Two Footraces: The World War on COVID

Taking the long view of an epic battle waged by Homo Sapiens

I start this with a prayer and moment of silence for those who have passed and tell you that although I will strive to get you to look beyond their numbers, the world’s loss of their lives does, and in fact, will always matter.

By the time this ends, we will all know people, and certainly many people who knew people, that have perished. I lost a business partner last weekend. And though all of the statistics were against him, at 92 years old and with a rich history of health challenges, I mourn his and his family’s loss and I know our world is less without him.

When I read that day’s death toll for New York, where he lived, it struck me that this is really more like a war. Warlike, because my conversation with him the week prior was more like a letter from the battlefront…and then he was gone. How? As in war, the news reports on the faceless numbers of those who have fallen in battle, and yet I have no way to see what happened to him, except that he was one of 670 people who died in New York that day from COVID.

I believe this war will end in our favor — we Homo Sapiens have a winning record over the last 200,000 years or so, one that rivals even the New England Patriots. This war will mostly bring out the best in us, our caring, our ability to work with each other, our ability to adapt and conquer adversity. We will win, and there will be losses in the battles as well.

I propose here to share my thoughts on how to watch what’s going on, in a way that lets you see the real landscape of this battle, and how to tell who is winning, and also to adjust your mind to what winning looks like.

How to look beyond the News

The “news” these days does a disservice to us all, focusing on the drama of life. It is never a go-to for me, even in better times, because there is rarely anything new in the news; death, violence, loss, injustice and its ugly cousin retribution, and of course the weather will be with us forever. But there are things that are not in the news about COVID, because of that medium’s bias for gossip and tragedy, and a whole other story line that is richer and more hopeful.

Bad news happens every minute, but good news happens much more slowly. A newspaper published every fifty years would contain amazing stories of reductions in poverty, decreases in child mortality, increases in lifespan and standard of living, new medicines, cures, and accomplishments. What could be bad enough to compete with us lifting half of the planet out of poverty in the last fifty years? There are good things in the making, even within today’s COVID bad news.

That’s because we’re tool builders, and building tools always takes time…and as history has shown, it pays off. I use the word “tools” in the way I think an anthropologist would use it: to include actual physical and electronic tools, but also the technology of how we do things, our methods.

Ten to twelve thousand years ago we perfected the ability to kill and eat pretty much anything we wanted on the planet, most notably mammoths and sabretooths, propelling us to be its apex species. Over the last couple of millennia, we’ve fought battles with much smaller opponents, smallpox, plague, Spanish flu, for example. In each case, we learned new tools and methods, whether they be using cats to eat rats, washing our hands and boiling things, or creating vaccines.

The War on COVID is a Footrace

There’s a lot of woulda-coulda in the popular news, as if we shoudl have seen this coming, should have prepared better. Comparisons with Pearl Harbor (to point out how we have failed so greatly) are amusing because they use shaming and blaming to obscure the reality of everyday life; there are many things to focus on and five Chicken Littles for every bona fide soothsayer. And no, we’re not great at predicting and preventing the first disaster of any sort, but we do tend to win a lot. We get better pretty fast, and that’s part of the good news.

This sort of war is fought like a footrace. Actually, two footraces. The first footrace is the local one, the personal one, when a COVID virus enters a person’s body and attaches to a cell. At that moment the footrace becomes between the person’s immune system and the virus.

Our immune system is pretty badass. It can and does kill most anything that gets inside of us, but if a virus reproduces faster than our immune system can get rid of it (or it damages the body, limiting our immune system’s ability to function) then the virus wins, death results.

You may not be aware of this, but most of our medicine is oriented toward that footrace, helping our immune system win. Antibiotics, for example, do not kill harmful bacteria, but instead they slow down their reproduction so that the immune system can catch up…and kill them. A drug that kills viruses would be called a virucide, a word you may never have heard because these are rare and often very toxic to our bodies; we are made up of the same stuff as viruses, so it is hard to kill one without killing the other.

For a small fraction of us, less than 3%, COVID grows a bit faster than can handle. For another 5–10% of us, it is a close race that we can win, but we might need some help. But for the other 90% or so, our immune systems handle COVID like eating a bad burrito: you’ll feel bad for a bit, and then you’re fine again. Some people may have even thought the burrito was just fine. So there’s the problem: sometimes COVID is a very bad burrito.

The second footrace, though, is the one you should be watching. The second footrace is to develop a tool or method to slow how fast COVID spreads in the population or slow its speed in the local footraces. The “news” is filled with the first footrace, the personal drama, and useless info about the second footrace, most notably, the death count, how many lost footraces there have been.

It is not that the lost lives don’t matter — they do, otherwise why would we care — but that the TOTAL count is not a good measure. The way to judge the second footrace is the RATE OF CHANGE in the first race; are we slowing its expansion and are we lowering its “win percentage” in the first footrace?

