Amidst the lockdown or to be politically correct mobility
circuit breaker due to COVID-19, I dusted something penned on Ebola
and SARS in 2014. Recomposing the current COVID-19 global crisis against my
old brainwave in 2014, there were striking similarities and differentials on
the societal and political fronts. Seems like our
human race is more xenophobic and
short-sighted collectively than many like to believe individually. Collectivism and individualism could be at polar opposite especially on orphaned issues.
If the therapeutics and vaccine path is unlikely to yield significant
results in the short run even if FDA fast track the time to bedside
usage or relaxes the criteria and hasten the approval of non-approved pipelined
drugs on compassionate grounds, it is good that the medical community is visiting
the re-purposing of existing drugs used for HIV, Cancer, Flu and the 100 year
old plasma therapy to fill in the gap. These initiative are important as COVID-19
can do a lot of damage in the minimal 12 to 18 months it takes to get a new
drug in. Perhaps, targeted research should be directed in this direction in the
short run as what we need is a tool that can drive in the proverbial nail and
not necessary the perfect hammer.
Another big hurdle is the accuracy, speed and cost of
testing for COVID-19 for more effective epidemiological and public heath
measures to work. No test is perfectly accurate but the existing gold standard using
certain RT-PCR process has an exceeding low level of accuracy in both type I
and II errors as well as a big indefinite band in statistical speak. Head of
WHO has gone on record in an earlier press briefing comparing the accuracy of HIV
test against COVID-19 test with the former having a confidence level of more
than 99% and he did not reveal any percentages in the case of COVID-19 but add
that he is less sure. A possibility is the newness of the test and lower population
size to arrive at higher degree of confidence. Some health authorities have
adopted the 2 to 3 serial consistent testing results to increase the level of
confidence. Speed of the test is crucial with a fast spreading disease like
COVID-19 and current RT-PCR test takes hours or days to turn around. Some of the
processes in RT-PCR involves centrifugal spinning of samples and re-agents repeatedly
that cannot be short cut. Cost was a hurdle in some countries as the cost of
RT-PCR test can be in the hundreds (USD) and initial USA health insurance
coverage presented a cost issue as some patients without requisite insurance
coverage and large co-payment might not be able to afford or simply do not see
money well spent for the test. This has been largely addressed in most health authorities
by having the government bearing the cost of the test. On this note, it surfaces
that cost of health care is no longer entirely a private and individual concern
can be dependent on the least common denominator in our population and
therefore perhaps another case for social medicine.
human race is more xenophobic and
short-sighted collectively than many like to believe individually. Collectivism and individualism could be at polar opposite especially on orphaned issues.
From the comparison between Ebola and SARS, my narrative on
the biggest similarities and differentials were along the lines of lack of therapeutics
or vaccines, orphaned disease status of the poor and infectability in terms of R0.
Ebola was clearly an orphaned disease of poor Africa. COVID-19 and SARS share
most similarities excepting orphaned disease and the spiraling extensive spill-over
into the economic, societal and political fronts. There has been reports of
overwhelming over-arching philanthropy across economic lines from rich to poor,
societal margins from capitalistic to socialistic leanings through various
governmental support schemes and lastly on political and diplomatic agendas
from cross country aids as well as putting aside rhetoric like the trade war
between America and China. Major problems plaguing these as are their shallowness coupled
with lack of depth or sincerity and lack of a trust-worthy leadership to carry these
through. Philanthropy has been sparse and even for the few, they were more
Hollywood than reality.
