 2010-186, August 2010.
Lee Wai Keong, Christopher, CPT, “Strategic Surprise,” Journal of the Singapore Armed Forces, Journal V24 N3 (Jul – Sep 1998).
Luttwak, Edward N., Strategy: The Logic of War and Peace, (Cambridge, MA: Harvard University Press, 2001 2nd edition), p. 4, cited by Crocker, “Thirteen Reflections,” p.2.
Yarger, Harry Richard, “The Strategic Appraisal: The Key To Effective Strategy,” In U. S. Army War College Guide To National Security Issues, Volume I: Theory Of War And Strategy, 5th Edition, J. Boone Bartholomees, Jr. Editor, Strategic Studies Institute Book, United States Army War College, June 2012.
Yarger, Harry Richard, “Toward A Theory Of Strategy: Art Lykke And The U.S. Army War College Strategy Model,” In U. S. Army War College Guide To National Security Issues, Volume I: Theory Of War And Strategy, 5th Edition, J. Boone Bartholomees, Jr. Editor, Strategic Studies Institute Book, United States Army War College, June 2012.
Featured image: USS California slowly sinking, USS Shaw burning – Pearl Harbor, 7 December 1941. By U.S. Navy [Public domain], via Wikimedia Commons – recolorised.
More than 110 million people have experienced or still suffer from Long COVID since the start of the pandemic (Chen Chen et al., full references and detail of calculation below). This is the number that follows from the findings of a study systematically reviewing the research done on Long COVID until August 2021 and published on 16 November 2021 (Ibid).
This staggering figure highlights that the condition known as “Long COVID” must be taken into account if we are to fully understand what it means to “live with the COVID-19”. More particularly, to estimate the multiple impacts of the fifth wave of the COVID-19 pandemic, we need to integrate Long COVID and its effects. Long COVID could well be, and this increasingly so, a key aspect of the pandemic, even though it has rarely been accounted for initially.
Thus, in this article in two parts, we focus on Long COVID. The first part reviews current knowledge. We try to comprehend in which way this aspect of the pandemic may impact security, understood in the broadest meaning of the word. We thus look first at what is Long COVID, its many names, its definitions, the number of people experiencing it, who is at risk in terms of age notably, how long Long COVID lasts and its intensity. We then turn to the vaccines and Long COVID. Finally, we start highlighting possible impacts, at individual and collective level. With the next part, we shall seek to assess more specifically Long COVID in the framework of the fifth wave.
We looked at the potential global lethality of the fifth wave with the previous article, after having focused on contagion and the shape the fifth wave could take, globally.
What is “Long COVID”?
Introduction to Long COVID
“Long COVID” is also known as “Post-Acute Sequelae of COVID-19 (PASC)”, “Chronic COVID-19”, “post-COVID condition”, and “Long Haul COVID-19”.
Long COVID means that, after having been infected with the SARS-CoV-2, one suffers for an indeterminate length of time, from three to nine months according to the WHO, or more according to the United Kingdom Office for National Statistics (see below), of some symptoms, among the 200 symptoms that have been identified (WHO Science conversation, “Post COVID-19 condition“, 30 July 2021).
The WHO suggests, for its part, the following definition:
“Post COVID-19 condition occurs in individuals with a history of probable or confirmed SARS CoV-2 infection, usually 3 months from the onset of COVID-19 with symptoms and that last for at least 2 months and cannot be explained by an alternative diagnosis.“
Long Covid does not include COVID-19 complications, defined as “any secondary disease that manifests after the acute phase of a COVID-19 infection. Multisystem Inflammatory Syndrome in Children (MIS-C), Chronic Kidney Disease (CKD), myocarditis/pericarditis, Chronic Fatigue Syndrome (CFS) or myalgic encephalomyelitis, and Kawasaki disease are complications known to be associated with COVID-19” (Chen Chen et al., “Global Prevalence of Post-Acute Sequelae of COVID-19 (PASC) or Long COVID: A Meta-Analysis and Systematic Review“, MedRxiv [not yet peer-reviewed], 16 November 2021, doi: https://doi.org/10.1101/2021.11.15.21266377).
According to Chen Chen et al.’s findings, globally, we can estimate that 43% of all COVID-19 tested positive cases develop long-COVID. Prevalence is worse for people who are hospitalised and reaches, in that case, 57%.
This is far from the “approximately 10–20% of COVID-19 patients” suggested by the WHO in its report grounded in a Delphi survey (WHO, “A clinical case definition of post COVID-19 condition by a Delphi consensus”).
Among others, this shows, once more, the danger of using the Delphi method, as Theodore Gordon highlighted (“The Delphi Method”, The Millennium Project: Futures Research Methodology,Version 3.0, Ed. Jerome C. Glenn). Incidentally, these dangers are repeatedly ignored. The methodology continues being promoted without users seeking to remedy problems. It is thus used again and again, most often without caution by many actors, including within governments.
The low prevalence selected by the WHO survey also shows, once more, that the WHO is first and foremost an international political body, thus an arena for diplomatic and normative struggles. Furthermore as an institution, the WHO also has its own agenda (see Helene Lavoix, The Coronavirus COVID-19 Epidemic Outbreak is Not Only about a New Virus, The Red Team Analysis Society, 12 February 2020). Hence, the WHO definitions and recommendations must always be seen and understood in their context.
Following Chen Chen et al., on 22 November 2021, this means that 110,5 million people have suffered or still suffer, globally, from Long COVID since the start of the pandemic (estimates of infection: 257,015 million on 22 November 2021, Reuters). This number rises every minute.
Always according to Chen Chen et al., the prevalence of long COVID varies according to regions with 49% for Asia, 44% for Europe, and 30% for North America.
These results are still estimates as studies differ widely in their designs, regarding for example the type of patients studied, when the research was done, or the type and length of symptoms considered. For example, Chen Chen et al. highlight that for global prevalence, “Estimates ranged widely from 0.09 to 0.81” (Ibid.). Furthermore, to have a better grasp of the prevalence, we would need to be able to consider evolution and changes according to variants.
Unfortunately, long COVID cases are hardly monitored throughout the world, a situation that should change if we want to address it properly. This monitoring is more than necessary considering the staggering amount of people concerned, the sufferings the disease entails and the various direct and indirect impacts of long-COVID, as we shall see below.
So far, we do not know exactly why someone develops long COVID. Indeed, the disease is not yet understood (e.g. WHO Science conversation, “Post COVID-19 condition“, 30 July 2021). Nonetheless, we start having some potential knowledge about the condition, that must still be considered very cautiously.
