COVID-19 Reality

Wow there is soooooo much bogus information about COVID-19 going around right now. Partly this is because the government didn’t say enough soon enough to inform people, partly it is because people don’t want to take the effort to actually look up real information, and mostly because people don’t know how to tell the real from the crap.

Here it is straight.

TL:DR The facts you need to know about COVID-19; How to spot fake news; How to stay sane

Corona virus is a kind of virus (there are many millions of different viruses) that can sometimes affect humans. Other viruses you might be familiar with are influenza, ebola and measles. None of these are the same virus, just like I am a vertebrate, so is a chimpanzee, rat and chicken. We aren’t the same, even though we are in the same category.

Corona virus is zoonotic. That is, it mostly exists in non-human animals and occasionally crosses over to infect humans. The most common form of this is about 20% of the common cold. The common cold is categorised as rhinovirus, which is the group name for many viruses that attack the nose, causing it to “run”. Usually we humans experience a runny nose, a sore throat, some fatigue and fever. Generally we successfully overcome it.

This version is different. It mostly attacks the lungs and heart. Age and gender appear to be less relevant than do you have an existing (whether you know about it or not) lung and heart condition. If so, you have switched from potentially 3 times more deadly than the worst influenza in the last 10 years to potentially 70 times more deadly [link] and [link].

Because this version is so different, we are giving it some special labels. 2019 coronavirus, SARS-2-Cov, SARS-Cov-2, COVID-19, COVID-19 virus etc. For all intents and purposes, they are the same thing (there is a slight difference between the virus itself and the pneumonia/heart conditions caused by it – but let’s keep this at layman’s level, hey?)

Numbers are hard. We humans struggle with them as soon as we reach greater than 1000 of anything. So let us compare COVID-19 to the last big epidemic most people know about – the Spanish Flu. As a matter of destigmatising, it is important to note that this outbreak was named only because Spain was the only country reporting on it. It was first medically detected in the USA. This influenza, while a completely different virus to COVID-19, rocked the world with how deadly it was. It killed about 50 million people world wide (the number varies between 20 million and 100 million because many countries did not keep good statistics). It’s estimated penetration into the community was infecting 1 in 3 people and spread at a rate of about 2.4 infections per infected people. It killed 2.4% of all people who were infected.

COVID-19 has an estimated penetration of 20% to 60% (we don’t really know yet, because it hasn’t finished infecting those who can be infected). This number is important because it gives you an idea of how likely you are to get it if you are in an infected area. This penetration number can be reduced by good hygiene, increased separation from people (social distancing) and isolating those known to be infected. The next number we gave for Spanish Flu was the infections per person. That is, how many people does a not isolated infected person infect? That average is currently being clocked around 2.4 people. In Australia, we are seeing the number increase by 100% every 2 days. That is, if 10 were infected yesterday, then 20 (including that original 10) will be infected tomorrow. If 1000 were infected yesterday, then 2000 will be infected tomorrow. [link]

It is spreading fast.

The next number we used for Spanish Flu was the kill number of 2.4% (estimated because of those bad stats we mentioned earlier). We don’t actually know what the kill number for COVID-19 is as it isn’t over yet (much like the total infectiveness number). However early stats indicate that when the thing is managed well, and the number of people needing hospital is lower than the number of hospital beds available, then the kill rate is 0.9%, which is about 3 times more deadly than the worst seasonal influenza in Australia in the last decade, and not too bad compared to the Spanish Flu estimate. In Australia, where we have kept the number of infected below the number of ICU beds we have, the kill number is really low. But that will change when our infection numbers exceed hospital. We recently saw that in Italy, where a statistic I saw about 7 days ago (approx 16 March 2020) indicated a death rate of 7.7% [link – stats may no longer be relevant]. That is about 3 times worse than the Spanish Flu.

Currently 80% of people infected walk away with no known long lasting effects from COVID-19. The other 1 in 5 infected people aren’t so lucky. The other 20% of people will need hospital assistance. Let us pretend that 5 people go to hospital for care. On average 4 of those will need low intensity support, and walk away with minor lung damage and a stressed heart and should watch that for the next few years. The 5th person will need to go to ICU [Intensive Care Unit] (on average) where they will probably recover and leave the hospital. As the numbers of infected people rise, the number will exceed the ICU beds, and those people will die. That is the difference between Australia now, and Australia when we hit Italy’s level of infection. Somewhere around 5% of the population that are infected, which is likely to be twice the number of the Spanish Flu, will not recover and will not leave the hospital to live their lives.

