Covid – YEAR 1

Looking back at 2020 and forward to 2021 – Part of 1 or 2

This is the first of a two-part series looking back at 2020, and forward into 2021.

Predicting the future is always fraught with risks. But I want to take a look back at 2020, discuss how I have made my prediction so far, and then in the next article look ahead into 2021.

Because I work in biotech and in infectious disease diagnostics, I was probably more aware than most of the start of the epidemic in Wuhan starting in December 2019. I had access to both data and to discussions with experts who had been on the ground during the early epidemic in China.

I also have the advantage of formal scientific training and more than 20 years of experience working in the biotech industry. So I have a solid grounding in molecular biology and virology, and good some good exposure to epidemiology and infectious disease. I also have a good knowledge of the history of infectious disease and virology.

This background gave me the expertise to follow the scientific literature and gave me access to knowledgeable colleagues to discuss what we were seeing and reading.

Predicting the Future

I rely on three key elements when trying to understand the future:

  1. What are the underlying dynamics -
    how do viruses work, how does infectious diseases spread, what do disease dynamics look like

  2. What's happened historically -
    how have similar epidemics functioned historically, how have similar viruses behaved, what has generally happened around the development of testing, vaccines, and treatments?

  3. What's the human factor -
    few can grasp change, denial in the face of overwhelming facts is the human norm. And denial always brings out the grifters, the charlatans, the opportunist, and the craven political actors.

The final element is to never attempt to make predictions while still in the grip of denial. The universal human tendency is to project our hopes and wishes and predict a fantasy world where the change we're facing is wished away.

My Journey

I follow a mailing list called ProMED’s that focuses on epidemiological surveillance. It tracks field reports of new emerging diseases and new outbreaks from around the world. So I became aware of the early outbreak in Wuhan in December 2019, through ProMED and through reports from colleagues coming out of China.

At first, I was in denial, thinking this would be isolated inside China, or contained regionally as SARS and MERS had been. But by early January, the level of infectiousness and the rate of spread was extremely alarming.

My personal “epiphany moment” was on January 21st, 2020. That was the date I knew with absolute certainty what was coming what it would imply. We were headed for the biggest global pandemic in a century!

Between late January and the end of February, I canceled all my travel for the year, and began stockpiling a multi-month cache of food, supplies, consumables, medical equipment, and pharmaceuticals that I thought would become in short supply during the coming epidemic.

And on March 10th, I decided to lock-down. I quit going into high-risk public venues, including grocery stores, restaurants, bars, and music venues, and began using a mask whenever I went out in public.

And in early March, I started writing about the epidemic and making predictions as to how things would progress. My initial warnings of what was to come faced an onslaught of derision and denial. But slowly as the year progressed, what had been seen as doom-saying because widely accepted as fact.

In fact, my predictions have consistently under-estimated the facts as they unfolded.

2020 Predictions

In the first three months of March, April, and May, I begin to write about what I saw as the unfolding course of events for 2020 based on my own evolving understanding of the rapidly progressing scientific literature. Most turned out to be highly accurate...

So here are some of my key early predictions:

  1. Airborne-transmission would be the primary route of infection

  2. Asymptomatic-spread would be a significant infection risk

  3. The virus would have a high level of contagiousness just short of smallpox

  4. Universal masking was the best hope for containing the spread

  5. No seasonality - the virus would be active year-round through the warm months

  6. Death rates 10x that of seasonal influenza

  7. Waning immune protection within 3-6 month with the risk of re-infections

  8. A rate of spread of between 1% to 2% per month of the US population (10-20M cases by the end of the year) even with unprecedented levels of mitigation

  9. Hospitals and medical capacity would be overwhelmed by localized outbreaks

  10. Between 300,000 to 350,000 deaths by the end of the year

  11. Herd immunity was would NOT occur through natural infection

  12. Even with a vaccine, herd immunity might still never be possible

  13. There would be no magical cross-immunity from common colds

  14. Viral mutation was NOT going to be an issue, coronaviruses are slow mutators

  15. Effective vaccines would not be available until 2024 (entirely wrong on this one)

Most of this was based on a few facts and intuitions:

  1. Early spread-rate in China meant extremely high levels of contagiousness (R0>3)

  2. Coronaviruses durable immunity is always short (2-6 months)

  3. Seasonality is based on low R-values, SarsCoV2 had a very high R0-value

  4. No effective vaccine had ever been developed for a human coronavirus

  5. The Spanish Influenza infected 20M people in 19 months (1% per month spread)

  6. Early death rates in China, Italy, and Iran implied an IFR well above 1%

  7. Exponential grown will ALWAYS overwhelm finite resources

  8. There has never been a SINGLE case of naturally occurring herd immunity!

  9. Coronaviruses are slow mutators due to its proof-reading enzyme

  10. The shortest time to develop a vaccine in history was 4-years.

Most of the early predictions has turned out to be entirely correct:

  1. 20 Million cases in 10 months (2% per month spread)

  2. 350,000 deaths (on the high-side of my April prediction)

  3. No herd immunity (an incredibly stupid idea from day-one)

  4. Bodies in refrigerator trucks (because hospitals and morgues are overwhelmed)

  5. Uncontrolled spread even in the face of significant mitigation efforts

The biggest miss was the unexpectedly rapid development of what looks like a series of highly effective and safe vaccines.

The key to early accurate predictions was based on:

  1. Knowing the science

  2. Knowing the history

  3. Following the research as it evolved

  4. Not being in denial – looking at the world without emotional blinders to see what's actually there, not what one might emotionally hope and wish for!

Predicting 2021

The next of this two-part series will look at predictions for 2021. I will go into depth as to what I see coming and the reasoning behind how things may play out in 2021.

But for now, here a short preview:

  1. Things will NOT go back to “normal” next year!

  2. There will be popular pressure to remove all mitigation measures

  3. There will be a failure to convince large parts of the population to get vaccinated

  4. Next year's death toll will be as high or higher than in 2020

  5. There will be NO herd immunity next year...or in the future

  6. The virus will likely go fully endemic with 20M cases/week by next Winter

  7. As vaccination rates increase, the Covid death-rate will also increase

  8. Masking will need to be a permanent fixture, even for those vaccinated.

  9. Covid will remain the 3rd leading cause of death indefinitely

  10. Covid will end up as a disease as common as the cold, but as deadly as the flu!

About the author:

I am a scientist with 20+ years in the biotech industry. I currently work as a consultant with companies involved in developing molecular diagnostics platforms, including some of the key testing platforms used to detect the SarsCoV2 virus.

So I bring an insider’s perspective that is scientifically oriented but directed to a general audience trying to make sense of the conflicting stories surrounding the Covid pandemic.

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