Long Read

COVID-19: a wild card event

One of the wild card events on our radar for some years is a global pandemic that might kill millions. Modern health strategies failed to prevent Ebola and Zika viruses, destroying the lives of thousands, and little has been done since to identify, track and respond to disease outbreaks before they become pandemics.

Wild cards are ‘high impact, certain’ events. It is not a question of ‘if’, but ‘when’ they occur.

Pandemics are about containment and mitigation depends on preparation. The progress of COVID-19 demonstrates that some countries are slow to act on weak signals: political leaders, concerned about public perceptions, too often wait for conclusive evidence before taking decisive action. They look for a coherent narrative when the reality is that there are multiple possible scenarios and they should have fully developed options that work in even the most extreme future. This is partly a failure of the imagination, partly a failure of methodology. The result: too little, too late.

COVID-19 has exposed the fragility of a hyper-connected world. Few leadership teams have explored how global political weakness, overstretched financial markets and vulnerable public health systems might coincide in time, transforming the world order. COVID-19 destroys causal linkages and dominant narratives about how the world works. Many global systems and supply chains are finely tuned for efficiency and profit, not resilience.

Some countries, like Taiwan and Singapore, are exceptions to the rule. They have demonstrated that early action and transparency is vital. Early action depends on readiness for extreme, worst-case scenarios. Contrast Taiwan and Singapore with Italy, or Iran. One of the lessons to draw is that despite the progress of medical science, the underlying strengths and weaknesses are political and cultural.

To put this in another context, public health early warning and security systems, from an innovation perspective, are ‘white space’. In other words, there are compelling public interest arguments for invention, but relatively little activity. It is well-known that profit-oriented pharmaceutical companies cannot justify large-scale research in this area and that public funding lacks focus.

More than eighteen months ago, we wrote:

“Increasingly globalised movement of goods and people, overcrowded cities, shanty towns lacking basic sanitation infrastructure, together with growing drug resistance and virus mutation, mean the possibility of a serious pandemic is ever-present.

Experts believe there is a high probability of a naturally-occurring influenza pandemic that could infect and kill millions worldwide, and maybe 750,000 in the UK.”

Although the spread of COVID-19 could be said to be worldwide, the World Health Organization (WHO) has not yet (as at 10^th March) described it as a pandemic. The total number of reported cases have reached 114,243, with over 4,000 deaths. Not all countries have reported cases and most have emerged in only a handful of countries. The WHO believes that if countries act with ‘speed, scale and clear-minded determination’ the epidemic can be pushed back.

Pandemic or not—the knock-on effects that come with panic are real. Apart from several thousand deaths, the damage to economies is considerable. The US stock market, after falls of 7 per cent on 9^th March, triggered ‘circuit breakers’, designed to allow investors to pause for breath. Many analysts argue that, given the fragile state of global politics, the vulnerability of the economy and overstretched financial markets, a global recession is inevitable. Russia and Saudi Arabia have started a price war over a ‘low demand’ oil market.

Airlines, already under pressure from ‘flight-shaming’, are in trouble. Tourist destinations, hotels, conference centres and major events, similarly will suffer. People are stockpiling. Schools are closing, causing havoc with working parents; many businesses are operating from home. Some will not survive. Other companies are benefiting – manufacturers of household staples like pasta, rice, sanitiser, face masks.

One of the lessons few political leaders have learned is that waiting for evidence to deliver ‘certainty’ is no substitute for imaginative, early action, particularly when faced with potentially catastrophic crises. Acting on worst-case scenarios is justified on the basis that the worst case can be prevented. With a few exceptions, like China and Singapore, government action has been too little, too late.

There are no predictive models, based on historical precedent and data, despite the attempts of financial market commentators to put figures on the recession that looms ahead.

Scenarios have a vital role to play.

In Walled Gardens one of our core long-term scenarios, we explore how isolationist politics, localisation and pervasive technology-based markets in ideas may bring globalisation to an end. Epidemics like COVID-19, one variant amongst many, may accelerate the process. On the other hand, the reminder that the world is deeply interconnected, irrespective of political rhetoric, may bring the international community together and lead the way to another scenario: One World. In the Dark Ages scenario, COVID-19 becomes a global pandemic, the world faces a decade of recession and survival conditions dominate at a time when co-operation on climate change is vital.

To put some of our earlier work in context, our February 2018 briefing Global Pandemics: unprepared? by John Casti is worth re-reading:

The current flu season in the USA has accounted for about ten per cent of all deaths in the country over the past few weeks.  Generally, such death rates arise only when an altogether new virus emerges, wreaking havoc on a vulnerable population that has not had a chance to develop even partial defences. At present, it appears that deaths from the current outbreak will far exceed those from the 2009-2010 season and is expected to reach a fatality level similar to the epidemic of 2014-2015 that resulted in over 56,000 deaths.  Despite these frightening numbers, the current flu is ‘just’ an epidemic.