So what can we do about this?

First of all, follow the medical advice.

  • Hygiene – imagine the world outside your safe zone (usually your house) is covered in wet paint that takes a really long time to dry (up to 48 hours). The only way to keep the paint off you and the things you care about is to avoid touching stuff. Before you eat or touch your face outside your safe zone, wash your hands. When you return to your safe zone, go and have a shower and wash the clothes that you were wearing. Also wipe down any objects you handled while out there, like your phone, wallet and keys. Wipe down the items you brought back. Get used to doing this now.
    • Soap and water is the best method to clean things – soap damages the virus. Use the WHO Standard of Hand Washing. Alcohol that is stronger than 60% harms it too, but not as well as soap. Bleach is the next best. Vinegar, cumin and tumeric are useless.
    • If you have to sneeze or cough, do so into your own elbow or shoulder. The idea is to cut down the spray you eject that covers surfaces.
    • Gloves and masks are minimally effective as most people are not trained to use them properly. Avoid the Dunning-Krugger ignorance effect and think you know how if you have not been formally taught.
  • Social distancing – keep about 1.8 m (6 ft) away from others [link] whenever you are outside of your safe zone. If you don’t touch a person, or get into the region their sneeze/cough can get you, you won’t get infected.
    • People forget that lines are close, schools are close and parties are close. These break social distancing protocols.
    • Sometimes you will have to get closer to people. Minimise these times and go wash afterwards.
    • Rethink going out – if you can avoid leaving your safe zone, do so.
    • Isolating those who have infection – if you know someone, encourage them to keep curfew. If you are in the government, enforce the fines for people who break curfew.

Myths – In an absence of real digestible information and in a spirited effort to make this less serious, people are grasping at quick fixes and misinformation in a delusion that they can get through this faster and unscathed. Stop it. You are putting yourself and others you love at risk.

Quick ways to tell if a thing you hear is fiction

  • “Scientists don’t want you to know” – actually they do want you to know the right information, they don’t want you to think you know misinformation.
  • “How to make your own cure” – no you can’t. If it were that simple, the government would be spending money on that instead of all of these expensive scientific methods.
  • “This natural substance cures/prevents” – not for this, not in humans.
  • “All you have to do is these simple things” that isn’t only listing the primary two methods of Hygiene and Distancing in various ways
  • There is no link to sources

How to not develop an anxiety disorder

  • Slow down your social media and reading all of the scary stuff that is above and beyond what I’ve written here. This is what you should be concerned about, not the other things designed to scare you and make you share stuff. Only share if it is sources and scientific.
  • Have a plan on how to maintain your safe zone. Practice it now while mistakes are not likely to cause contamination so that later when it is more critical you have the system down pat.
  • Stay in contact with your village via the internet (in today’s society, our friends are our village – the people we care about)
  • Reach out to those who are health compromised and offer to get them stuff when you get your own stuff. Leave it at their door to avoid possible contamination. Try to disinfect it first.

And most of all, plan for a long time in this new world, because this isn’t going to blow over soon.

Chronic and Complex Health

There is an interesting point in chronic illness when you have got past the shock, denial, bargaining and anger stage and you have settled on sadness/numbness.

This stage is where the reality of your condition hits you the hardest. The life you had is gone. You can’t do the things you use to do the way you use to do them. You have to factor in this condition for the rest of your days (or for those with just a complex health issue, for a few years).

There are three common phases at this point.

Survival – Doing what you can to get through today, possibly tomorrow. There is no space to really think about next year. It’s just about surviving now.

Existential crisis – A sense of unreality where things stop having meaning, or the meaning of things has shifted. It’s like suddenly discovering that the thing you’ve been calling red all this time is actually green. You’ve woken up from the dream into the wrong world. You look at things that others are getting all anxious about, or slaving their guts out for and realise that it is all fiction. They have no idea what hardship actually means.

Attempted acceptance/planning – In moments where you realise that you’ve kind of got the hang of day to day management considering this thing, you start to wonder what next year is going to look like. You try to make guesses for long term set up and realise that you actually have no idea, because you’ve never experienced this thing before and your guesses now will be invalide next week. Because as your diagnosis sets in, and you’ve been scrabbling to make sense of it all, the situation is changing so rapidly that what was true yesterday is fiction today, and what is true today will be fiction tomorrow – or next week. Planning is a strange concept, but you keep trying.