According to Chen Chen et al., women tend to be more at risk of long COVID than men: the prevalence in females is of 49% (95% CI: 0.35, 0.63), and in males of 37% (95% CI: 0.24, 0.51) (Ibid: 13). Pre-existing asthma seems also to heighten the risks to experience long COVID (Ibid.). However, as the authors highlight, these conclusions resulted from less than five studies and thus should be considered with caution. Other “pre-existing conditions such as obesity, comorbidity, and hypothyroidism” were also singled out as favouring long COVID (Ibid.), but such findings do not seem to sit well with the very high prevalence.
By the end of 2021, thus almost two years after the start of the pandemic, we are only certain of one thing: if we are infected by the SARS-CoV-2, even if we are asymptomatic, then we can experience Long COVID and the odds this happen are rather high.
Young people and even children increasingly experience Long COVID
Taking the British monitoring as indication, worryingly, long COVID seems to be spreading with time among the younger population. In November 2021 the percentage of the British people aged 17 to 24 years who had long COVID was “comparable to people aged 35 to 69 years” (Ibid.).
Furthermore, children also develop Long COVID. The British November 2021 survey highlighted that the percentage of long COVID increased among people aged 12 to 16 years, from 0,89% of the total UK population on 2 September to 1,27% on 2 October 2021 (Ibid, Table 4).
This corresponds to what was found in Israel. According to a mid-September 2021 survey by Israel Health Ministry,
Ongoing symptoms (long-COVID) exist among infected children in the state of Israel: 11.2% of all children experienced some symptoms after recovery, and about 1.8%-4.6% of them, depending on their age, continue to experience long-COVID symptoms after 6 months from the time of acute illness, as of the time of the survey. …
According to the same survey, the older the child, the higher the chance to experience long-COVID. Symptomatic children have a higher chance to develop the illness. Nonetheless, asymptomatic children also develop long-COVID:
“Among teenagers aged 12-18 who developed symptomatic illness, 5.6% experienced long-COVID compared to 3.5% among those who experienced no symptoms when confirmed as coronavirus positive. A similar situation has been observed among other age groups.”
According to Chen Chen et al. Meta-Analysis and Systematic Review (Ibid.), global prevalence of long COVID according to time since “index date”, which is the date for the positive COVID-19 test, but should ideally be the time of infection, evolves as in the following table:
Follow up time after index date (in days)
30
60
90
120
global pooled prevalence of long COVID
36%
24%
29%
51%
Global Prevalence of Long Covid according to time after positive test (from Chen Chen et al.)
Researchers explain the increased rates with time by an overrepresentation of hospitalised patients in studies of reference and drop out of people as they get better, both possibly distorting results.
If we turn to the UK ONS ongoing survey, we have the following figures. In October 2021, 1,2 million people reported they had long COVID (United Kingdom Office for National Statistics; “Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 4 November 2021). Out of these, “426.000 (35%) first had (or suspected they had) COVID-19 at least one year previously“; 204.000 (17%) thought they had COVID 19 between 39 and 52 weeks before (9,75 months and 1 year); 172.000 (14%) thought they had COVID 19 between 26 and 39 weeks (6,5 and 9,75 months) before; 46.000 (4%) thought they had COVID 19 between 12 and 26 weeks before (3 months and 6,5 months), 240.000 (20%) thought they had COVID 19 less than 12 weeks (3 months) before (Ibid).
It is difficult to compare the results of the two studies because the first considers the length of long COVID according to prevalence and the second according to long COVID patients. Furthermore, the first study only covers 120 days, i.e. 17,14 weeks, while the second goes beyond 52 weeks.
Both approaches are nonetheless informative and highlight the long length of time during which people suffer, while their family and society is also impacted.
How many of the people suffering of Long COVID are incapacitated by their symptoms
The symptoms of Long COVID are often incapacitating. Unfortunately, there is so far no treatment against Long COVID because the illness is not yet understood (WHO Science conversation, “Post COVID-19 condition“, 30 July 2021; Long Covid Diagnosis and Treatment by Dr. Seheult of Medcram – 5 June 2021: some data notably on prevalence are outdated).
According to a Swedish study, carried out between 15 April 2020 and 8 May 2020, among health care professionals after mild COVID-19, thus prior to the Alpha and Delta variants, 8 to 15% of people suffering of Long COVID saw their symptoms interfering with their daily lives (Havervall S, Rosell A, Phillipson M, et al., “Symptoms and Functional Impairment Assessed 8 Months After Mild COVID-19 Among Health Care Workers“, JAMA, 2021;325(19): 2015–2016, doi:10.1001/jama.2021.5612).
However, if we consider the ongoing monitoring carried out in the UK, by 4 November 2021, the proportion of people suffering from incapacitating symptoms is much higher:
“Symptoms adversely affected the day-to-day activities of 780,000 people (65% of those with self-reported long COVID), with 233,000 (19%) reporting that their ability to undertake their day-to-day activities had been “limited a lot”.
The variations between the two studies may stem from a host of reasons, the most worrying being an increasingly worse outcome because of variants, as well as, possibly, a repetition of infection creating some type of fragility.
Vaccination and Long COVID
What is the impact, if any, of current vaccination on Long COVID? Here again, we are faced with uncertain knowledge.
A 26 October 2021 study “reviewed data on nearly 20,000 U.S. COVID-19 patients, half of whom had been vaccinated (Maxime Taquet, Quentin Dercon, Paul J Harrison, “Six-month sequelae of post-vaccination SARS-CoV-2 infection: a retrospective cohort study of 10,024 breakthrough infections, medRxiv, [not yet peer-reviewed], 26 October 2021, doi: 2021.10.26.21265508). The researchers looked at “confirmed SARS-CoV-2 infection (recorded between January 1 and August 31, 2021), thus probably including Alpha and Delta variants. Considering the importance of the findings, I quote them at length:
This study… confirm[s] that vaccination protects against death and ICU admission following breakthrough SARS-CoV-2 infection [i.e. infection after vaccination]. … Our study also shows that vaccination against COVID-19 is associated with lower risk of additional outcomes … namely respiratory failure, hypoxaemia, oxygen requirement, hypercoagulopathy or venous thromboembolism, seizures, psychotic disorder, and hair loss. On the other hand, previous vaccination does not appear to be protective against several previously documented outcomes of COVID-19 such as long-COVID features, arrhythmia, joint pain, type 2 diabetes, liver disease, sleep disorders, and mood and anxiety disorders. … The absence of a protective effect against long-COVID features is concerning given the high incidence and burden of these sequelae of COVID-19. … our results highlight that some post-acute outcomes of SARS-CoV-2 (and notably long-COVID presentations) are likely to persist even after successful vaccination of the population, so long as breakthrough infections occur.
