The executive director of the World Health Organization, Mike Ryan, said it loud and clear on Friday: «There are no perfect measures to stop the expansion of the coronavirus: each country makes its decisions and time will tell which ones are right and which are not» . It is discouraging to note that the degree of uncertainty about the evolution of the pandemic is so high that fighting it has become a sort of lottery. Extreme containment measures like in China? Low profile like in Spain? Do we close the borders? Do we isolate entire regions? Making the right decision becomes the closest thing to a bet. On the one hand, the social and economic cost of the protocols that can be implemented; on the other, the expected benefit from them. The bad thing is that the virus plays with marked cards: we don’t know enough about it.
On the board, the players have already begun to raise their positions: China was the first to bet and opted for the large-scale company to isolate millions of people and establish the strongest measures ever taken in epidemiology. South Korea chose a moderation strategy with great efforts in trying to diagnose as many cases as possible early. Italy began seeing them come to pass the hardness of the measures we have known this week. And Spain? After a first phase in which practically all experts agreed to praise the moderate measures of the Ministry of Health, the example of the Italian neighbor, the increase in national cases and impatience begin to cause the first doubts. The Spanish position, exemplified by the calm man Fernando Simón, is to bet because we still have time to contain the virus. In light of the lightness of the measures taken, it seems that our authorities do not find sufficient objective data to think otherwise. The evolution of contagions, the fact that in theory most of the foci are easily traceable, the mortality contained … invite moderation. That is our bet. If we win, Simon and Minister Illa will be heroes in Europe. If we lose …
Amid the apparent uncertainty some scientific studies could throw more firewood. Four researchers from the Canadian Health Agency and the University of Toronto have suggested that the data of the epidemic in Italy may be much worse than we think. They have done so in an article not yet published, awaiting review, and therefore must be observed with caution. His work has been to analyze cases of infection in Europe between February 25 and 29 of people who had been in Italy or in contact with someone from there. Using statistics from the IATA (International Air Transport Association) and the World Tourism Organization, the estimated volume of passengers passing through Italy and visiting Europe immediately afterwards has been analyzed. When crossing this information with the percentage of infections exported by the transalpine country, the authors have found a gap. In order for these exports of the disease to make sense, the number of actual infected in Italy should be three times higher than what is being considered. If this study is true, only one third of the infections are being counted. It would be one more reason to understand that drastic measures begin to be taken there and to understand the countries that limit the circulation of Italian travelers (Spain, for the moment it will not do so).
China the laboratory
Luckily or unfortunately, China has served as a laboratory for many of the questions that assail us. A multidisciplinary work of the University of Huazhong assesses the impact of draconian non-pharmacological measures taken by the Chinese government since the beginning of the crisis. The data is spectacular. The scourge of Covid-19 has gone through four phases in China: before January 11, between 11 and 22, from January 23 to February 1 and afterwards. In global terms, the average age of those affected is 57 years and, contrary to what was believed, affects the same number of women as men. The crisis peaked in the third period (from January 23 to February 1). Then it has declined in practically all regions and age groups except in children under 20, among whom infections continue to increase.
The number of people infected by each patient increased from 3.86 at the beginning of the crisis to only 0.32 at the end. That means that the measures taken stopped about 94% of possible cases. If he had not acted that way, in China today there would be twice as many infected. Most revealing is that it is assumed that 59% of these cases avoided could have come from infections of asymptomatic people. That is, the measure of keeping the general population at home and not only patients with symptoms has allowed stifling the progress of evil. It seems that China has given us time with its sacrifice, with its millions of people locked up, its factories ruined and its economic losses. Will we take advantage of that extra time or will we waste it? The problem is that certain measures are only thinkable in a non-democratic country. The West may be doomed to waste time given away.
In our part of the world we are obliged to act otherwise. But we can do better. The magazine “The Lancet” has just published a very enlightening editorial commentary on the effect of different national measures on the development of the epidemic. The first phase is emphatic, «governments cannot limit the death toll and stop the economic consequences of the epidemic at the same time. They have to choose ». One of the most damaging measures for the economy is the limitation of the free movement and forced isolation of thousands of people in an area. Something that is Spain is being done with droppers yet. Makes sense? The key to answer in the case of the transmission of Covid-19 is in the number of asymptomatic people who can be contagious. If it is shown how it seems that in this case there are many people without symptoms capable of transmitting evil, the measures of distancing or social isolation make perfect sense. According to “The Lancet”, without isolation measures this virus can reach its peak of infection in 2.5 or 3.5 months. If quarantine measures are taken, it is delayed in two or three months and, in addition, the peak has less than half of those infected in the first case.
It is likely that outside China it will not be so easy to lock millions of citizens home. But the article offers an alternative: «Individual behavior can be crucial. Personal measures, rather than those imposed by the Government, must work in Western democracies. Teach the population to detect early symptoms and raise awareness so they stay at home and ask for remote medical help. Self-insulate on time for the good of the community? The bet is tricky. States must decide which cards they play with. But good mus players know the value of a good time and the little revenue that, in the long run, strives to play the “girl.”