2020 vision: Look back and lean forward as we revisit COVID-19 and early scenes of a biological Armageddon

It was a time before social distancing, face masks and coronavirus vaccines. 

March 11, 2020 was a Wednesday. It was also the day the world changed.

On that day, a year ago today, the World Health Organization (WHO) officially declared COVID-19 a pandemic, after the novel coronavirus was detected in more than 100 countries.

That same day, the Dow Jones plummeted into bear market territory, the National Basketball Association (NBA)  abruptly halted its season, then-U.S. President Donald Trump announced a European travel ban in a national address and Tom Hanks and his wife Rita Wilson announced they had contracted the virus while filming in Australia. That was one day: March 11, 2020.

March 2020 was simply the March that never ended. Last March, the calendar may have said 31 days, but in truth it was the month without end. Never mind notions of March coming in like a lamb and going out like a lion, or vice-versa, or beware the Ides of March, that sort of thing. A year ago this month was far more terrifying, yet simultaneously, surreal than anything so pedestrian as lambs, lions and ides.

The National Center for Medical Intelligence (NCMI) at Fort Detrick, Maryland warned as far back as November 2019 that a contagion was sweeping through China’s Wuhan region, changing the patterns of life and business and posing a threat to the population. The report was the result of analysis of wire and computer intercepts, coupled with satellite images. The medical intelligence (MEDINT) cell within Canadian Forces Intelligence Command (CFINTCOM) gave a similar warning in January 2020.

As early as Jan. 23, 2020, I had written here: 

Novel Coronavirus 2019-nCoV [as it was then provisionally known], which “shows signs of being far worse than SARS-CoV, has resulted in lockdowns today in two Chinese cities, Wuhan and Huanggang. The Coronavirus Study Group (CSG) of the International Committee on Taxonomy of Viruses, which is the entity within the International Union of Microbiological Societies, founded in 1927 as the International Society for Microbiology, and responsible for developing the official classification of viruses and taxa naming (taxonomy) of the Coronaviridae family, proposed the naming convention SARS-CoV-2 for COVID-19. The World Health Organization, perhaps finding the recommended name a tad too resonant politically to SARS from the not-so-distant past, opted instead for the official name COVID-19.

“Yi Guan, a Chinese virologist, who played an important role in tracing the development of SARS-CoV, said, ‘I’ve experienced so much and I’ve never felt scared before. But this time I’m scared,’ Nathan Vanderklippe, Asia correspondent for the Globe and Mail, and Alexandra Li, in Beijing, reported today.”

A few paragraphs later, I wrote “2019-nCoV was first detected last month in Wuhan City, Hubei Province, China, and the virus did not match any other known virus. The U.S. Centers for Disease Control and Prevention describes it as ‘an emerging, rapidly evolving situation.'”

Yet that same day – Jan. 23, 2020 – the Geneva-based WHO said that “now is not the time” to call a global health emergency related to a new coronavirus that has left 17 dead and more than 500 others infected in China, according to reports from the Associated Press, CTV News Channel, and other media. A “Public Health Emergency of International Concern” (PHEIC) must be an “extraordinary event” that poses a global risk and requires co-ordinated international action, according to the WHO. Global emergencies had been declared before, including for the Zika virus outbreak in the Americas, the swine flu and polio.

That decision would be revisited just a week later on Jan. 30, 2020, when, following the recommendations of its emergency committee, WHO Director General Tedros Adhanom Ghebreyesus declared that the novel coronavirus outbreak constituted a Public Health Emergency of International Concern (PHEIC).

Less than six weeks later, the WHO said a Public Health Emergency of International Concern was now a global pandemic.

The day before COVID-19 was declared a global pandemic, the New York State National Guard were  deployed to the New York City suburb of New Rochelle in Westchester County to enforce a COVID-19 containment area comprising a circle with a radius of about one mile.

In Italy, scenes from the new contagion were apocalyptic by mid-March of last year. “Unfortunately we can’t contain the situation in Lombardy,” said Daniela Confalonieri, a nurse at a hospital in Milan “There’s a high level of contagion and we’re not even counting the dead any more,” she said.

Underscoring the scale of the drama, soldiers transported bodies overnight March 18 and 19, 2020 from the northern town of Bergamo, northeast of Milan, whose cemetery has been overwhelmed.

An army spokesman said 15 trucks and 50 soldiers had been deployed to move coffins to neighbouring provinces. Earlier local authorities had appealed for help with cremations as their own crematorium could not cope with the huge workload.