In the second footrace, our tools are behavioral (limit how much we interact with each other, essentially limiting how many burritos can be served and eaten) and technological (making eating a burrito less deadly to the few). This second footrace is against deaths — the faster we run to a solution, the fewer people die. The more we slow the transmission, the more time we have to find the solution, and the fewer deaths per day we will see.

Our Footraces with Other Badass Pathogens

Smallpox took hundreds of years to cure — it spread slowly for several centuries, starting in the 1500’s. Like COVID, it was communicated through coughing, but a meager global transportation network meant that it spread very slowly. By the mid-1700, 6 out of 10 people globally were infected, and the death rate was around 30%, and many survivors left disfigured. That’s like a whole Mexican restaurant with very dangerous food, not just a few bad burritos. Smallpox caused between 300–500 million deaths, including wiping out almost the entire native population of the Americas.

In 1800, Edward Jenner created the first vaccine and within a decade the contagion slowed, though the disease was still prevalent as late as the 1950’s and only finally eradicated in 1980. More recently, HIV, the AIDS virus, was tamed in a period of about 20 years. AIDS took the lives of over 30 million people as of this writing. It’s early now, but there’s a good chance that COVID deaths will number (only) in the single-digit millions. Certainly, projections are trending downward recently, and as certainly, it is still early.

There is a Moore’s Law effect that you should notice in this — the speed of our toolmaking, and the sophistication tools and process have grown dramatically; our ability to stem the loss of precious human lives is increasing somewhat geometrically. This toolkit grows more powerful with each challenge.

Though it was a global scourge, people did not even understand what smallpox was for centuries. In comparison, HIV spread worldwide for a “mere” decade or two before it was seen for what it was. In December 2020, COVID-19 genome was sequenced by Chinese researchers within two weeks of its discovery. We’re moving faster these days. A lot faster.

Winning Doesn’t look like What You Imagine

I use Smallpox and HIV as examples also to highlight a phenomenon that is very human — we solve problems enough to not make them matter so much, but rarely in a way that makes them go away. It’s a very human behavior you could call “minimizing the maximum regret.” We tend to attack the worst problems until they are no longer the worst. Thereafter, we focus on the next (or newly) most worst problem. It is a strategy that works.

What makes COVID important now, the worst thing, if you will, is that people are dying. And that is the thing to focus on: when people stop dying. When that happens, COVID becomes just a bad flu for the 3%. That will likely be an easier problem to solve than to stop it from spreading.

Beating COVID isn’t about killing it — we have only eradicated two diseases like this in our whole history — but about reducing its impact. You all know the average influenza death rate by now: 300,000–500,000 annual deaths, something like 1 in every 1,000 burritos is deadly. Winning looks like fewer deadly burritos.

Why We All Should Wear a Mask: COVID’s Strategy is to Lose Slowly

Ask people to name a deadly virus, they’ll say “Ebola”. And they’re right because infected people die at a crazy rate, like 50%. That COVID probably fails to kill 90%+ of the people it infects make the virus sound like a bit of a failure, but it is a very good strategy. In this way COVID is pretty badass, too.

COVID is more badass than Ebola because Ebola kills too quickly. If we say that the “goal” of a virus is to survive, then it shouldn’t kill its hosts at all; it should just reproduce and spread. Herpes Simplex 1 is a great example; everybody has it, including babies.

Ebola is also pretty lame compared to COVID because it is not contagious until someone shows symptoms. Once someone shows the very scary symptoms of Ebola, people kinda know to stay away, reducing the virus’s chances of infecting someone else.

But COVID is contagious even without symptoms. All those people who win the footrace with COVID and feel little or nothing? They were contagious that whole time, spraying COVID all over everyone else. Think spring break, bro, when a bunch of 20-somethings with strong immune systems spread COVID around between themselves. And yes, COVID will lose the footrace with virtually all of them, but when they return home, they’re carriers for a week or two.

Some estimates of COVID’s asymptomatic to symptomatic ratio are as high as 10-to-1. [update: as of April 17, research suggests that this number is quite a bit higher, likely around 50X] It often takes at least 5 days to show symptoms, if any, but it can be as long as 15 days, during much of which the person is infectious. You may not know whether you have ever had COVID…or at least not until there is a good RNA test available for it, but if you did, you almost certainly infected other people.

The combination of these two factors makes COVID far more effective at kiling than Ebola: it has already killed more people in total, almost 7 times as many, in fact.

Slowing the spread of COVID helps us with the second footrace.