Of course, you’ll also be flicking around bargaining and anger for a bit too.

For those of you who have experienced chronic illness or complex disease, you’ll recognise these phases.

People being affected by COVID-19 are going through this now. For those people recognising these phases because of COVID-19, you’ve just been given a deep insight into the flailing stage of chronic and complex medical health crises that many people experience.

When all of this settles down to a predictable life, try to remember this for when you come across people experiencing chronic and complex health.

Change

Change is hard, and when unnecessary, it is a waste of resources. There are some very predictable phases that change prompts in humans, which Elizabeth Kübler-Ross describes in the phases of grief. Understanding these phases may help us to understand some of what is happening in the world right now.

Prior to the event that may require you to change, maintaining the status quo is the most efficient way to be. You have a rhythm, a set of expectations and known measures for success. It is within your best interests, as a general rule of thumb, to keep things going this way. An advantage of keeping this status quo, even if it isn’t that good for you, is that it is predictable, and even if we don’t like what we are predicting, predictable is comforting.

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Surprise

Generally change events are unexpected. We experience surprise as our predictions for what is supposed to occur fail. Prediction helps us know what to do and when our predictions fail, we need to pause to re-assess. Consider crossing the road. If the traffic behaves as you predict, then you know when it is safe to cross and when it is not. If the traffic starts doing weird things, then you will freeze as you assess how you are going to get across.

Denial

We don’t want the change to be real, or if it is real, bad enough that it requires us to change. Often if we just wait a bit, the anomaly that has caused the change in our prediction will go back to normal and we can continue as we have before. There is an efficiency in denial, where it delays us expending resources on change when that change isn’t necessary as the event was a false alarm, or delays us in over committing resources to a thing that only requires a small modification. We usually don’t notice when denial is effective, because things didn’t become a problem.

Bargaining

If we can do a small thing, pay a small price, make a small deal to get us back to how things use to be, then that is an efficient use of resources. If that doesn’t work, then we will expend more resource on a bigger bargain with someone or something to try to get back to where things use to be. In the cold light of analysis, this expenditure of bargaining resource can be more expensive than making the needed changes, but it feels smarter to do, because we return to the known model – the status quo. When bargaining works, when we can solve the event, then life returns to normal and it was probably the smart way to go. When bargaining works, we often feel like we have overcome a thing and we feel powerful.

Anger

When we realise that bargaining has failed, we try harder. With more aggression. When that fails, we feel powerless. We push harder, or find someone to blame, or something to blame. When we can’t find someone to blame, or blaming others is not in our nature, then we turn the blame to ourselves. When we try harder, or find the person or thing at fault, we can force it to change the thing we can’t do ourselves. When this works, the status quo is resumed. When it fails we run out of options. We despair.

Sadness

Sadness, despair, numbness – these are all ways to describe the reassessment phase as you realise this is real and you can’t stop it. The change has happened. At this point going back is not feasible, but you don’t know what going forward looks like. You are lost.

Acceptance

The change is real and to survive this you must change. An acknowledgement of reality and an assessment of self is common here. Things you use to do that are no longer valid, relevant or effective are discarded and a search for new strategies to go forwards begin. It is important to survive in the moment.

Planning

We have survived, but we haven’t really grown into our new future. Planning looks forward to what the world now looks like with this new reality begin, amidst a frank assessment of how things need to be. Plans are made for that future and changes in the now are implemented to get there.

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It is important to note that resources can be emotions, action, assets, wealth, friends and so on. IT is also important to note that people don’t just go through these phases linearly – there is a great deal of jumping about between phases, you can visit phases more than once and not everyone goes through every phase.

As I look at the world today, I see a great deal of the first four phases and not much of the last three. Mostly because we just don’t know yet how the world’s changes are actually going to affect us.

It is important to be patient with people who are in denial, who are trying to bargain a way out of this and who express their anger poorly. It is also fair to be patient with people who are sad and between actions. These are all normal. Help people to transition as best you can.

Some people have made it to acceptance and they are making immediate changes to survive the now. We just can’t really do the planning bit as the picture of the world keeps changing every time we look back into it.

People are Bad at Evaluating Future Risk

People are bad at evaluating a risk that is in the future. We seek certainty and struggle with shifting probability or uncertain error margins. This can lead to polarised thinking where we either grossly underestimate a risk, or grossly overestimate a risk.

