A new virus appears in the world

What might we anticipate from the Wuhan coronavirus?  What does a futures perspective bring to the table?

Coronavirus_C-Tan-nCov_Wuhan_strain_01-20200123104509This is a very risky topic to address, naturally.  The outbreak is ongoing.  Data is often provisional or suspect.  Multiple layers of privacy, bureaucracy, local politics, geopolitics, and media stand between us and what’s going on.  All kinds of accounts are contradictory or vague.  And we’re talking about real human lives, some in pain and suffering, some to the point of death.  We can only proceed with great care.

Yet I think it’s worth commenting now, based on the best we know.  We can try to improve discussion, trying to ward off dangers from panics, ignorance, or complacency.   We can also place markers in time, which we can look back on later on.  And we can keep pushing our minds ahead.

In this post I’ll summarize some evidence and analyses, then outline general thoughts about how the coronavirus story might unfold.  In a followup post I’ll dive into early signs of educational implications.

First off, there seems to be some rough idea about the nature of the coronavirus so far.  It’s caused by severe acute respiratory syndrome coronavirus 2 (#SARSCoV2), according to the Lancet.  Its R0 number (the average number of people an afflicted person can infect) is somewhere between 2 and 4.  It has killed at least 1,000 people and infected tens of thousands more.  Its epicenter is the Chinese city of Wuhan, Hubei province.  That province is where nearly every case has occurred, although some global infections and a few deaths have been reported, and WHO is concerned about two European cases that might have arisen without any Chinese connection.

Coronavirus stats 2020 Feb 12_JHU

And yet so much is uncertain!  The thing’s lethality rate might be very low, as in 2%, but it’s hard to say for sure as data are cloudy.  Incubation times are all over the map, perhaps as long as two weeks or as short as a day, with wildly different results for how far and quickly the infection spreads. China might be failing to diagnose infected people by a factor of as much as 19. Moreover, one prominent scientist offers a truly scary vision:

The coronavirus epidemic could spread to about two-thirds of the world’s population if* it cannot be controlled, according to Hong Kong’s leading public health epidemiologist.

His warning came after the head of the World Health Organization (WHO) said recent cases of coronavirus patients who had never visited China could be the “tip of the iceberg”.

The Guardian accompanies those shocking assertions with these graphs:

Coronavirus rising_Guardian 2020 Feb 11

Those portray a virus with infections and deaths rising steadily.  We can extrapolate from them into serious global danger or disaster.  But at the same time China’s senior medical advisor, the leading SARS expert, stated that the number of new cases was actually falling, and that things are coming under control.

The peak should come in middle or late February, followed by a plateau and decrease, Zhong said, basing the forecast on mathematical modelling, recent events and government action.

“I hope this outbreak or this event may be over in something like April,” he said in a hospital run by Guangzhou Medical University, where 11 coronavirus patients were being treated.

The BBC offers a graphic that expresses this peak:

coronavirus_cases_Jan-Feb 2020 BBC

So which picture is correct, a brief outbreak or a global nightmare?

As a futurist, I’m always looking for how present day trends can unfold in the future.  Based on this very brief sketch so far, I’d just like to pose a question.  Where does the outbreak go from here, following the trend of a global pandemic or towards just a brief outbreak?  For the latter, we could imagine coronavirus becoming a minor but long-standing piece of our total disease puzzle.  For the former, something between SARS (which it has just exceeded) and the unspeakably devastating Spanish flu. It’s a wide range, but we don’t have a lot of data now.

Along another futurist line, people have asked me if the virus is a black swan.  That’s an event with an extremely low likelihood of occurring, yet with huge impact when it goes. (The term is Nicholas Taleb’s.) I don’t think that’s so here.  For one, major health organizations have been watching and planning for such events for decades.  For another, everyone else has as well: governments, disaster planners, urban planners, you name it.  We’ve gamed, simulated, and told stories about outbreaks.  In fact, I led a short workshop session on this very idea a year ago for Georgetown’s new Learning, Design, and Technology students.  (More on that next post)

Now, for a third futures approach, let me try to assemble what I’ve seen so far as a kind of matrix of possibility.  Let me range across a series of top-level categories, fitting evidence into each one, teasing out implications for where this all could head.  Then we’ll conclude with speculation informed by all of that.  Yes, each of these categories has many points of overlap with the others.