Echoing current IMF views that a lack of post COVID-19 solution
like who would own or pay for the bill of the bailouts cannot be reason enough
in this hour as the impact of stasis is un-imaginable chaos that will be harder
to see daylight, this line of reasoning carries the hazard where the fittest might
leverage to maximize their interest instead of being applied to the needy. This
is not an unreasonable worry as 2008/2009 schemes like the troubled
asset relief program (TARP) in USA has mainly benefited Wall-Street who
were the main culprit leaving much of main street to shoulder the burden
although Wall-Street would opined that they re-paid every penny but imputing
the risk adjusted interest on these re-payment makes a joke as Wall-Street are supposed
to be good at pricing risk. They operate the primary risk market not only for
financial risk but a broad spectrum from food to natural resource like wheat, corn to
oil and metals. The best legal and law making minds must be deployed to craft
caveats to guard against such through either a combination of policies and wide
ranging prosecution measures embedded to make such attempts improbable. The
process of law making and has mostly tipped in the favor of industries through
their lobbying machinery against limited resources of the populace. In addition,
history through the ages and across civilizations have taught us that legal
frameworks does not ensure that justice is served in all cases as at the
perimeters, the powerful do get away normally out of legal technicalities or
the voiceless poor given all but cosmetic legal aid defense or not getting the
necessary time of day from the public prosecutors who holds some discretionary
power. Although this is not the most urgent, its importance cannot be thrown
under the bus of urgency.
The current COVID-19 situation is slightly different as the
source seems to be a product of mother nature although the verdict is not or
will never be out on it as with the likes of SARS, better to focus on the
solution for now. Unlike events like WWII, nipping the bud in terms of eradicating
the primary agents like the Axis of Evil will not solve the problem. This is entertaining
the wildest far fetched imagination that it might be a product of scientific laboratory
malfeasance or accident unless the source possess the formulary to the anti-dote
in the form of a combination of therapeutics or vaccine.
Some diseases like COVID-19 do not live in a vacuum and pull rail
truck loads of collateral damage the length and speed of the Trans-Siberian
Railway along with them. Although the collateral damages and its interlinkedness makes it difficult to
separate between cause and effect, perhaps centrifuging the maze of collateral
damage might spread them out on a spectrum for better visibility and addressable
bit size.
Economically, it would generate simultaneous demand and
supply shocks resulting in massive un-employment or a newly coined temporary
non-employment with wage freeze. Unemployment in USA is north of 10% within
weeks of limited lock down measures. Airlines were the first industry to be impacted
intensively and extensively at the speed of light. It didn’t help that Boeing, one of the two largest
aircraft manufacturers globally was already reeling in a safety crisis
resulting in planned shutdown of some facilities after two crashes of her new
737-MAX leaving about 100 newly built 737-MAX aircrafts sitting parked in their
facilities un-deliverable as airlines refuse delivery and some even threatening
to cancel orders or not exercising purchase options for pipelined orders. Problems
of another nature surfaces as shortage for personal protection equipment (PPE)
to both protect front line staff especially those in medical and essential services. Key amongst the shortages were for surgical masks, N95 masks, ventilators and
disposable protective suits. Complicating this problem further progression or
some say regression, the manufacturing process and supply chain has become longer
and more complex. Most end products traverse continents with thousand of
touchpoints each of which is highly specialized to be optimized. This could be
one of the reasons to keep some of these manufacturing facilities and supply
chains mothballed instead being liquidated to pieces with lesser hope and longer to
re-assemble after the crisis. There is always room for re-organizing and re-purposing
resources for shorter term needs but the choices have to be made holistically for
the longer run and not solely on economic basis.
The central banks have been quick perhaps too hasty in re-acting
to ensure proper functioning of the banking system and liquidity a float. Central
banks have chiefly operated in the domain of interest rates, reserve ratios,
government bonds and the like even during various quantitative easing
undertaken previously. Even wildest dream could not envision central banks dabbling in
corporate bonds even venturing onto those rated as junk by the big 3 rating
agencies so long as the downgrade to junk happened after the onset of the COVID-19
crisis or can be attributed to the COVID-19 crisis. This might be done on the
one market without any restrictive covenants limiting certain top executive
compensation, share buy backs, dividend payments and declaration or the likes imposed
on companies that took money under TARP. This can present itself as a money making
trading opportunity by tail coating behind this novel and more opaque move by
the central banks with little or no accountability.
