COVID-19: Black swan or a bad sequel of evolving pandemics?

The Pirates of the Caribbean was a fun movie I remember enjoying with my children. The immediate next sequel was tolerable with subsequent sequels quickly sinking to the abyss of forgettable waste of celluloid.

It is more or less established that movie sequels are almost always worse than their predecessors. Consider the sequel map of popularity built by Box Office Quant, based on two simple metrics (1) Gross business and (2) Rotten Tomatoes score. The bubble size gives the domestic gross. Based on the Rotten Tomato score, the sequels below the line are worse than the original and the few bubbles above the line represent the rare sequels better than the original, the most notable at the top being Star Trek II – the Wrath of Khan.

Lesson from Hollywood:

In spite of the high statistical likelihood of a worse sequel, there seems to be little lesson learned and movie studios everywhere continue to churn them out, perhaps believing that they are immune to the challenge. This reminds me of the series of viral pandemics we have seen in the first twenty years of this century.

COVID-19 and 21^st Century Pandemics:

In January 2020, an outbreak of viral pneumonia in Wuhan, China was attributed to a novel corona virus, aka SARS-CoV-2. The disease, later named COVID-19 quickly spread globally, causing, so far, over 3.5M infections and claiming close to a quarter million lives (Source: https://ncov2019.live/ , www.cdc.gov ).

This is not the first time an international health crisis occurred due to the spread of a zoonotic (animal-originated) virus, such as influenza that created the swine, bird and seasonal flu epidemics in recent history. In fact, like a repeating movie sequel, we’ve seen at least three outbreaks in less than 20 years.

First Edition- 2002 SARS: SARS-CoV or simply SARS (Severe Acute Respiratory Syndrome), first widely reported in February 2003 was tracked back to November 2002 in Asia. It quickly spread to over 26 countries before being mostly contained, with over 8,000 known cases and 774 deaths with a case fatality rate of about 10%.

Second Edition – 2012 MERS: Middle East Respiratory Syndrome or MERS was first reported in Saudi Arabia in September 2012 and has since spread to at least 27 countries, according to the World Health Organization. Among all reported cases of 2519, about 80% occurred in Saudi Arabia, claiming about 866 deaths, with a case fatality rate of over 30%.

Third Edition – 2014 Ebola: The Ebola outbreak of 2014, although a different type of zoonotic virus (but with a far higher case fatality rate of almost 50%) happened only six years back, had some of the same hallmarks of a major contagion and ravaged many countries of West Africa, eventually making its way to UK, US, Spain and other countries.  

There is clearly a pattern. And not to forget, in 2015 Bill Gates spoke in uncannily clear terms about the onset of an impending pandemic, which could be a worse outbreak, (sort of like a bad sequel) and posing a bigger threat than a nuclear war.

Is history repeating itself?

Forget SARS, MERS or Ebola. Let’s go back just about 100 years after World War I to the 1918 influenza pandemic, aka the Spanish flu (also caused by a virus with genes of avian origin). In the US, it was first identified in the military. Even though the world was not as connected then, global troop movements by trains, trucks or ships and other conditions of the big war, including overcrowding helped the flu spread. The lack of vaccines and any prior experience exploded the public health crisis, causing over 50M fatalities globally, including about 675,000 in the United States.

With no technology, vaccine or pharmaceutical remedy at hand, governments world-wide had to depend on non-pharmaceutical interventions such as isolation, quarantine, good personal hygiene, use of disinfectants, and limitations of public gatherings – the same common-sense approaches that today’s people and governments also have to resort to in spite of the medical advancements.

Social Distancing: 1918 – Ironically, in a 2007 Proceedings of the National Academy of Sciences USA paper, researchers (Lipsitch et al) showed that during the 1918 pandemic, cities that intervened early to slow transmission through social distancing, such as such as St. Louis, Mo., had slower epidemics with smaller peaks, compared with those that waited longer to act, such as Philadelphia. Yet, those lessons from the 100-year old pandemic clearly were lost among many, with many making it a political football.

Black Swan & COVID-19 – Really?

Now, many experts are qualifying the COVID-19 outbreak as a Black Swan event – perhaps due to its rapid spread through most of the globe catching many countries relatively off-guard. But does it really qualify as a Black Swan?

