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COVID-19 and the 3 things I got wrong about it

It is amazing what a virus can do. Something nobody can even see without a microscope has mercilessly torn apart life as we know it. No more live concerts; no more Olympics. No more school classes; no more zoo visits. No more thinking of these as essential activities, as most of us are forced to work from home or not at all, to walk alone and stand apart, to stay home unless absolutely necessary.

COVID-19 has swept our entire world off its feet in a matter of months. While the likes of Taiwan, Hong Kong, China and Korea appear to have it under control (at time of writing), a return to full normalcy is nowhere in sight, not with the persistent spread of the coronavirus in many countries despite unprecedented measures to restrict in-person interaction.

As we continue to grapple with this chastening experience, in which some of us have lost livelihoods and loved ones, perhaps the more privileged among us should take a step back and ponder over what it is we are facing and what lessons we can learn from this collective chapter for humanity.

To learn something, you have to first admit the things you were wrong about. As such, let me start the ball rolling with three things I was mistaken about COVID-19.

Mistake 1: COVID-19 is not a good choice of name

When the World Health Organization (WHO) first came up with the official name of COVID-19, I was quite sceptical. I knew it was necessary, but wondered if it would catch on.

First, it didn’t sound catchy enough. It wasn’t immediately clear what it stood for (COronaVIrus Disease 2019). It also has 4 syllables compared to the 1 in SARS (Severe Acute Respiratory Syndrome), the 2003 viral outbreak which many in Asia will remember. I was in primary school then. For me the abiding memory was of queuing up in class and displaying my polished hand washing skills to my approving teacher. It killed 774.

Second, the name felt a bit slow to arrive. By 11 Feb, there were already over 42,000 infected and 1,000 dead in 25 countries. That’s already more than SARS killed. Those living in the early infected countries had already started calling it the ‘Wuhan virus’. It was an apt name when we believed the virus stemmed from the practice of eating wild foods in China.

Yet despite my initial doubts, the name has caught on somewhat. As the virus spreads globally, most are calling the virus either COVID or coronavirus. The 19 suffix may be cumbersome on first sight, but WHO has spared itself naming problems for subsequent coronavirus outbreaks. On the other hand, we would also be able to better distinguish different strains of the virus and understand how their potency might vary.

COVID 19 vs Wuhan Virus: Google search patterns (Jan to May 2020)

COVID 19 vs Wuhan Virus: Google Search Trends in China (Jan to May 2020)

COVID 19 vs Wuhan Virus: Google Search Trends in Singapore (Jan to May 2020)
COVID 19 vs Wuhan Virus: Google Search Trends Worldwide (Jan to May 2020)

Mistake 2: COVID-19 is infectious but not lethal

As this invisible threat started to make its presence felt in Singapore, I looked at the statistics and quickly inferred that while COVID-19 spreads more easily than SARS, it is not as lethal. On a surface level, this is true. The early indications in China were that fatality rates were around 3%. While much higher than the 0.1% for seasonal flu, it was not as lethal as the near 10% for SARS. This means COVID-19 was cause for concern, but not drastic action.

Yet the subsequent unfolding suggests we should have been more cautious. As of 1 May 2020, these are the observed fatality rates from the most newsworthy countries thus far:

  • United States: 65,435 dead / 1.13m cases = ~5.8%
  • Spain: 24,824 dead / 215k cases = ~11.5%
  • Italy: 28,236 dead / 207k cases = ~13.6%
  • UK: 27,510 dead / 177k cases = ~15.5%
  • China: 4,643 dead / 84k cases = ~5.5%

The observed fatality rates are above 5% in the world’s two largest economies, and in Spain, Italy, UK and several other countries, exceed the 10% global average for SARS. We cannot look at these figures and conclude that COVID-19 is not lethal. It is lethal.

What about countries with far lower fatality rates? For instance, the fatality rate is only 0.1% in Singapore. Isn’t that comparable to seasonal flu? There are several reasons for the disparity I can think of: Having better medical equipment, having enough medical equipment, proximity to medical facilities and services, seeking medical help earlier, age of infected persons, health levels of a population.