As most currencies are principally issue on a fiat
basis with some like HKD based on a peg to USD, a lost in trust in any major
currency could fall quickly like domino into a global monetary system collapse. The result
might be a return to the ancient practice of barter trade. Barter trade might
not necessarily be a bad temporary solution. However, the slide into barter
trade will be anything but orderly and might entail societal anarchy if not properly
unwound.
Politically, the COVID-19 crisis could polarize countries
further. It is a funny phenomenal that as our world become more inter-connected through
technological leaps in air, sea and land transportation and tele-communication,
countries are turning more xenophobic. This could further fracture crack lines already
present in relationship between countries and escalating into trade wars,
border disputes and perhaps limited scale local or regional conflict. Such
conflicts can leveraged by super powers into a proxy war with an enlarged foot print.
Assuming that humanity crosses this sea of danger to land
safely on solid ground, economic frameworks for distribution of wealth,
societal norms for power allocation and political boundaries and agendas might
have to take a reset. Communism might attempt to green-shoot but its track
record is both too poor and tainted. Capitalism will most probably still win
the day but the wide ranging GINI might not withstand the weight demanded by
social justice and the clarion call for a more egalitarian society.
Finally, humility and transparency should trump over over-confident smug calls by the authorities. We might be in the early days where the known-unknown and the unknown-unknown dominates the scene. This is no time for evidence or fact based decision not that we throw caution to the wind and make decisions recklessly. It does call for novel, adoptive and practical approach in place for bureaucratic norms and precedents. For example, the not wearing masks in public is a poor judgement just because there is no proof that wearing of masks reduces spread of the disease. Why not explain that we might not have enough masks as we do not know how long the crisis might last and and need to prioritize for front line healthcare workers and are working on the supply situation actively either through local manufacturer or overseas sourcing. It was quite clear that masks were hard to come by in retails pharmacies and even at government pharmacies at times. Now that we have photos of our PM and his cabinet wearing mask during their meeting tells the obvious. The lack of public hospital beds has been a problem of many year with the long wait time between transfer from A&E to wards taking hours sometimes up to 12-20 hours is proof of that. We cannot degrade this deficit in healthcare facilities under the bus of more urgent matters any longer without paying a dear price as has been shown in various parts of the world recording needlessly higher mortality due to a lack of hospital beds and ventilators.
Finally, humility and transparency should trump over over-confident smug calls by the authorities. We might be in the early days where the known-unknown and the unknown-unknown dominates the scene. This is no time for evidence or fact based decision not that we throw caution to the wind and make decisions recklessly. It does call for novel, adoptive and practical approach in place for bureaucratic norms and precedents. For example, the not wearing masks in public is a poor judgement just because there is no proof that wearing of masks reduces spread of the disease. Why not explain that we might not have enough masks as we do not know how long the crisis might last and and need to prioritize for front line healthcare workers and are working on the supply situation actively either through local manufacturer or overseas sourcing. It was quite clear that masks were hard to come by in retails pharmacies and even at government pharmacies at times. Now that we have photos of our PM and his cabinet wearing mask during their meeting tells the obvious. The lack of public hospital beds has been a problem of many year with the long wait time between transfer from A&E to wards taking hours sometimes up to 12-20 hours is proof of that. We cannot degrade this deficit in healthcare facilities under the bus of more urgent matters any longer without paying a dear price as has been shown in various parts of the world recording needlessly higher mortality due to a lack of hospital beds and ventilators.
Peter Lye aka lkypeter
lkypeter@gmail.com Safe Harbor. Please note that information contained in these pages are of a personal nature and does not necessarily reflect that of any companies, organizations or individuals. In addition, some of these opinions are of a forward looking nature. Lastly the facts and opinions contained in these pages might not have been verified for correctness, so please use with caution. Happy Reading. Peter Lye (c) Peter Lye 2019