Medical systems These may come under unbearable stress.  We’re already seeing signs of this in China. The way that symptoms appear – sniffles, joint pain, etc. – could lead many people not actually carrying the disease to present themselves to urgent care facilities, overwhelming normal capacity.  Medical staff are getting infected, reducing medical capacity while expanding the people needing treatment. And despite trying to lock at least 50 million people in place, quarantines might not actually work, yielding poor results and a lot of costs.

There’s also a question about how much American health care depends on medicines produced in China.  Which brings us to…

Economic effects These are starting to building up.  American stock market prices have already ticked down.  If Chinese workers begin staying home to avoid sharing/obtaining the virus, this could hit the complex network of trans-Pacific supply chains, in turn driving up prices and reducing stock.**  This could lead to layoffs, which then depress demand for goods and services.  Blockades of Chinese cities, declining worker time on the job, shortages of supplies, and anxiety about shopping in public could clamp down on that country’s economy, which now plays a major role in the global economy.  Slowing down travel crimps every effected business and area.  Xi knows this and has apparently warned officials to not clamp down too harshly on the coronavirus, because of economic damage. A slowdown or recession in China then impacts the global economy.

We are seeing some other signs of economic impact.  Working from home is apparently rising in China.  At least one company has developed a new “contactless” delivery approach:

Meituan was among the first to introduce “contactless” food delivery, which basically means leaving the meals at a designated area for the customer to pick up. The company also installed meal retrieval cupboards around hospitals for Wuhan medical staff.

Last week, KFC and Pizza Hut started offering the same service, and the measures are going beyond food delivery. Several ecommerce companies will also offer contactless delivery to avoid infections, according to announcements from the Chinese Ministry of Commerce.

One Twitter user even claims this development:

Meanwhile, “contactless” digital businesses are surely doing well.  Think of it: stuck at home, unable to go out, how attractive even more digital entertainment must be.  I imagine gaming and streaming services are enjoying more demand.  The 11 million (!) Chinese expats who visited China and are now stuck there might well find solace online.

On a related economic point: a business slowdown or recession would likely cut carbon emissions, so some could coldly view COVID-19 as good for addressing climate change.  This might add to last year’s emissions decline in the developing world.

Politics Disease in the modern era can expand state power.  The Chinese government is using its powers to quickly build hospitals while throwing up the biggest quarantines in history.  The city of Shenyang is requiring travelers to check into transit with their real names, in order to better track the virus’ spread.  People’s Daily has a stirring editorial calling on the nation to battle against the sickness, including this photo of Xi:

Coronavirus Xi with mask

“Chinese President Xi Jinping, also general secretary of the Communist Party of China (CPC) Central Committee and chairman of the Central Military Commission, inspects the novel coronavirus pneumonia prevention and control work in Beijing, capital of China, on Feb. 10, 2020.”

In America, the Pentagon is preparing to offer military bases to the Department of Health and Human Services as extra medical facilities. Officials have great incentives to use governmental power, and popular opinion can support them in this drive.  The early signs of a 21st century surveillance state that we’ve experienced (or aided) so far may grow quickly.

This is the opposite of what small government politics seeks, as we saw with Trump’s actions:

In 2018, the Trump administration fired the government’s entire pandemic response chain of command, including the White House management infrastructure. In numerous phone calls and emails with key agencies across the U.S. government, the only consistent response I encountered was distressed confusion. If the United States still has a clear chain of command for pandemic response, the White House urgently needs to clarify what it is.

Meanwhile, face masks – of dubious value outside of clinics, but popular nonetheless – apparently mess with the facial recognition tech China has been deploying.

China checking for virus_NYT

In fact, we know from history that a disease outbreak can erode public trust in authorities.  The death of tragic doctor Li Wenliang provoked some public outrage.  If this occurs in China, it could play out in terms of local (city, province) governments being paralyzed by unrest.  Beijing can then intervene, perhaps making a case for its involvement in localities because of the latter’s incompetence or corruption.  We may already be seeing signs of this (example) (example) (example).