To reach the level of a bona fide pandemic, the flu virus would have to spread on a worldwide basis and infect a large fraction of the global population. By far the biggest pandemic in recorded history was the 1918 Spanish flu, which was responsible for 50-100 million deaths. There have been about three pandemics in each century, the last being the 2009 ‘swine flu’ outbreak, so-called due to the combination of bird, swine and human viruses, aided and abetted by a Eurasian pig flu virus.

So how does the world actually get sick?

In a 2017 book Deadliest Enemy, the epidemiologist Michael Osterholm and writer Mark Olshaker present a fictional Shangai scenario tracing how a Spanish flu-like pandemic might break out today. The details of their scenario are too long to present here. Suffice to say that experts in public health around the world have reviewed the scenario and there is general agreement that it is realistic and possible. That is the scary part because the scenario envisions more than 360 million deaths and over 2.2 billion total cases, with the average age of those dying just 37 years old. The authors conclude, “There is no way to know how many warnings we will get before the events we have portrayed become all too possible. They may not be far off.”

A similar exercise was carried out by the World Bank. Organisers looked at the impact on travel and tourism of an outbreak of a mysterious respiratory virus in a hypothetical country (sounding a lot like somewhere in central Africa). The end result of the simulation Ron Klain, the US Ebola czar during the outbreak in 2014 and moderator for the World Bank simulation stated, was “We still are not ready for the big one. We’re frankly not ready for a medium-sized one. That threat is still out there.”

Where are these new bacteria and viruses coming from?  One obvious source is simply mutations from existing pathogens, as postulated by these scenarios. But another source that is seldom discussed but equally viable is the re-appearance of long-dormant viruses trapped in ice and permafrost for centuries that may be released as the ice melts as global temperatures rise.  What would happen if we suddenly confronted deadly pathogens that have been absent for thousands of years, or that we have never met before?

People and animals have been buried in permafrost for centuries, so it is conceivable that other infectious agents could be unleashed. For instance, scientists have discovered fragments of RNA from the 1918 Spanish flu virus in corpses buried in mass graves in Alaska’s tundra. Smallpox and the bubonic plague are also likely buried in Siberia. In a 2011 study, Boris Revich and Marina Podolnaya wrote, “The vectors of deadly infections from the 18th and 19th centuries may come back, especially near the cemeteries where victims of these infections were buried.”

That is not all that is hiding under the ground. Bacteria found in the Lechuguilla Cave in New Mexico, a thousand feet underground, have not seen the surface for over 4 million years. Yet these bacteria have somehow become resistant to 18 types of antibiotics, including drugs of “last resort” for fighting infections. Since the bacteria were isolated for millions of years, they clearly developed this resistance through processes of natural selection and not involving exposure to any known antibiotics developed by humans.

The conclusion we can draw from these and many other studies of permafrost bacteria and viruses is that even though we cannot quantify the risks they pose, we should not ignore them either.

In the other direction, recent studies have discovered that millions of viruses rise up into the atmosphere and often travel thousands of miles before falling back down on to the surface.  To be more specific, every day more than 800 million viruses are deposited per square meter above the planetary boundary layer. This newly discovered information accounts for why we have seen genetically similar viruses in disparate parts of the Earth for at least the last twenty years. The viruses are swept up in one location, then travel in the upper atmosphere to ultimately come back to rest on even a totally different continent. Obviously, this is one pathway by which a pathogen seeming localised somewhere in Africa could mysteriously resurface in North America and start a new outbreak of some killer disease.

While there are many opinions as to where the next global pandemic will occur and what form it will take, just about everyone who writes about global pandemics seems to agree on three points: (1) About three major pandemics take place every century, (2) a major incident that could kill hundreds of millions of people might well occur at any time, (3) we are unprepared for such an event. With these not-so-comforting thoughts in mind, let’s look at the chances of a literally life-changing pandemic taking place sometime in the next fifty years.

In a study by top epidemiologists, more than 90 percent of them felt such a global event would occur during their children or grandchildren’s lifetimes. The reasons they gave are several-fold:

• • Population size – the global population has dramatically increased since the Spanish flu a hundred years ago. There are just more of us, which means more to spread the infection.
  • Central locations – people are moving to urban centres where they are in closer proximity. This makes it much easier to spread an infection to more people at a faster rate.
  • Increase in Travel—A hundred years ago, it took weeks, if not months, to circle the globe. Now it takes less than a day.  Since almost no diseases show symptoms in such a short time after infection, there is plenty of time for a carrier to spread the disease around the globe before he or she even knows they have it.

This is a grim picture and perhaps the most surprising part is that such a pandemic is not already upon us. Presently, there are a mishmash of partial efforts being mounted in many countries to address one or another of the problems.  The one thing that everyone agrees is that these efforts are not nearly enough to prevent, or even very much mitigate, that “three-times-per-century” pandemic. When (not if) it occurs, many millions may die.

March 2020