Another study has shown contradicting results. The research was realised on self-declaring people in the UK and its results were much more optimistic. It looked also at the impact of vaccination on Long Covid, with data covering variants between 8 December 2020, and 4 July 2021, thus mixing both the Alpha and Delta variants, and suggested that the odds to develop a Long Covid after vaccination was lowered by 50% (Steves, “Long COVID: double vaccination halves risk…; Antonelli M, Penfold RS, Merino J, et al. Risk factors and disease profile of post-vaccination SARS-CoV-2 infection in UK users of the COVID Symptom Study app: a prospective, community-based, nested, case-control study. Lancet Infect Dis. 2021;0(0), doi:10.1016/S1473-3099(21)00460-6).
Taquet et al. address the difference between their results and the UK study on self-declaring patients, highlighting among others that self-declaration may introduce biases. The 26 October study, being done in the U.S., does not include ChAdOx1 nCov-19 (‘Oxford/AstraZeneca’) vaccine, while the second does, as it was realised in the UK (Taquet et al. Ibid.). Further research would be needed, especially considering the positive potential of the ChAdOx1 nCov-19 (‘Oxford/AstraZeneca’) vaccine for Long COVID. However, if we look at the ongoing monitoring of Long COVID done in the UK, we still have significant figures for patients suffering of Long COVID, when the population is largely vaccinated. This would thus tend to suggest that even if the Oxford/AstraZeneca vaccine offers some modicum of protection, it is insufficient regarding the prevalence of long COVID and its intensity.
Another study at 120 days, but not considering the variant Delta, suggests that vaccination improves the condition of Long COVID patients (Viet-Thi Tran et al., “Efficacy of COVID-19 Vaccination on the Symptoms of Patients With Long COVID…“, SSRN/Preprints with The Lancet, 29 Sept 2021). Meanwhile, “the proportion of patients with an unacceptable symptom state” was reduced to 38.9% from 46.4% (Ibid.). Note that 38.9% people “with an unacceptable symptom state”, is still very high indeed.
As a summary, waiting for further research and bearing in mind the precaution principle, it appears wise to contemplate that the current existing vaccines, possibly, hardly have any positive effects on long COVID.
Furthermore, we know first that, considering the current state of knowledge, it is so far infection that triggers long COVID. Second, vaccines seem to have, at best, only a limited positive effect on infections (see Helene Lavoix, “Towards a Covid-19 Fifth Wave“, The Red team Analysis Society, 27 October 2021). Third, whatever protection current vaccines offer in terms of contagion, it is lowered in time as immunity wanes (Ibid). Thus, so far, the only certain means we have to fight and prevent long COVID are non-pharmaceutical interventions (face masks, distance, quarantines, lockdowns etc.).
Individual and collective impacts
Actually, for our purpose, the UK ONS gives us some very interesting data, as it also breaks down the intensity of incapacitation created by Long COVID according to length of illness, as shown in the graph below:
People with long COVID according to activity limitation and length of condition From Table 9: “Estimated number of people living in private households with self-reported long COVID by subsequent activity limitation, UK: four week period ending 2 October 2021”, United Kingdom Office for National Statistics; “Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 4 November 2021
This graph shows possibly also how debilitating long COVID can be as the longer people suffer, the more limited they are in their activities.
The figure of people being severely limited in their day to day activities and having started experiencing symptoms more than 52 weeks ago is substantial. It represents almost one mid-sized city.
In terms of impacts, it should be taken into consideration that one person who experiences a strongly limiting long COVID means that it is the entire family that will be impacted. Indeed, the person limited in her activities must be cared for, while the psychological impact on the family must also be taken into account. If ever the person who is suffering of Long COVID is the care taker and the resource provider, then the consequences are even more dramatic. One person with a partially or severely limiting long COVID thus actually means far more people being directly impacted.
As a result, the graph above highlights that a relatively considerable number of people will be “removed” from society as they will be unable to carry out their work. As the family is also impacted, this will also imply milder but nonetheless most probably perceptible impacts on society stemming from the increased burden and worry on the family.
Notably for small and medium size companies the impact of Long COVID can be disastrous. Indeed, the absence of one person may endanger the very survival of the company. For larger companies, which nonetheless have chosen tight employment policies, the impact of long COVID may also be very serious. Collectively, the severity of the impact will vary according to sectors, and analyses per sector of activity should be made urgently..
For example, it would be very interesting to estimate how much of the current ongoing disruptions of the global supply chain (e.g. Judy Greenwald, “Port logjams exacerbate supply chain risks“, Business Insurance, 1 Novembre 2021) can also be related to long COVID.
As a summary, it is obvious Long COVID is a serious condition, impacting many people and with many and possibly cascading consequences. Next, we shall turn to estimates regarding the future to have a better vision of what long COVID could entail for the fifth wave.
At the end of October 2021, we provided our third intensive training on early warning systems & indicators, part of this year programme on “management of social conflict” of the Ecole Supérieure des Forces de Sécurité Intérieure (ESFSI) of the Home Ministry of Tunisia.
The programme is supported by the European project “Counter-terrorism in Tunisia” via CIVIPOL. The first session took place in August 2020 and the second in March 2021.
It was a 40 hours long intensive training including lectures, tutorials for software and practice around real life issues. It was a fantastic week, as previously. Trainees were very committed, attentive and succeeded in learning new concepts and methodology very quickly and in applying them concretely to their everyday work.
Again, considering the COVID-19 pandemic, we did everything through Zoom, but we are now all used to this framework. It worked perfectly well, thanks to the ESFSI, the great team operating for CIVIPOL in Tunis, and of course, to fantastic trainees!
Trainees hard at work during a practice sessionTutorial for Early Warning: getting ready to practice with yEd graphThe Final Ceremony: I could be present through video but, here this was definitely not as nice as being there!
As the global fifth wave of the COVID-19 pandemic has now started, should we be worried about it? How lethal will it be?
This article and the next will focus on direct health-related impacts of the COVID-19 pandemic fifth wave. Indeed, these effects are those that determine all others. Here, we shall look at the potential lethality of the fifth wave. The next article will address the Long-Covid, a key yet rarely accounted for aspect of the pandemic.
We focus, first, here, on the lethality of the previous waves and examine if a pattern emerges. Then we address the various factors that will impact the lethality of the fifth wave, notably the two anti-viral treatments of Merck and Pfizer and the waning vaccinal immunity after six months. We use the U.S. as case study and, adding the case of Israel, we deduce possible global trends. We also highlights some hurdles that political authorities could face regarding the acceptance of the 3rd dose.
This series on impacts of the COVID-19 fifth wave is the second part of the previous article: “Towards a Covid-19 Fifth Wave?“. There, we assessed it was very likely the global start of the fifth wave of the COVID-19 pandemic had taken place at the end of October 2021. There we also highlighted the factors that would shape this fifth wave. We now use the elements identified in this first article as basis to ground our evaluation of impacts.
