The Second Wave

In February, I estimated the mortality rate of Covid-19 at 0.2%. So far, this limit seems to hold. There are no countries or large areas where the virus has proven more deadly.

Sure, there’s New York where 0.17% of people have died and New Jersey with 0.18%. If we look closely, county by county and suburb by suburb, we have Bronx with 0.34%.  However, Bronx has a high obesity rate, and more uninsured and poor black people who appear to be more susceptible to COVID-19. These factors naturally contribute to a higher COVID-19 mortality. Overall, the 0.2% estimate seems to hold, as a rough, but reliable guideline.

This makes COVID-19 about twice as deadly as the common flu. It has interesting complications involving the brain, heart, lungs and other organs. This is not unheard of for viruses — just think of Adenovirus 36 that is strongly linked to obesity. Colds, themselves, are caused by a wide variety of viruses including coronaviruses. So, COVID-19, welcome to the clan!

In this article, I want to look at the future. What will happen in the next few months, when fall brings lower temperatures, more rain and more … colds. COVID-19 is now firmly established as an endemic virus across the globe. No country has been spared. OK, perhaps North Korea, but it is hard to believe the North Koreans! From New York to South Sudan, we all face the same virus and, like with all viruses, modern medicine can do remarkably little to help. Thus, we should not expect to see across Africa or Brazil vastly higher mortality rates than we have seen across NY or London. In fact, India has reported a lower mortality rate in Mumbai's slums than Western Europe has because they have a younger population and because they have likely tested more.

In hindsight, the dominant feature of the first wave was rapid onset with a fast exponential growth in cases and deaths. This was due to the novelty of the virus. Everyone was susceptible and the R-factor (the number of people the average patient passes the virus to before getting cured) was high.

This R-factor depends on various things such as
— immunity — if half of the population is immune, R will halve.
— weather. Colds don’t like summer.
— social distancing

— school, work, public transport use.

Now, through various measure and through the grace of God’s summer, we the people, have brought R well below 1. This led to an exponential decay in the number of cases, but the virus has not disappeared. It may never go away. At least not in the near future.

In the second wave, the R-factor will be close to 1. It will inch slowly above 1, as cold weather makes us more susceptible to colds and people naturally share viruses more efficiently in the fall because they spend more time inside in the proximity of other people.

Thus, we will see an increase in cases, but it will be much slower than in the first wave. It will be like Iran now. The virus is there. Some people are dying, but the numbers do not change by a factor of 10 a week.

If immunity is long lasting, some places, where almost the entire population was infected will not see a serious second wave, e.g., India's slums, NYC and NJ if the death rate is what I have predicted.

If immunity doesn’t last long, such places will see a second wave of milder illness. The virus will infect adults for the 2nd time — with far milder symptoms due to some degree of immunity from the first infection. It will also infect children who were breastfed or not yet born during the first wave. Thus, like most other colds, it will do the rounds in day care centers, again, mostly with mild symptoms.

In countries where the quarantine stopped the virus successfully this summer, the second wave will be more substantial. For people who first meet the virus during the winter, we should expect more pneumonia and a higher mortality compared to those first infected in summer. This happens with all colds.

In such places, like Norway, Denmark, Austria, and perhaps parts of Germany and Eastern Europe, where most people appear to have avoided the virus in summer, we will see a lot of death and pneumonia in the fall. Sure, still of the order 0.2%, so not the end of the world. The difference between summer and winter mortality could be substantial.

How about Sweden? Sweden is interesting. Sweden’s first wave mortality was about 0.05% — about a quarter of my 0.2% rough limit. I wonder if they can get away with less. This may be due to the general good health of the Swedish people, their good discipline, good health care and low incidence of obesity. Maybe, in Sweden, this virus only kills 0.1% or, maybe, even less. It will be very interesting to see if Sweden gets and 2nd wave and how it will look like.

Iran, if we believe their numbers, has only lost 10% of the 0.2% I expect. But I am not sure I believe their numbers. I think they may be further along. We’ll see when it stops. Iran is in a stationary state, with R hovering above 1 when it rains or too many people turn on the AC and blow 1 otherwise.

A look in the Southern hemisphere — Chile has nearly reached 0.05% dead while New Zealand and Australia have very low numbers. Argentina is much lower than Chile but still on the growing exponential. Slow growing exponential. So, the Southern hemisphere doesn’t look too bad. We’ll be lucky if we’ll have it so easy in the north.

My 2 cents on politics and policy advice:

Allowing the virus to go though the population during summer will result in some degree of herd immunity. Usually, summer colds are vastly easier than winter colds — less likely to result in complications, pneumonia, etc. Thus, letting the virus go through the population now will, in the long term, save lives. Sweden has dome this experiment and is probably going to be proven right.

Austria, Denmark and Norway will probably see more deaths in the fall and perhaps Eastern Europe, Germany, too if the lockdown is the reason the numbers are low. These countries will be in a particularly bad position as they would have paid the economic cost of the lock downs — children lost school, everyone lost money, and, may have more COVID-19 deaths than if they had done nothing at all.

Italy, Spain, US, the UK and Sweden seem to be managing to pretend to be taking measures against Covid-19, but their mortality rate seems to be the same as if they had done nothing at all. Doing nothing at all to prevent the virus spreading during summer seems to be the best strategy.

I am surprised by New Zealand and Australia — they are in the middle of winter and they seem to have few Covid-19. Although, Australia is seeing an increase in cases at the moment. I didn’t believe their containment strategy would work. We’ll see if the low numbers will lasts until the end of winter.

Across the world, inflation, political instability and war appear unavoidable now.  I worry about my children, and my nephews and about their future. Will David and Edward go to war instead of college? If so, will David fight against or with his siblings in this new twisted world?