Betting on the Horses

Yeah, I know, a mangled metaphor, but I already messed things up with the burritos as well. Here’s my version of a bookie’s odds sheet for this war or footrace. When I say “win” I mean being the first solution to create a reduction in death rate by 80%+. The house favorites are already under study:

• Existing drugs or compounds from the broader pharmacopeia. (1:1 odds, probably greater than 50%) I would bet on this: that we find something that is unassociated (or only marginally) with corona viruses that effectively breaks one or more “pathways” that COVID exploits. It could be something simple, like increasing your dietary zinc. Or a class of treatments for malaria — another killer that we have mostly tamed — called quinines. Or maybe not. But we have a huge platform of 1,500 different tools, most of which are pretty safe, to work from. Probably worth noting that another of our tools, a supercomputer is part of the mix as well, selecting 77 compounds out of 8,000+ that might interfere with the virus. how long would that have taken in 1700, or even 1980?
• Existing retroviral drugs (they “break” the way viruses replicate). (1:3 odds) There is already an interesting line of work — in clinical trials already — using retroviral drugs from our battles with HIV and Herpes.

The good news in the above, is that any of those could happen very soon — there are something like 60+ therapies being tested out as of a few weeks ago. So, I add my next odds-line bet:

• One of the above approaches is found to be significantly effective by the end of April. (3:2 odds) The side benefit of this winning bet is that existing drugs and treatments can be scaled quickly. And that means that life returns much more quickly to the new normal.

Though I obviously don’t think this will be a long war, there are a few ways to end it that will take longer:

• New, tailored retrovirals that are purpose-built for COVID. (1:10 odds) This is uber-high-tech stuff, and it also can look like magic when it works. But it is still early in the field and biotech failures after massive design and investment efforts are legendary. If one is found, then scaling it may be challenging as well — how to create one billion doses of something that we’re not very good at making yet?
• A vaccine that immunizes people to COVID. (1:30 odds; yes, the long shot to win) We never were able to make a SARS or MERS vaccine, the two other corona viruses that we’ve dealt with, and only now, 25 years later, do we have an apparently viable HIV vaccine going into human trials. Vaccines are a tricky business and also can be tough to scale — we run out of flu vaccine most years because production capacity does not scale well.

Economics, Commerce is Prosperity for All

When people stop dying from COVID, or at least most of them, then the economics change. When people stopped dying so much from AIDS, that changed things. Smallpox killed for decades, and even today almost a million people a year die from Malaria…and the global economy does not crash.

Yes, I know Malaria is skewed poor and sub-Saharan and I mean nothing regarding their deaths being okay, in fact, there are major initiatives funded by the wealthiest people and nations to solve these problems. The fact that any pandemic war can be “won” while others in less affluent societies still die, is not a modern phenomenon. It predates the Western-dominated economic system that we now live in.

We’re seeing a textbook example of how important commerce and capitalism are to quality of life and global prosperity. The Economist recently pointed out that even countries not impacted by COVID (yet) are impacted greatly by the economic contagion. Rich nations have choices, but poorer nations and their even more vulnerable people do not.

The shuttering of many retail locations and the obliteration of the sports, live event, and travel and tourism businesses are having a massive ripple-effect throughout our economy, and the resultant unemployment will stall many global supply chains, impacting the rest of the global economy. The poorer nations will suffer economically, and the cost there is even higher as poverty and disease go well together. Unfortunately, COVID will thrive in that sort of environment.

If you need a noble reason for wearing masks and staying home, consider that you’re actually easing the impact and death toll in the poorer, more vulnerable nations.

Profound Discovery will create a Profound Recovery

How well we stop the bad burritos will matter. To simplify, let’s look at two finish lines. The first finish to footrace #2 is that we can prevent death but not a bad illness; you still stand a 5–10% chance of having a really bad time, including deep chest cold and maybe some hospital time. Let’s say, it is like a bad flu season.

I think then in that case the economic relaxion will be more minor, allowing the opening up of all retail again, for example, but large events, which fuel both consumer and business spending (sporting events and trade shows) may be off the table for a while, or if they are open, people will be fearful of attending. Likewise, with travel.

Our culture doesn’t usually fear the flu, but we have learned to fear COVID, so even a lower death rate will not eliminate that fear.

The second finish line is a stronger solution, something that means you might have a doctor visit, maybe a shot, maybe some pills, maybe some of that in advance, like a vaccine. There is even the outside chance that the solution may be something allows you to get infected without risk, which would mean that public gatherings could even be encouraged in order to immunize the whole population. The more profoundly we win the race, the faster things clear up economically.

In closing, I am optimistic about our ability to solve this challenge and solve it enough in the near-term. I can tell you that I am looking forward to going out to my favorite restaurants again — I have had enough homemade food and takeout/delivery meals watching Netflix. It is a small price to pay to save lives, wearing masks and avoiding friends like they are enemies. Help with the footrace and you save the world…or at least many people.

And I will be happy when we have won this war, at least as well as we ever win these things…and move on to the battles that follow. And my next burrito.

Jack Skeels is a former Rand senior analyst, successful entrepreneur, speaker and author.