Black Swan theory (BST): The idea was popularized by Nassim Nicholas Taleb after the 2008 financial crisis, who in his turn, used the concepts pioneered by Yale mathematician Benoit Mendelbrot. Black Swan describes an event that is extremely unlikely or unexpected, but is highly impactful and of serious consequence, if or when it happens.

Other examples:

• The dot-com bubble of 2001 is another black swan event that has similarities to the 2008 financial crisis.
• In June 2009, the loss of Air France AF447 was a ‘Black Swan’ event — a one-in-a-million chance that saw a large airliner, operated by a reputable airline and flown by an experienced crew, disappear over the ocean.

What is Black Swan: Prior to 1697, most of western civilization had not seen any black swans (and so all swans could only be white!) and was under the impression that they didn’t exist. The notion was debunked after a black swan was finally observed in Australia in 1697. Typically, a ‘black swan’ event has three characteristics.

• First, it is typically an outlier outside the realm of regular expectations, because nothing in the past can convincingly point to its possibility.
• Second, it carries an extreme impact.
• Third, in spite of its outlier status, human nature makes us concoct explanations for its occurrence after the fact, making it explainable.

COVID-19 certainly does not meet the very first characteristic. Even if we exclude the memory of the 1918 Spanish flu, we still have multiple recurring cases of similar outbreaks, albeit at smaller scale, that made any future outbreak far more likely. Hence, after repeated cases since 2003, a viral pandemic is hardly unforeseeable or unexpected.

The swan may not be black but perhaps grey or some other lighter shade

One might still argue that the rapid-fire contagion, fully global nature of the spread and high fatality rate still makes COVID-19 somewhat of a black swan-esqe event. The potential impact of the pandemic and the still unknown nature of how it may continue to play out through all facets of our life in an ultra-connected world still remain a mystery. The exact trajectory of how the impacts of COVID-19 will ramify through the global economy remains as unpredictable as the fractal dynamics discussed by Mendelbrot.

With all the sequence of global or regional pandemics steadily cropping up since the first SARS outbreak, COVID-19 may not be a totally unexpected black swan, but the nature of the beast is still confounding the global community. The riddle of COVID-19 appears to be far from understood and everyone needs to put their heads together.

Coming back to the history…

The impact of the 1918 Spanish flu may have faded away in to the last century, but several key aspects are eerily similar. Given its juxtaposition with the world war I, 40% of the U.S. Navy and 36% of the US Army was hit with the flu, exacerbated by troops moving in crowded ships and trains.  The recent spread of the disease among navy men of the aircraft carrier USS Theodore Roosevelt and reports of cases from more US Navy vessels reminds us that history may have an eerie habit of repeating itself.

In the same token, all the recent chest-thumping about freedom to gather and crowd notwithstanding, records show that measures against people coming in proximity and strategies to minimize crowding that were used to battle Spanish flu are still relevant today.

Conclusion:

The onset and spread of COVID-19 arguably is no black swan. It is a bad pathological sequel that has already played out through several regional pandemics since the turn of this century. However, its stunningly fast spread and severity came at us as if it is a black swan – fueled partially by our faded memory of the history and a complacence and a temporary amnesia of our global connectedness.

The Impending Future

What comes next and how it will impact our future security, health, economy, education, business and life as we knew it will depend on how societies fight this using science and strategy driven by the long-term common good. Clearly, we are in uncharted territory of a large scale. Even if the pandemic is not exactly a black swan, there is likely to be many a new twist and turn down the road. Will there be secondary or tertiary waves of infections as cities and countries go through cycles of closing and opening of lockdowns? Will the virus mutate to a far more dangerous level? Are big public gatherings a thing of the past? How will our digital world expand? Will virtual reality and augmented reality technologies step up to fill in the gaps of our digital world? Or will there be a silver bullet, may be a super-vaccine that will immunize humanity from future attacks so we get back most of our lives? The ride ahead will surely be bumpy before it stabilizes again.

Disclaimer:

The thoughts or opinions described in this blog are mine and in no way, shape or form are intended to represent opinions or conclusions of any other person, group or organization.

Some terms explained:

1. Coronaviruses are a large family of enveloped RNA viruses that mostly infect birds and mammals.

2. Zoonotic viruses are those where infections pass from animals to humans

3. The R0 or the Reproductive Number is a measure how contagious an infectious disease is as it displays the average number of people that will be infected from a contagious person. World Health Organization reports put the R0 of COVID-19 between 2 and 2.5. The median reproductive number for the 1918 flu pandemic was around 1.8.