April 29, 2020
Will the first be the last? Virus edition
One of the biggest mistakes we can all make right now is trying to arrive at definite conclusions about the virus and its spread. Some countries have clearly handled the early phase better than others. Germany has one of the best health services in the world, and was relatively better prepared. But Germany was also lucky in that the crisis hit the country a little later, and initially mainly among younger people. But, despite the very low rate of hospital admissions and deaths compared to other European countries, it may be too early to declare a policy victory. We are seeing more and more countries that did well initially, but where the virus is spreading rapidly right now, like Japan and Russia. And there are also reports of a second wave of mass outbreaks in China.
As Germany prepares to lift its lockdown, the head of the government-owned Robert Koch Institute said that the R0 rate is now estimated to have risen back to 1. We agree with the assessment of its president, Lothar Wieler, that the R0 is not in itself a clear indicator of what is likely to happen. We noted gullible journalists gushing over Angela Merkel’s scientific precision when she explained the impact of different levels of R0 on hospital capacity. This is pseudo-scientific bunk. R0 is a model estimate. We do not observe it in real time. Merkel suggested a determinacy that simply does not exist.
Where we agree with her is her caution. In Germany, pressure to lift the lockdown is coming from the two most promising CDU leadership contenders, Friedrich Merz and Armin Laschet. Laschet in particular has been out campaigning for lifting the lockdown, placing himself on the opposite side of Merkel. Plans are now at an advanced stage to allow football games - without visitors - to resume in two weeks. With all the paraphernalia this will still involve several hundred people including journalists, doctors, and support and security staff. Once you set a precedent here, it may be harder to stop other sectors demanding the same rights.
As historians are reminding us, previous episodes of pandemics usually occurred in two or sometimes three waves, of which the second was often the most lethal. We don’t know whether this will be so this time. There will be no vaccination ahead of a second wave, but it is possible that one or several drugs currently being tested might reduce the death toll. Until we have more information, however, we should treat the consequences of a second wave seriously, especially since we are unlikely to revert to a total lockdown for a second time.
We noted an interesting report on the role played by large gatherings. The Telegraph reports this morning three UK sporting events can be statistically linked to a spike in death rates: the Cheltenham festival, a horse racing junket; the Liverpool-Atlético football game; and the Manchester derby. A regional analysis of death rates suggests a clear association between those events and a spike in subsequent deaths in nearby local hospitals, compared to hospitals further away from these events. Those three events were held between March 8 and 13, ahead of the government lockdown. Data from Imperial College suggest that mass gatherings constitute the biggest factor in the spread of the virus, with an impact twice as large as that of schools.