Global deadly waves of Covid-19
Using the available global statistics, unsurprisingly, we find a periodicity of waves of death similar to what we found with infections.
Deadly impact in two phases for the first global contamination rise – until 17 October 2020
The first wave – the global contamination rise – lasted from December 2019 to 9 October 2020. It corresponds to a wave of deaths that lasted until 17 October 2020, i.e. 8 days after the turn towards the second wave of contamination.
However, here we have distinctively two phases. The first phase peaks around 15 April 2020 with 8.905 death per day, then recedes to 4.677 deaths on 26 May 2020 and 3.628 on 1st June. This is the lowest global number of death since the start of the pandemic. By 3 November 2021 (8.078 deaths), we have so far not yet lowered again the level of daily deaths to this number.
As far as the very early stage of the pandemic is concerned, the high number of death compared with the low number of infection shows the global unpreparedness as well as lack of medical understanding, then, of what was a completely new illness.
The second phase of this first wave is a slowly ascending plateau from 4.677 to 6.056 deaths per day, with small peaks, showing the global spread of the illness, while medical knowledge nonetheless improved.
Comparison of global yearly deaths for influenza in 2019 and deaths from the COVID19 1st wave
The deadly second wave lasted from 17 October 2020 until 9 March 2021, with a low at 10.524 deaths per day. The shape follows closely the shape of the wave of contamination with a first peak on 22 December 2020 at 15.430 deaths per day followed by a higher peak on 27 January at 18.357 deaths per day. It lasted around four months and three weeks.
The second wave represents 1,54 million deaths.
Compared with the second wave of contamination, the deadly wave started one week later, the peak of daily deaths took place 13 days after the contagion peak, and the end of the wave took place 20 days after the end of the wave of infections.
The third wave
The third wave, in terms of daily deaths thus started from around 10 March 2021 and lasted until 28 June reaching then 6.909 deaths, i.e. 65% of the previous low. The peak happened around 28 April with 15.471 deaths, i.e. 84% of the previous peak. The wave lasted thus approximately 3 months and two weeks.
Compared with the infections, the deadly wave started 3 weeks later, the peak occurred surprisingly one day before the peak of contagions. The deadly wave ended one week after the wave of infections.
Cumulated deaths per wave of COVID-19 pandemic January 2020 to Oct 2021 plus reassessment for India .
The third wave represents 1,23 million deaths. Actually, it is likely this figure is vastly underestimated. Indeed, the third wave includes the tragic spread of the Delta variant in India. A study using three different types of methodologies concluded that the death toll for India only between the start of the pandemic and June 2021 could be between 3.4 million and 4.9 million excess deaths (Abhishek Anand , Justin Sandefur and Arvind Subramanian, “Three New Estimates of India’s All-Cause Excess Mortality during the COVID-19 Pandemic“, Center for Global Development, 20 July 2021. These figures must be compared with the official death toll that counts 339.053 death on 1st June and 399.459 on 30 June 2021 (e.g. Financial Times).
The fourth wave
The fourth deadly wave started around 28 June 2021, lasting until 17 October 2021 with 4.067 daily deaths, i.e. 59% of the previous low. The peak occurred around 26 August 11.717 deaths, i.e. 75% of the previous peak. The wave lasted around 3 months and slightly less than 3 weeks.
Compared with the infections, the deadly wave started 1 week later, the peak occurred also one week after the peak of contagions. It ended on the same day as the wave of infections. In other words, the fifth wave started surprisingly being felt in terms of deaths without any time lag. This likely comes from the various stages of waves for individual countries mixed with varying vaccination and induced-immunity. This shows the limits of relying uniquely on global aggregated data when we need to evaluate the potential lethality of a wave.
Comparison total number of deaths (combat) for the US during wars and the fourth wave of COVID-19 (sources: see text)
The fourth wave represents 0,97 million deaths.
To understand better what this means in reality, let us give a couple of comparisons.
For the U.S., during the fourth wave, 131.276 (732.634 – 601.358) Americans died of COVID-19. This is 2,46 times more than the Americans who died fighting during World War I (53.402), almost half (45%) of those who died during World War II (291,557), 3,88 times more than those who died fighting during the Korean War (33,686), 2,76 times more than those who died fighting during the Vietnam War (47,434) (Wikipedia, United States military casualties of war). And this is for the least lethal of the last three waves of COVID-19.
Comparison total number of deaths (all causes) for the US during its most deadly wars and the COVID-19 pandemic (up to 7 Nov. 2021) – (Sources: see text).
Of course, the relative importance of wars compared with the pandemic waves will vary according to countries. However, considering the influence of the U.S. in the world as a superpower, it is key to understand that the COVID-19 so far as been more deadly for the U.S. than any other war it waged in the world.
The COVID-19 has killed more Americans than World War II that counted 405.399 American deaths (all causes of death – Wikipedia, ibid.). The pandemic has even been more deadly than the Civil War (1861–1865), the most lethal conflict the U.S. has ever known so far. Then, the number of deaths is estimated to 655.000, while by 7 November 2021, the COVID-19 pandemic has killed 752.196 Americans (CDC data, 7 November 2021).
A pattern for the lethality of the waves?
What can we deduce from the lethality of the four first waves of COVID-19? Is there a pattern and an evolution emerging that may help us evaluating lethality for the future and more specifically the fifth wave?
As far as lethality is concerned, the periodicity and length of the waves are far less regular than those of infections. Similarly, the relationship between, on the one hand, the wave of infections, and, on the other, its impact, the number of deceased, is also irregular.
The main reasons for the differences and irregularities lie probably in the very diverse capabilities of health systems according to countries, added to the heterogeneous availability type, and spread of pharmaceutical treatments and vaccines.
If we do not consider the very likely reality of the third wave in India compared with official estimates – which is a very big if – then, since the second wave, we see an overall diminution of the lethality of the waves of COVID-19.
The global trend for the last three waves would tend to indicate a diminution of the height of the waves – the peaks of daily deaths are successively lower for each wave, while the lower points are also similarly lower. Again, the reasons for this overall diminution of deaths are most probably a mix between an improvement of medical treatment and capabilities of health systems to handle the illness, alongside the spread of vaccination.
Thus, looking at this general trend, we could start our assessment with, as baseline, a wave lasting until the end of the wave of infections, i.e. around 20 February 2022 and peaking between 20 December 2021 and 20 January 2022. If the favorable trends towards less lethal waves of the pandemic continues, we could have a peak around 50% of the previous one, i.e. 5.858 deaths, and a low around 50% of the previous wave. i.e. 2.034 deaths.