Most people are fine at understanding relative numbers within two orders of magnitude. That is, we can easily comprehend up to 10 of a thing (first order of magnitude), and frequently up to even 100 of a thing (second order of magnitude), but fail when the number is greater than that.

For example, if I ask you to indicate how much area we need for 200 people you will indicate a certain amount of area. If I had instead asked you to estimate the area we need for 400 people, it would be only marginally larger. If I ask you to estimate one and then the other, you will double the area of the first – but that second area wouldn’t have been the area you picked if I asked you for 400 first. Because the number is greater than 100, we struggle to comprehend it. This is because in nature, when we were roaming around the fields looking for food, the difference between 100 animals and 1000 animals, or a small tree full of berries and a large tree full of berries, was insignificant.

The reverse is also true. When we start looking at 100th or 1,000th.

Our math has got pretty significantly tricky in the last few hundred years. We can do some really fancy stuff. Logarithmic math is really handy for dealing with numbers on vastly different scales of magnitude. However most people don’t really understand what that means. For example, the Voyager probes (1 and 2) had just under 64 kb of memory each. My mobile phone has an extended memory of 64 gb. We recognised that gb is bigger than kb, but by how much? If a byte is an ice cube worth of water, then 64 kb (kilobytes) is half of a bathtub. Now pause and try go figure out what 64 gb (gigabytes) is going to look like.

What do you picture?

The volume of 64 gb (gigabytes) of ice cubes is 2,500 olympic swimming pools, which still defies comprehension except that we get the idea that this is a lot of water. I’m fairly confident that you didn’t think your phone’s storage was that big when compared to the amount used in the Voyager probes.

Still, these are fixed numbers – so even if we can’t really comprehend the scale of it, we can work better with it than a moving number. We struggle when the numbers shift in time. We want a definite thing to plan for and against, ironically so that we can change the definite thing.

We saw this with the millenium bug back before 2000. Our computer scientists warned us that the mechanism of how our computers calculated the date was going to fail. A design flaw that was created for efficiency was not supposed to still be in use by 1995. The problem was that people weren’t upgrading as they should be doing and we really needed them to. What is the worst that could happen? Well, if enough computers fail, then modern civilisation halts. Planes could literally fall out of the air, power stations could stop, water could stop and databases could be irreversibly corrupted (health databases, banks and government registers). Just think about all the things you currently rely on electricity to do. 

“Of course”, said the scientists, “we could just fix it”. The computer scientists estimated the world cost for upgrading the key systems that would ensure that civilisation continues and were ignored for another few years. Which magnified the cost by roughly 100 times. Not percent (which would have just doubled it), but 100 times. It cost up to 1.6 trillion dollars to fix world wide.

Here’s the irony. Because it was fixed, there was no disaster.

People felt justified in calling it a hoax. Even though over 30,000 failures were reported around the world to relevant computing bodies (the systems that weren’t fixed). It was known that not all systems could be fixed due to the long delay in acting, but if enough systems were fixed, the infrastructure would be robust enough to survive a few failing systems.

This is kind of like getting upset that your car didn’t crash like your mechanic warned you about, if you don’t get your brakes repaired. Heeding the warning of your mechanic, you repair your brakes, and then… lo and behold, your car doesn’t crash. Whoa…. spooky.

Climate change is another similar problem. Our world scientists have warned us of a problem. The science is really solid that this is a real problem and that we are going to have dire consequences if we fail to act. That the longer we wait, the worse it is going to get, and the more it will cost to fix.

Much like the millenium bug, people are not taking it seriously because it is hard to comprehend. How bad will it be? Scientists can’t tell you for certain, because it is a moving target. But they all agree it will be bad.

Going back to a previous analogy, if you don’t change the brakes in your car, how bad will it be? Well, you will crash when they fail. But how bad will it be? That depends on the crash. You could just crumple a fender, or you could kill a busload of children, or a range in between.

The denier will say “if you can’t tell me how bad the crash is going to be, I don’t believe you know what you are talking about” and refuse to change their brakes.

Here is the irony though. If we do the world actions needed to stave off climate change, the denier will call it a hoax. If we fail to act, human life on earth might end (worst case bus full of school kids scenario, and kind of hard to come back from), or we might just lose 2/3 of the population. As in 5 billion people. If we do act, we can stave off the worst of that. We are going to lose people, our goal is to try to make that number as small as possible.