International cooperation seems to be uneven.  WHO is working away (from the director’s speech on Feb 11: “The bottom line is solidarity, solidarity, solidarity”), but China is resisting many offers of assistance.  Meanwhile Japan has decided to bar visitors from a Chinese province – not Hubei, but Zhejiang.  As Bill Bishop asks,

https://twitter.com/niubi/status/1227387599335120901?s=19&fbclid=IwAR1yu0ljaOTKfsMgQuKWQHrNi2AGFki7AEz2FP5hVRdOrq_HSLWJNsnpDOo

Good question.  According to WHO Zhejiang has 1117 cases, compared to Hubei’s 31728. Guangdong also has 1177, but isn’t targeted by Japan.

Culture We should expect pseudo- or openly anti-scientific practices, products, or services to appear.  The very useful film Contagion (2011) offers a good example of this as an unscrupulous character talks millions into a useless floral “cure.”  I wonder what will emerge from the different woo worlds: the elite and liberal (Goop), the right wing (Alex Jones), and the poor and desperate.

I have anticipated anti-Chinese racism from the start, of course.  This is a classic human response to a feared disease, to blame the carriers’ group for some flaw or failing.  In the United States this may be understated, given the Obama and Trump administrations’ successive failure to mobilize anti-Chinese feelings for their respective policies (TPP and trade war), and given Chinese-Americans’ status as a model minority.  But it could well take off, especially as problems people perceive as coronavirus-driven start biting hard.

Interestingly, there’s no settled word for the virus.  The CDC calls it “2019 Novel Coronavirus (2019-nCoV),” a name guaranteed to trip off of nobody’s tongue.  Wikipedia allows “Wuhan coronavirus.”  WHO just dubbed it COVID-19. The lack of a clear name for something can be a sign of its novelty.

On a different cultural front, the virus seems to have launched from animal food markets or preparation sites.  If we’re seeing rising interest in vegan/vegetarian diets, perhaps some will connect the two.

It is fascinating to see some cultural responses going transnational.  There’s a spat between Denmark, Hong Kong, and China over a Jyllands-Posten corona-virus-themed flag parody.  And some Chinese citizens have taken to writing cryptic reviews of the American-produced Chernobyl series (about the Soviet disaster) as a way of criticizing Beijing.

Media It’s easy to imagine American media outlets whipping themselves and viewers into a frenzy of panic, as they did with Ebola.  And not just American media.  On the other hand, they might fear overhyping the disease and losing audience as a result.  So far my limited sampling of American tv news shows little interest in the coronavirus, as their attention focuses on the presidential race (today, fear and dread of Bernie Sanders, it seems).  Newspapers are following suit, although usually maintaining some ongoing drip feed of continued disease coverage.

Digital technology The coronavirus represents a new test case for the digital world.  Social media will play a vital role in how we respond to the disease as a civilization, while falling under rising scrutiny.  All kinds of disinformation and fake news can spread easily, as can too-quick reactions. (Snopes has a good archive)  This puts pressure on the tech giants to do more, even costing them at the bottom line, which can also lead to more fumbles and misfires around content management.  Governments can get involved, as when Malaysia prosecutes a women for sharing dubious content on Facebook.  The Chinese state is using its digital tools to manage the outbreak to some extent, even launching a virus detector app based on a lot of surveillance.

At the same time technology can allow people to share information around state censorship (already happening), or state control can fail to either detect or intimidate people on certain themes.  Some citizen journalists are reporting out (for example).  There is also (to some degree) popular digital activity to support the Chinese state.

A range of people and organizations are already using digital platforms to help address the virus.  The CDC uses its web presence to share calm, updated information (for example).  Wikipedia has been busy.  Global Voices has started sharing Chinese responsesBaidu open sourced some gene sequencing detecting software Others have pointed to disease simulations and games, like this World of Warcraft event.  One blogger is translating a Wuhan diarist’s report into English, nearly in realtime.  Businesses are scrambling to play a rewarding part, like this firm’s quick release of a coronavirus tracking tool.

The crisis may be a testing ground for AI’s utility in the real world.  A Canadian firm used “an AI-driven algorithm” to detect the coronavirus before anyone else did.  Beijing is running some kind of AI to analyze human temperature data.  Companies are applying AI to speed anti-viral drug development.