However, the reality of the impact of the Delta variant in India cannot be ignored. This strongly stresses that our collective global efforts must be directed at preventing variants of concerns (VoC) to emerge and spread. They are indeed a major factor of lethality.
Our total inability to anticipate the emergence of new VoC, apart knowing that the more the virus circulate, the more likely a VoC will emerge makes it difficult to assess in advance the lethality of a wave. However, as we saw, borders’ control throughout the world, and notably in the U.S. are being relaxed (see Towards a Covid-19 Fifth Wave?; Reuters, “What you need to know about the new U.S. international air travel rules“, 7 November 2021). This considerably heightens the likelihood to see a VoC emerging and spreading, hopefully not for the fifth wave.
Besides VoC, assuming health systems capabilities and medical practice remain constant the availability of new treatments, vaccination and the length of induced immunity are the factors most likely to influence the lethality of the wave, as we shall now see.
Factors impacting the lethality of the COVID-19 pandemic waves
Too early or or just in time for the new anti-viral treatments?
In October and November 2021, two new antiviral treatment, easy to administer came to the fore. What are these treatments? Are they the anti-COVID-19 treatments that will allow us finally overcoming the pandemic?
Monulpiravir (Lavgevrio in Britain)
U.S.-based Merck & Co Inc and Ridgeback Biotherapeutics developed the new antiviral pill using the molecule molnupiravir. It has been authorised in the UK on 4 November 2021 under the name Lavgevrio and could have a positive impact on lethality (Pushkala Aripaka, “Britain approves Merck’s COVID-19 pill in world first“, Reuters, 5 November 2021).
As explained in the video below, Merck’s pills aims “to introduce errors into the genetic code of the virus” and thus generates random mutations (Deena Beasley, “Explainer: How does Merck’s COVID-19 pill compare to Pfizer’s?“, Reuters, 8 November 2021). It is also believed that, as a result, variants of concern will not evolve, as the mutations are random (ibid.).
At the probable start of the fifth wave of COVID-19, we only have the results of the phase III trial of the company, stemming from “a planned interim analysis [that] evaluated data from 775 patients” (Merck, News Release 1 October 2021). According to the company, if “at risk, non-hospitalized adult patients with mild-to-moderate COVID-19″ receive twice a day four pills for five days within five days of the onset of symptoms, then “molnupiravir reduced the risk of hospitalization or death by approximately 50%” (Ibid.; Aripaka, “Britain approves Merck’s COVID-19 pill in world first“, Reuters, 5 November 2021; Deena Beasley, “Explainer: How does Merck’s COVID-19 pill compare to Pfizer’s?“, Reuters, 8 November 2021).
The very interesting video by Dr. Seheult of Medcram helps understanding better the new treatment, how it works and the trials.
Merck COVID Pill (Molnupiravir): A New Treatment Option? (Coronavirus Update 130) by Dr. Seheult of Medcram – 20 October 2021
For readers who are not fluent in English, use translated captions:
Click on the small wheel (“Settings”) just before Youtube on the bottom right hand side of the video player.
Click on “subtitles”, then on “auto-translate” and then choose your language.
Furthermore, the way Great Britain will use the pills is still experimental (Aripaka, ibid.). Finally, safety data for the drug are not public for now (Aripaka, ibid.).
Pfizer’s Paxlovid
Pfizer’s drug is not yet authorised on 8 November 2021 and was annouced by the company on 5 November 2021 (Pfizer, News Release). It will be commercialised under the name Paxlovid (Ibid.).
The active molecule, used in combination with an older antiviral ritonavir, is “part of a class known as protease inhibitors designed to block an enzyme that the coronavirus needs to multiply. Pfizer said that because the drug targets a part of the virus essential to replication, the pathogen cannot become resistant to the treatment” (Beasley, “Explainer“, Ibid.).
Pfizer phase 2/3 trial for the “Evaluation of Protease Inhibition for COVID-19 in High-Risk Patients” began enrollment in July 2021, and two other studies, one for Standard-Risk Patients and one for Post-Exposure Prophylaxis are still ongoing (Pfizer, News Release, 5 November 2021). “The primary analysis of the interim data set evaluated data from 1219 adults who were enrolled by September 29, 2021” (Ibid.). Safety evaluation used a larger cohort of 1881 patients and continues (Ibid.).
According to Pfizer, for high risk patients, the drug was found to reduce the risk of hospitalisation or death by 89% if given within three days of symptom onset and by 85% if given within five days (Ibid.). Pfizer’s regimen is three pills in the morning and three pills at night (Beasley, “Explainer“, Ibid.).
Too early for a global impact on the fifth wave?
Results for Pfizer’s drug are thus much better than for Merck’s pills, and because they involve less pills might be more easily available. However, as for Merck, there are no independent studies, the number of patients who have used the pills is small and the trials are so recent that secondary effects, especially on medium and long term, can hardly be known with certainty.
It is thus too early to consider widespread and global use of the pills and impact. Furthermore, to envision such a global impact we would also need to take into account manufacturing.
What happens in the UK regarding the use of Molnupiravir will need to be closely monitored.
But panic leads political authorities to discard precautionary principles
Nonetheless, we should also note that countries, for example Indonesia as well as “The United States, Malaysia, South Korea, Singapore, Thailand and the Philippines”, are hurrying up to authorise and pre-order Merck’s treatments, and most probably Pfizer’s (Reuters, “Indonesia reviewing Merck COVID-19 pill, up to 1 mln doses targeted“, 8 November 2021; Merck, News Release 1 October 2021; Pfizer’s news. Ibid.). They may thus have impacts – positive and negative – earlier than caution and safety would require.
It is worth here highlighting again that, usually, discovering a new drug and especially testing it takes a much longer time than what was done in the two cases of the antiviral pills, for example the 3 months of phase 2/3 trial for Pfizer, as we stressed in our earlier article “COVID-19 Antiviral Treatments and Scenarios“:
Here phases for clinical trials have been extraordinarily reduced. If things go well, then it will be perfect and optimism will triumph. If not, then we may be facing a tragic disaster, or even multiple disasters. The rule in strategic foresight and early warning is to always consider high impact scenarios even if the scenario is unlikely, for example when building wild cards scenarios (see Course on scenarios). This is what ought to be done.
Meanwhile, manufacturing of the pills has only started. However, Merck asserts that it could have manufactured 10 million courses of its treatment by the end of 2021 and more for 2022, at least 20 million according to Beasley for Reuters (Merck, News Release 1 October 2021; Beasley, “Explainer“, Ibid.). For its part, Pfizer would have 180.000 courses ready by the end of 2021, and 50 millon by the end of 2022 (Beasley, “Explainer“, Ibid.). Thus should these announcements all be correct and no bad surprise emerge, then severe illnesses and deaths could be significantly reduced (at least by 50%) for countries taking these drugs, before the end of the fifth wave.
