Learning to live with coronavirus in our midst

Efforts to contain coronavirus within Hubei province or China are failing, with substantial outbreaks reported from South Korea to Italy and Iran, and smaller numbers of confirmed cases in most other regions of the world.

Public health officials in the United States and Britain have warned about the likelihood of local transmission, with messages switching in recent days from containment to management and mitigation.

The US Centers for Disease Control has warned "we expect to see community spread in this country" and that the question is not if, but when ("CDC warns it expects coronavirus to spread in US", Wall Street Journal, Feb. 25).

Preventing the spread of the virus outside Hubei or even China was always likely to be a long shot, despite the country's unprecedented efforts to quarantine the worst affected cities.

With multiple cases of transmission outside China, including in countries with weak public health systems and those which are central to international trade and tourism, the chances of containment are fading.

Experience with viruses such as influenza suggests there is a high probability coronavirus will become a pandemic in the short term, with the possibility that it then becomes endemic, leading to further outbreaks in future.

ECONOMIC DISRUPTION

China's economy has been severely disrupted by extreme quarantine, isolation, social-distancing and other public health measures designed to halt coronavirus transmission.

The economic impact has already spread far beyond the country's borders through global supply chains. Financial and commodity markets are now braced for an even more severe impact as business, trade and travel disruptions go global.

Equity valuations and oil prices have been hit hard since Feb. 20, coinciding with evidence of widespread transmission outside China.

But investors and traders may be mischaracterising the likely policy response and economic impact if containment in China fails and transmission goes global.

The messaging from policymakers is likely to switch from aggressive quarantine to the importance of maintaining business as usual, while taking basic precautions to reduce the risk of further transmission.

The focus will shift to self-isolation for infected individuals and the importance of good respiratory hygiene (basically lots of hand washing) rather than business and travel shutdowns.

Governments, businesses and employees will be encouraged to live with the new threat and maintain normal life as much as possible rather than overreacting.

PANDEMIC PLANNING

Like most members of the World Health Organization, Britain has extensive plans for how to handle a pandemic, with the current round of planning starting a decade ago.

Pandemic planning has centred on an outbreak of influenza rather than coronavirus, but transmission and case fatality rates are similar.

In 2011, the UK Department of Health issued an influenza pandemic preparedness strategy that included "reasonable worst case" planning assumptions.

In the reasonable worst case, 50% of the population could experience symptoms of influenza during one or more pandemic waves lasting 15 weeks, though the severity of the symptoms would vary from person to person.

Between 1% and 4% of symptomatic patients will require hospital treatment and 2.5% might die if no treatment proved effective ("UK influenza pandemic preparedness strategy", Department of Health, Nov. 2011).

Local authorities should aim to cope with a population mortality rate of up to 210,000-315,000 additional deaths, possibly over as little as a 15 week period and perhaps half of these over three weeks at the height of the outbreak.

Over the course of the outbreak, 50% of employees might be absent from work, with 15-20% absent on any given day, with absences lasting for an average duration of 1.5 weeks.

The reasonable worst case scenario was never intended to be a forecast, and the consequences of most pandemics would be less severe. Crucially, it assumed no effective measures are taken to deal with the epidemic.

Instead, the pandemic strategy aims to reduce the severity of the outbreak and the number of deaths through infection control as well as the appropriate use of antivirals, antibiotics and hospital care.

OPEN BORDERS

The United Kingdom has planned on the assumption containment of a pandemic virus overseas was unlikely to work and an epidemic cannot be kept out of the country.

Its high level of international connectivity means Britain is likely to be one of the earlier countries to receive infectious individuals, according to scientific advice.

"Modern mass global transit … affords opportunities for the virus to be rapidly spread across the world, even before it has been identified," the Department of Health noted.

"It is likely to take at least four to six months after a novel virus has been identified and isolated for an effective pandemic influenza vaccine to become available from manufacturers."

"This means that it almost certainly will not be possible to contain or eradicate a new virus in its country of origin or on arrival in the UK"

"The expectation must be that the virus will inevitably spread and that any local measures taken to disrupt or reduce the spread are likely to have very limited or partial success at national level."

"An influenza pandemic could emerge at anytime, anywhere in the world, including in the UK It could emerge at any time of year. Regardless of where it emerges, it is likely to reach the UK very quickly," the department warned.

Given the ease of transmission, the government's scientific advisers have not recommended border restrictions or restrictions on public events and public transport.

Pandemic models suggest that imposing a 90% restriction on all air travel to the country as soon as a pandemic emerges would only delay the peak of the pandemic wave by one or two weeks. Even a 99.9% travel restriction might only delay the pandemic wave by one or two months.

There is no evidence of any public health benefit from meeting planes with thermal scanners and other screening methods.

"The economic, political and social consequences of border closures would also be very substantial, including risks to the secure supply of food, pharmaceuticals and other supplies," the department warned.

BUSINESS AS USUAL

For much the same reasons, the government's scientific advisers recommended against restricting public gatherings and mass transit systems because the likely health benefits are not significant.

"The social and economic consequences of advising cancellation or postponement of large gatherings are likely to be considerable for event organisers, contributors and participants," they warned.

"For these reasons, the working presumption will be that the government will not impose any such restrictions. The emphasis will instead be on encouraging all those who have symptoms to follow the advice to stay at home and avoid spreading their illness."

"During a pandemic, the government will encourage those who are well to carry on with their normal daily lives for as long and as far as possible, whilst taking basic precautions to protect themselves from infection and lessen the risk of spreading influenza to others."

Maintaining business as normal is crucial to maintaining health services, supply chains, food distribution, and essential services such as utilities, banking and transportation.

In contrast to China, where the government placed much of the country in lockdown, Britain will try to carry on as normally as possible, and most other countries will probably follow the same strategy.

Most governments will likely conclude virus transmission cannot be completely stopped, and a business-as-usual strategy has fewer political, economic and social costs than extreme quarantines.

Media reporting and commentary will also likely change. In past pandemics, reporting has tended to be sensationalist when the disease is overseas, but once the disease is domestic, the focus switches to coping and the importance of getting life back to normal as soon as possible.

If coronavirus cannot be contained in China, which now seems likely, governments, businesses and individuals will have to learn to adapt to it.

As a result, the economic and financial impact may be significantly less than the worst case that some traders and investors are currently contemplating.

The most likely outcome is still a severe but short-lived economic impact concentrated in the first and second quarters, followed by a progressive normalisation later in the year.