And so?  What does all of this suggest for the short and medium term future?

Depending on how long coronavirus keeps killing and terrifying people, a great deal of friction, for a start.  Cultural, political, economic: the virus has roughed up our edges and painful intersections are happening.  We could see China’s political order shaken up, leading to either some change at the top level (Xi sidelined) or a more controlling state.  In the United States Trump could arrogate emergency powers at some level to address the crisis, although his combination of small government ideology and trademark incompetence make that less than a sure thing.  Economic mini-recessions can ripple globally, growing or flattening businesses and industries.

I’m very interested in the cultural and technological changes now in the offing.  The experience of another human-animal disease that launched from a meat market might nudge us a bit further towards a veg/vegan diet.  Physical isolation could drive us further online, jostling against the rising techlash.  We may have to rethink how much power we want states and companies to have over digital information as a result of this outbreak.

Economically, we might speak of a coronavirus recession striking certain areas.  Depending on how damaged supply chains are, global business could rethink them, either in the direction of growing more local capacity or of hardening those complex systems.  I do wonder if we’ll see less personal contact in certain businesses.

If COVID-19 truly escapes Hubei and sweeps the world, these frictions can catch fire. Then we can see national or regional effects: economic recessions, medical systems melting down, political orders shaken or knocked over.  Cultural responses could come quickly and in great diversity, from changes in interpersonal relations (will people still shake hands? how does dating fare?) to possible religious activity.  Perhaps alternative medicine will enjoy a boost, if people view the outbreak as a failure for established health care systems.

Or: coronavirus is this decade’s SARS and fades into the background.  All of these potential changes dwindle into quite ripples, then drop below the surface.  Xi’s government proceeds, if with fewer signs of popular support and more suspicion from the rest of the world.  Some additional signs of anti-Chinese racism will crop up.

Which of these trends and problems seem most likely from your perspective?  What are you seeing in the coronavirus?

Next post: COVID-19 and the future of higher education.

*That’s a pretty huge “if.”  Which is, I think, exactly the speaker’s point.

**On a personal note, my wife ordered eyeglasses from China.  She just got a note saying they’d be delayed a few weeks.

(thanks to Rodney Murray’s Militant Optimist newsletter for the AI links; thanks to Exponential View for more links; ditto the excellent Sinocism newsletter; thanks to Steven Kaye, Tom Lairson, Phil Long, Roger Schonfeld, Tim Pendry, and more for conversation and links)

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7 Responses to A new virus appears in the world

  1. Ignore the media, look at the data says:

    A few more pieces of information for your consideration. R0 is not a constant, nor it is likely to be 2 in this case. Here’s a pre-print paper (not yet peer-reviewed) from The Los Alamos National Laboratory that puts it between 4.7 and 6.6:

    https://www.medrxiv.org/content/10.1101/2020.02.07.20021154v1.full.pdf

    If the death rate (aka Case Fatality Rate) were 2%, the virus would already be 20x more lethal than Influenza. Unfortunately, the CFR appears to be much higher than that. Here’s another pre-print paper out of China putting CFR at over 3%:

    https://www.medrxiv.org/content/10.1101/2020.02.10.20021675v1

    Additionally, just as important as the CFR, is the percentage of patients requiring ICU care. Current front-line estimates put that number at 26%. From JAMA:

    https://jamanetwork.com/journals/jama/fullarticle/2761044

    Here’s an older paper on the ability of the US health care system to deal with large amounts of patients needing ICU-level respiratory care:

    https://academic.oup.com/cid/article/60/suppl_1/S52/356562

    And one final note: The number of new confirmed cases in China is only decreasing because China has changed they way they are counting them. I’d suggest taking any data out of China with a grain of salt and instead focusing on the situation in Singapore.

    • Bryan Alexander says:

      Excellent links and thoughts, Ignore. Together they suggest following my greater outbreak/pandemic scenario.

      4.3% mortality!

  2. Ignore the media, look at the data says:

    Also, you mention the world community gaming these kinds of scenarios, so I thought you and your readers might get value from exploring the most recent of these: Event 201

    http://www.centerforhealthsecurity.org/event201/

    Reading their conclusions will help frame the response of government and the media in addressing COVID19.

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