We should consider widespread usage of these pills initially as an outlier that must be closely monitored.
For now, for the fifth wave, vaccination remains the major factor to consider as potentially altering the lethality of the fifth wave.
Vaccination, Immunity and lethality
If we want to have a better assessment of the lethality of the fifth wave of COVID-19 we need to consider vaccination.
Safety of the third dose
Note that we shall assume below that there are no serious side effects and safety concerns on the medium to long term for the third dose of vaccination. The existence or absence of such safety concerns is so far unknown. Israel, the first country to do so, authorised the administration of the so called “booster shot” on 30 July 2021 (Yinon M. Bar-On, “Protection of BNT162b2 Vaccine Booster against Covid-19 in Israel“, October 7, 2021, N Engl J Med, 2021; 385:1393-1400, DOI: 10.1056/NEJMoa2114255). It is thus too early to know if there are any negative effects on the medium to long-term.
On the short term, according to the ongoing monitoring of the U.S. CDC (the US started administering booster shots on 12 August 2021), most effects reported were similar to those of the first doses (“Fever, headache, fatigue and pain at the injection site were the most commonly reported side effects”). They are estimated as “mild to moderate” (for 92% to 94% of reports). Nonetheless, 6% of reports were tagged as “serious” (“reactions reported after getting a booster shot”, on data “from August 12–October 10, 2021 for persons aged 12 years and older”).
When vaccinal immunity wanes
For our purpose, most aggregated statistics available are difficult to use. Indeed, these statistics were created for the initial “race to vaccination”, which took place during the first semester of 2021. They thus tend to show mainly the percentage of a population that has received one dose or two doses of vaccines, sometimes using the more relevant criteria of full vaccination scheme. Then they compare countries.
However, what matters to us is not only the proportion of a population that benefits from a full vaccination scheme, and how advanced or late a country is compared to others, but also when vaccination took place and for which proportion of the population.
Let us explain further why this matters.
Vaccinal immunity wanes “considerably” six months after the full vaccinal scheme
This is also true for the Chinese vaccine CoronaVac from Sinovac, as scientists have shown that immunity falls after six months. A Chinese study concluded:
“Our study found that a two-dose vaccination schedule of CoronaVac (3 μg formulation) generated good immune memory. Although the neutralizing antibody titer dropped to low levels 6 months after the second dose, a third dose was highly effective at recalling a SARS-CoV-2-specific immune response, leading to a significant rebound in antibody levels.”
Considering that such a large proportion of the world population uses the Chinese CoronaVac, which is administered in 26 countries and part of the global COVAX scheme, the results of Hongxing Pan et al. are key in terms of the global lethality of the fifth wave, as well as, potentially for next ones.
Update 25 November2021: According to studies from Israel, a third dose administered at 5 months is highly effective in increasing protection against hospitalisation, severe forms of COVID 19, and death compared with two doses at least five months before. For example:
“Vaccine effectiveness evaluated at least 7 days after receipt of the third dose, compared with receiving only two doses at least 5 months ago, was estimated to be 93% (231 events for two doses vs 29 events for three doses; 95% CI 88–97) for admission to hospital, 92% (157 vs 17 events; 82–97) for severe disease, and 81% (44 vs seven events; 59–97) for COVID-19-related death.”
It would have been interesting to have similar studies checking more precisely when the full scheme of vaccination had taken place (5 months ago, 6 months ago, 7 months ago for example) to have a better understanding of the immunity boost on the one hand, waning on the other. Calculations below are don on the 6 months timeframe for an imperatively needed booster injection and not five months. If ever the truly dangerous waning generalised at 5 months, then results below must be adapted accordingly, The burden and risks are increased.
Waning immunity after six months and impact on the lethality of a wave
Thus, to estimate the lethality of the fifth wave, we must consider that at approximately 180 days after full vaccination, because levels of antibody will have strongly declined, the severity and lethality of the COVID-19 tends towards levels “similar” to those that would be known without vaccination. We do not know how fast a return to full lethality of the COVID-19 will take place. We do not know the proportion of the population who will be at risk and when. Both are nonetheless significant enough, considering studies and what happened in Israel (see previous article).
However, when a third dose is administered, enhanced protection against severity and lethality of the COVID-19 returns, for an unknown length of time. We shall only know if the length of immunisation after the third dose is superior to six months, earliest end of January to mid-February 2022, as third doses have started being administered in Israel on 30 July 2021 et in the U.S. on 12 August 2021 (Ibid,, CDC note 2), assuming no other variant of concern spreads.
We had warned about the key uncertainty relative to the length of immunity and the impacts on the idea of herd immunity as well as on the need for follow up vaccines in our article “COVID-19 Vaccinations, Hope or Mirage?” in October 2020. Knowing that if there is critical uncertainty, then we need to monitor the evolution of the key factors, as well as, preferably, to create scenarios, political and health authorities should not be surprised by the reality of the current situation. If an actor is surprised, then it means this actor should urgently revise its system of early warning (see our related training and online courses).
Waning vaccinal immunity, which impact on the lethality of a wave? The case of the U.S.
We now know that there will be an impact, that it will happen after six months and that it should have been monitored. However, how large or small could this impact be?
We are in the realm of trends because we do not know exactly how these dynamics work.
The figures of the Financial Times we use here, as they provide the multi-country historical series we need, consider all vaccination irrespective of age. As less than 18 years old are increasingly included in vaccination statistics, but as these specific vaccinations vary according to country and dates, distortions may be introduced when trying to assess lethality.
We are thus here rather in the domain of crude estimates. Further detailed research at country level would be need. It is nonetheless interesting to detail what could be happening.
For example, the U.S. has vaccinated between 8,6% of its population on 5 March 2021 and 40.6 % on 1 June (Data Financial Times – all ages). Thus, using the 180 days/six months interval, this means that on 5 September 2021 8,6% of its population needed a third dose or risked severe illness and death. By 1st December 2021, it is 40.6% of the population, whatever the age, that will need to have received a third dose.
Let us continue with the U.S. The country started administering the 3rd dose on 13 August 2021. On 4 November 2021, 11.9% of fully vaccinated Americans above 18 years old (11.1% of the total vaccinated population) had received their third dose (CDC statistics). If the 6 months limit for immunity is correct, we should look at the number of people vaccinated six months before 4 November 21, i.e. 4 May, to have an idea of the gap between those who have received their 3rd dose and those who should have received it. This gap represents the people who are facing increased risks of serious illness and death, if they become infected by the SARS-CoV-2. On 4 May 2021 31.7% of the Americans were fully vaccinated. Hence, on 4 November 2021, using total figures, 20,6% (31,7 – 11,1) of Americans are facing again rapidly rising risks of severe COVID or death. Actually this statement should be revised per categories of population (age, comorbidity etc.).