Yet lethal is defined as being “sufficient to cause death”. The answer from the 5 countries above and many more has to be a resounding YES. Yes, COVID-19 is definitely sufficient to cause death. It has killed around 15.5% of the UK population. Perhaps two-thirds of those deaths could have been prevented, if there were better and enough medical equipment to meet surges in demand. But we have to live with what we can get, and the hard truth is that in the UK today, 15.5% will die from the coronavirus. And for the older ones, it’s far worse.

So make no mistake: COVID-19 is lethal. Its ease of spread then makes it more likely to be fatal in countries where hospitals cannot meet demand. The question is how prepared are our governments, our healthcare systems and our people: To collectively save as many as we can who might otherwise die.

Total infected and fatal cases in countries worst-hit by COVID-19 (as of 1 May 2020)

Mistake 3: Past experiences have prepared us well for COVID-19

As a people we tend to count on experience a lot in our lives, and for good reason. Students want to learn from teachers who have spent years mastering their subjects and honing their crafts. Employers want to hire employees who have done well in relevant jobs. Patients want to consult doctors who have helped others resolve similar ailments before.

Yet a CV which boasts the experiences of SARS in 2003, H1N1 (swine flu) in 2009, Ebola in 2013-2016 and/or Zika in 2015-2016 doesn’t necessarily translate to being prepared for COVID-19, whether the CV is that of a person or a government. It depends on whether past lessons have been learned, and whether future problems have been anticipated. Singapore presents an interesting case study in this regard.

The observed fatality rate in Singapore for SARS was 13.9%, higher than the average of 9.6%. This makes its unusually low fatality rate of 0.1% from this coronavirus quite remarkable. It suggests that the government has learned lessons from its past and built its healthcare systems to handle such viral outbreaks better. Yet after winning early international plaudits, the cases started soaring. The virus reached the foreign worker dormitories, where it has escalated out of control with over 14,000 cases. This situation has sparked a plethora of opinions, but what’s clear is that there will be new lessons to pick up from here.

On a global level, COVID-19 has shown that most of us were not prepared for a pandemic. We don’t know exactly how viruses can spread. We don’t know how testing works. We don’t know if we should hog toilet paper along with the essentials. We don’t know when we should wear masks, and which. It’s easy to single certain people out to mock and blame, and sometimes for good reason. But the truth is none of us have experienced lockdowns of this scale. We are all forced to find our ways in the dark. It is easy to panic.

Migrant Worker Dorms During Covid-19 in Singapore
Photo of migrant worker dormitories in Singapore, after spike in COVID-19 cases

Lessons we have to learn from COVID-19

It might be hard to contemplate right now, but pandemics of this scale can strike us again and again as viruses continue to mutate as they always have. There appear to be different strands of the virus within what we singularly call COVID-19. We await the return to normal life, when we can unmask ourselves on the streets and bond with our friends and celebrate our artists and sporting heroes again—or just eat the food we like again. But what if abnormal has become the new normal, and we as a society have to shuttle back and forth between freedom and constraint?

This is a very real prospect. We have to be more prepared next time. On an individual level, we can all learn to be more socially responsible. The soundest advice I’ve heard this pandemic is to think of yourself as infected with the virus. Will you then go around without a mask and put your colleagues and friends and elderly people—for whom the virus is most lethal—at risk? Can you live with that guilt the rest of your life?

That said, a heart in the right place still needs a well-informed mind to guide it. We need to know how to be socially responsible. Not everyone is privileged enough to be able to hole themselves at home from the get go of an outbreak. It then becomes a matter of reducing risks wherever you can. Understanding how viruses actually work will be vital.

And as we should now know, keeping viruses in check is not a private matter, but a public issue. It is not enough that you are prepared, or that your family is prepared. An unwitting carrier can spread COVID-19 to dozens without showing any symptoms. So we really need to prepare everyone. We need our leaders to keep us prepared, with science, social policy, and concern for the people. We need to elect leaders we can trust—not to get everything right, but at least to try to. They must at the very least want to.

If our leaders cannot learn from their mistakes, and invest what’s necessary in science and healthcare and policies which protect all of its people, including its most marginalized and vulnerable groups, then our communities are doomed to repeat the tragedies we have seen, with the line between lethal and fatal stretched too thin, and where our only comfort would be having names for the viruses which are all too familiar.