Recently there has been a virus outbreak, which has been named COVID-19. Extrapolating from early numbers in Wuhan China indicated that this corona virus had the potential to be really bad. It might also be mild. Extrapolating from a small number set usually has problems.

Consider a random sample of 10 people. 3 of them have blue eyes. Does this mean that the whole population of the world has 30% blue eyes, or that the only blue eyed people in the world were in that sample of 10 people? We just don’t know. So we increase the sample size to 100. It turns out that 20 people in this group have blue eyes. That tells us that there are more than 3 people in the world with blue eyes. We adjust our prediction to 20% of people have blue eyes, but it is still possible that there are only 20 people in the world with blue eyes. Now we look at 1,000 people. 100 of the 1,000 people have blue eyes. What does this mean when we try to extrapolate a trend? Does that mean that only 10% of the world has blue eyes, or that the region that we are sampling from has less than usual, or more?

This is the kind of difficulty that trying to predict how deadly a virus is. As the virus spreads to more people, more accurate predictions of the virus can be made. Yet deadliness is a deceptive term. A virus that is so deadly that it kills its host before it can spread has a 100% deadliness, but poses no real risk to humanity (except for the single host). For a virus to be a risk means it has to be able to spread. This is referred to the reproductive number, or R0 (pronounced “R Naught”). This is a combination of how good the virus is at infecting others and how much people can mitigate that ability. I might normally be the fastest runner at school, but if you break my legs, I’m not going to win the foot race. My ability to win the race has been mitigated. Falling on an object that punctures my lung hundreds of kilometres away from a hospital increases my risk of dying from that wound compared to puncturing my lung in a hospital. The punctured lung is inherently bad, but the risk of death goes up the further away from a hospital I am.

This shifting risk makes it hard for people to grasp risk.

In the case of COVID-19, in the best circumstances, it appears to infect some people asymptomatically. That is, they experience no ill effect and don’t even know they have it. Humans frequently have infections that spread throughout the population without them knowing about it. If COVID-19 only did this, mostly we wouldn’t care.

But it doesn’t.

There are people experiencing serious to deadly outcomes, and potentially 4% of the people infected have died. Or has it. We have not tested every person in the world to get proper numbers, so we can only extrapolate based on the information we have – I refer to the above blue eyed problem.

Factors that change the inherent deadliness of the virus for the individual are related to age, pre-existing conditions, luck, how good the hospital near you is, how overwhelmed the hospital near you is, when you go to seek treatment and so on. There is no fixed number to define this.

Which means that most people don’t comprehend how dangerous the virus actually is.

Another two factors are news coverage and misinformation.

People who report News have their primary goal on profit. Their job is to sell advertisements, which means capturing your attention so you can see those advertisements. Which means hyping everything up. News outlets generally either exaggerate the risk, or complain that the risk has been exaggerated. This leads to a false polarisation of information – it is either really deadly so be afraid, or everyone is lying about how deadly it is, aren’t they silly? Seem familiar? Gone is the myth that news was reported impartially.

Then we have special interest groups who are pushing an agenda above and beyond selling adverts. They are pushing misinformation. Fox media, owned by Rupert Murdoch, shows very strong bias for Murdoch’s interests. Gina Rinehart is a mining billionaire in Australia who pays special interest groups to confuse the public about the risks of mining and fossil fuels. The West Australian Newspaper keeps publishing “opinion pieces” that require no fact checking over “scientific evidence” that does, which strangely enough coincides with the Murdoch agenda and the Rinehard agenda.

A quick way to tell the difference between real news and special interest news is this: If it is a prediction, real news will say “it depends on these factors” with a recommendation to make those factors more favourable; while special interest news will either attack the authority of specialists or give you a definite fixed risk assessment – a confident lie.

We look for something solid to base our next plans on, so we tend to fall for the confident lie rather than taking the time to understand that the outcome is not fixed and we need to understand the factors involved to navigate this threat.

So take that time. If it is a concern for you, take the time to learn about the basic science behind it and ask questions. People who give you confident certainty should be trusted less than people who say “it depends on these factors”. Learn some basic science, learn critical thinking skills, look to international agreement from world scientists – they are usually right, ask “where is this information from, and what is their agenda?”. For example, a strangely named source that refers mostly to itself versus the Australian Government’s CSIRO science department – I’d trust the CSIRO. Educate yourself, but be careful not to fall down a conspiracy theory hole. Most conspiracy theories are wrong.