Thus, on 4 November 2021, the total number of Americans truly protected by vaccination is only 37,6% (58, 2 – 31, 7 + 11,1).
Note that if we use the proportion of Americans over 18 years old for the current level of vaccination and of booster doses, we obtain a larger coverage of 50,1% (69,9 – 31,7 + 11,9). This figure is however probably incorrect as the historical number for May given by the FT concerns the total of people vaccinated, irrespective of ages.
The U.S. thus starts the fifth wave with 30,1% of its population over 18 years old not vaccinated at all and 20,6% of the total U.S. vaccinated population facing renewed risks. The latter, furthermore, may be lulled into a sense of false security. By 1st December, as seen, it will be 40,6% of vaccinated people that will need a booster dose, knowing that on 4 November only 11,1% had received one. Thus 29,5% will need a booster dose. These figures will evolve with time as more people get a 3rd dose. We are nonetheless far from any herd immunity.
Now, let us look at what happened in the U.S. during the fourth wave (20 June to 20 October 2021). The fourth wave started apparently with 44,7% people vaccinated and ended with 56,4% vaccinated. We could thus think there is an improvement. However, we must consider the vaccinated people who were seeing their vaccine-induced immunity waning as the fourth wave progressed. These people who started being at risk again were those who had been fully vaccinated between 20 January (n.d.; less than 8,6%) and 20 April (25,8%) minus those who had received a booster dose.
The Americans really protected during the fourth wave decreased from 44,7% (minus an unknown number) on 20 June to 44% (52,5 – 8,5% on 5 March) plus those having received their booster dose on 5 September, to 30,6 % (56,4 – 25,8) plus those having received their booster dose 20 October (in the framework of an open-access article it is not possible to give more precise figures).
As a result, during the fourth wave, 131.276 (732.634 – 601.358) Americans died of COVID-19.
Let us assume that this corresponds to an average protection of 45%. If we imagine that the U.S will both slightly increase its vaccination of the population and accelerate its booster dose, we could take an average protection of 50% for the fifth wave, then we would have 119.341 deaths. The more third doses will be given and the more unvaccinated people will be fully vaccinated, the lower the actual figure will be.
However, we can use this type of crude estimate only if infections do not rise. Considering the opening up of borders and travels (ibid.), the decrease of non-pharmaceutical intervention, and possibly the feeling that the pandemic has ended, it is possible not to say very likely that the death toll worsen.
Vaccination and waning immunity, should we be worried about the global lethality of the fifth wave?
It appears clearly from the example of the U.S. that it would be meaningless to try to give a figure for the lethality of the global wave without entering into long simulations. We can nonetheless assess if we should be worried or not.
If we look again at Israel, between 20 June and 25 October 2021, cumulative deaths went from 6.427 to 8.049, i.e. 1.622 people died during the fourth wave. Comparatively, during the previous wave (21 November 20 – 21 April 20), 3.550 people died (6.346 – 2.796 – Our World in Data). Thus, vaccination with waning immunity, but with some non-pharmaceutical measures such as the mask being rapidly reinstated and with borders remaining closed led to a wave that was less lethal than previously by 54%.
From the Israeli and U.S. cases, we can deduce that even if we are very optimistic, we should nonetheless be worried about the fifth wave.
Israel, a country with a high level of vaccination, a highly efficient medical system, a very reactive policy in terms of non pharmaceutical intervention, and a small population succeeded to only halve the deaths caused by the virus as the fourth wave hit it.
The U.S., for its part, is dedicated to vaccination, but has the highest number of deaths in the world caused by the pandemic including because of politically biased relationships to caution. Its perspective for the fifth wave are that many Americans will still die, probably more than 100.000, especially if borders are opened without caution.
Now considering that the rate of vaccination worldwide is still very low (2,994 bn on 4 November 21, i.e. 37,89%), out of which an unknown number is already susceptible to become severely ill again and die, the prospects cannot be very good. We should brace to face again a wave with a high lethality (compared with no pandemic), including because of the reopening of borders.
Globally, in terms of vaccination an immense effort must still be made to fully vaccinate more than 60% of the world population. Yet, vaccination for the 3rd dose must, at the same time, be implemented for people already fully vaccinated, and that as soon as we reach 6 months after the last injection. The effort thus remains immense.
The initial assessment made out of the 2d, 3rd and 4th wave was probably too optimistic, including because, for the first waves, borders were closed. This is not the direction that still prevails at the dawn of the fifth wave.
One more hurdle
For countries which have already implemented a vaccination policy, a supplementary hurdle may exist, that could heighten lethality.
If governments have enticed their citizens in being vaccinated by promising the end of the pandemic and a return to a pre-pandemic time, then these citizens may develop various adverse reactions.
They may not believe a third dose is truly necessary, considering the bias called “belief perseverance” or “persistence of discredited evidence” (see course on mitigating biases or on analytical modeling). They may thus fall prey to conspiracy theories. They may also fail to adopt an appropriate behaviour to protect themselves and others.
If citizens realise that knowledge of the weakening immunity after 6 months was easily available or could have been anticipated, when they were given a contrary message, then they may think that their government is either incompetent or a liar. In both cases, this is very bad news for legitimacy and the capability of said government to implement any policy, including a mass vaccination campaign for the third dose, or any other campaign for non-pharmaceutical intervention.
Thus, according to countries and to the type of policies used for the campaign of vaccination for the first two doses, the fifth wave may become more or less lethal.
Conclusion
In general and globally, lethality, despite efforts, is very likely to continue until vaccination delivers an immunity that lasts and prevents also infections. We should be even more concerned considering the remaining high risks of emergence of new variants of concern, as seen.
The new treatments may completely alter these prospects. However, the risks entailed in spreading these treatments widely is also very high, even if they may materialise only much later.
As a result, the less borders will be opened without considering the 180 days of immunity, the more non-pharmaceutical interventions, notably face masks and quarantines, will be operative and reinstated flexibly, the less lethal the fifth wave will be.
As climate change intensifies, a major issue is to understand how rapidly changing geophysics and war are intertwined. Since 2013, at the Red Team Analysis Society we study the way climate change, the military and geopolitics interact (Climate change security, The Red Team Analysis Society).
Since then, things have changed dramatically. The complex relationship between climate change now evolves increasingly rapidly. To understand this relationship, we must first understand what are or will be “climate wars”.
“Climate wars” are wars
It’s politics, stupid!
All around the globe, there is a growing involvement of the military in response to multiplying extreme weather events. This may appear as an obvious link between climate and war. However, we must keep in mind that, as Clausewitz defines it “War is a mere continuation of policy by other means” (Carl von Clausewitz, On War, chap. I, 24, 1832)
In other terms, political authorities decide to wage war, or not. Politics is the decisive factor.
The French translation is done by artificial intelligence / La traduction française est faite par intelligence artificielle
Furthermore, the state of the climate may have consequences upon the living conditions of human groups and impose a major stress. For example, climate change endangers agriculture and the water cycle of small, large and very large populations and societies (Jean-Michel Valantin, “The Midwest Floods, the Trade War and the Swine Flu Pandemic: the Agricultural and Food Super Storm is Here”, The Red Team Analysis Society, June 3, 2019).
This kind of situation has the potential to trigger competition for basic resources, such as food and water (Richard S. Cottrell, “Food production shocks across land and sea”, Nature Sustainability, 28 January, 2019).
As it happens, at the world level, several years of bad cereal crops took place between 2006 and 2011. Those bad crops resulted of a series of extreme weather events in the most important regions of cereal farming.
There was a heatwave in the rice farming Chinese south in 2006. In 2008 and 2009 and 2010, we had giant floods in the U.S. Midwest, heatwaves in Canada, Australia, Ukraine and Russia. Then, the relatively low agricultural yields triggered speculation (Werrell and Femia, The Arab Spring and Climate Change, 2013).
The consecutive price inflation badly hurt Arab societies from Morocco to Syria (Ibid.). Indeed, bread is the basic staple for 70% of the population in these countries (Ibid.). Thus, tensions were triggered in already overstressed countries. As a result, the first demonstrations to contest Ben Ali in Tunisia were demonstrations denunciating the unbearable price of bread (Ibid.).
These bread protests were the trigger events of the massive social, political and geopolitical reactions called the “Arab Spring”. This massive process entangles political upheavals, civil and international wars and prolonged itself with the Syrian war (Werrell and Femia, ibid).
Polarization
From Himalaya with (not so much) love
We must keep in mind that there are several families of war, and different levels of intensity and scales. We must not confuse a state of tension with a state of war. However, the latter may emerge from the former.
For example, on 1 June 2020, Indian and Chinese patrols fought each other during a skirmish in the Ladakh region. Twenty Indian soldiers died and there were 43 Chinese casualties (Aijaz Hussain, “India: 20 troops killed in Himalayas clash with China”, AP News, 16 June, 2020). Since this uniquely violent incident, there has been military and political tensions flaring up between the two Asian giants.
This incident appears to have been triggered by mounting tensions between the building of roads, dams and fortifications by both China and India along the border. Since 2020, China and India keep on building military infrastructures while amassing thousands of troops. And thus, aggravating the risk of military and political escalation (Baani Grewal and Nathan Ruser, “ A 3D deep dive into the India-China border dispute”, ASPI- The Strategist, 21 October 2021) .
We must note that six months after this military skirmish, Beijing announced that PowerChina will build a dam on the Yarlung Tsangpo river in Tibet. This is likely to change the political context of these tensions into an explicit international water dispute. Indeed, when it leaves Tibet, this river passes through India. There, it becomes the Brahmaputra in India and the Jamuna in Bangladesh (Jagannath P. Panda, “Beijing Boosts its Position as a “Himalayan Hegemon” through Hydropower”, The JamesTown Foundation, June 7, 2021).
For China, on the one hand this new dam is necessary for securing enough water for the South-North Water Project. Mao first thought about this project in 1950. The new dam was finally announced in 2014. It aims at transferring water from the southern water rich region in order to support the development of the North.
On the other hand, the 60 gigawatts dam will support the Chinese climate change mitigation policy. Its renewable electricity production will support the development of the Chinese energy mix by diminishing the national coal consumption (Shan Jie and Li Xiaoyi, “China to build historic Yarlung Tsangpo river hydropower project in Tibet”, Global Times, 2020/11/29).
However, these new water politics and military tensions are inscribed in the already overcharged geopolitical and strategic landscapes. As it happens, China and Pakistan, India’s arch-adversary, have signed a memorandum of agreement for the construction of two giant dams on the Indus, one of them in the Gilgit-Batilstan region, in the Himalayas, claimed by both India and Pakistan and close to China (Drazen Jorgic, “Pakistan eyes 2018 start for China funded mega dam, opposed by India”, Reuters, June 13, 2017).
These dams will produce 4200 MW and 2700 MW of electricity respectively, and their construction will cost 27 billion dollars. They are parts of the Chinese “One Belt One road – New silk road” agreements signed between China and Pakistan in 2015 (Valantin, “China and the New Silk Road: the Pakistani strategy”, The Red Team Analysis, May 18, 2015). The Indian political authorities are concerned about the consequences of these dams on the Kashmiri water flow, which is a major source of water for the country, as well as for Pakistan.
These strategic tensions take place in a rapidly changing ecological and climate environment. This “dam race” happens when the melting of the mountain glaciers accelerate because of climate change.
Climate change: it changes everything
As it happens, climate change is a major factor of geopolitical and strategic tensions, because the sources of major Asian rivers, necessary to the lives of billions of people are located in these very glaciers.
Now, China and India together dominate South Asia and East Asia, while being regional and international economic and political powerhouses. Furthermore, their overall population amounts to almost 3 billion people – i.e. almost 40% of all human beings.
As a result, the tensions created by their competition for water in a warming world is a new kind of geopolitical crisis. It means that climate change is putting an increasingly growing pressure on political and military actors, which are already at odds with each other, while putting water cooperation systems under an intensifying stress.
Climate change thus becomes an amplifier of current and future geopolitical crisis. Indeed, first it accelerates the glaciers melting. Then, for China, those dams are also a way to mitigate climate change, while having enough water for its development. Yet, this approach is a major driver of competition for India, which refuses to depend upon the Chinese hydropower.
So climate change drives the emergence of a new kind of geopolitical crisis of an incredibly large scale. The nexus of this crisis of a new kind is the complex relationship between securing access to water for giant countries while suffering the effects of climate change. In the same time, they try to mitigate climate change, while adapting to it.
In other terms, the very nature of the growing military tensions between China and India is the transposition of their historical depth in the context of the current geophysical crisis. Water being life, especially for 1,5 billion strong nations, climate change “turbocharges” those and turns them into something that may turn into existential conflicts.
War for basic needs?
The 2011 Arab Spring and the 2020-2021 military tensions between China and India reveal how climate change is inflicting major stress on food and water access to entire countries, including the two most populous countries on Earth.
This tells us that climate wars, under the guise of civil or international wars, are wars for basic needs. As such, if there is no massive effort for mitigation of climate change, the threat on basic needs may very well lead to military and strategic rise to the extremes.
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