One of the most chilling things on this side of the Atlantic, and there have been many, that I’ve heard to date during the COVID-19 pandemic, was this audio clip posted on Twitter last March 21. I heard this brief 30-second clip on Twitter March 24, 2020, the day after the “surge” hit New York City. Tim Mak is National Public Radio (NPR’s) Washington investigative correspondent – and an emergency medical technician (EMT), which is how he got the message. Aside from the subject matter, there is something eerie about that electronically-generated voice on the automated message that went out, with this message:

“This an emergency message. This is a priority request for D.C. MRC volunteers (District of Columbia (DC) Medical Reserve Corps (DC MRC)…” (https://twitter.com/i/status/1241471610395267084)

The District of Columbia (DC) Medical Reserve Corps (DC MRC) supports the DC Department of Health (DC Health) in its role as lead for public health and medical emergency preparedness, response and recovery by recruiting, training, and deploying medical and non-medical volunteers to assist with planned events and emergencies.

Last March 30, I wrote on Facebook: “Consider this. Ordered earlier this month to “lean forward,” a military term familiar to those who serve in the United States Navy, meaning the willingness to be aggressive, to take risks, the U.S.Navy hospital ship USNS Comfort (T-AH-20), homeported at Naval Station Norfolk, Virginia, sailed from port up the Atlantic seaboard Saturday and arrived in New York Harbor this morning.

“The Comfort will provide relief for New York hospitals by taking on non-COVID-19 cases and allowing the hospitals to focus on the most critical patients suffering from the virus.

“Picture this.

“What those sailors, military doctors and nurses, officers, enlisted personnel and civilians aboard the USNS Comfort (T-AH-20) must have been thinking as they answered the call of duty and sailed north into a Biological Armageddon.”

The following day, on March 31, 2020, I posted again on Facebook, “Waking up every morning in March 2020: ‘Red alert. All hands stand to battle stations’” (https://www.youtube.com/watch?v=wV30YwXaKJg).

Since Feb. 6, 2020, COVID-19 has killed more than 530,000 people in the United States, more than influenza has in the last five years, notes the Johns Hopkins Bloomberg School of Public Health.in Baltimore. COVID-19 has a higher severe disease and mortality rate than influenza in all age groups, except perhaps children under the age of 12. “Influenza is a significant burden on the population, but COVID-19 has had a vastly larger effect,” Johns Hopkins says.


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Hope in a dangerous time: Projected peak in daily deaths and hospital resource use reached or at hand for U.S.

The Institute for Health Metrics and Evaluation (IHME) is an independent population health research center at UW Medicine, part of the University of Washington, that provides rigorous and comparable measurement of the world’s most important health problems and evaluates the strategies used to address them. While there is no shortage of models to look at, IHME’s infectious disease modelling for estimating the COVID-19 pandemic growth rate and basic reproduction number (R0) for the United States has been among the best.

With that in mind, here are two reasons for hope this Easter Sunday 2020, although the payoff will only come later, so be prepared to wait until at least June, maybe even July, because this is going to be a case of delayed gratification, measured in months, not days:

• It has been one day since projected peak hospital resource, including all beds, intensive care unit (ICU) beds, and invasive ventilators in the United States on April 11;
• It has been two days since the projected peak in daily deaths on April 10 of 1,983 deaths (the actual number was slightly higher, 2,056);

While models differ on peaks, the United States is close to its peak of the novel coronavirus disease, Food and Drug Administration Commissioner Dr. Stephen Hahn said on ABC’s This Week earlier today.

Canada’s pandemic is in earlier stages. Many countries reached their first 500 cases before community transmission started in Canada.

Like any mathematical model, there are caveats and disclaimers to be noted. The Institute for Health Metrics and Evaluation model prominently notes that it is making its “COVID-19 projections assuming full social distancing through May 2020.” Assuming “full social distancing” from now through May 31 strikes me as one very big assumption. Still, the U.S. government’s early modelling suggested that only 50 per cent of Americans would observe the stringent federal social distancing guidelines, currently in effect until April 30, when in actuality U.S. Surgeon General Dr. Jerome Adams said last week that a much larger number – 90 per cent – were observing the guidelines.

My best guess is the United States will reboot the economy too quickly in early May, against public health advice, and there will be a resurgence of COVID-19 cases, but the resurgence, while regrettable and wholly unnecessary, will be a temporary setback, delaying, but not wiping out the gains being made right now through social distancing, and shutting down the economy, with the exception of “essential” work,  whatever that really means from state-to-state, community-to-community.

I wrote a piece Jan. 23 headlined, “The fire this time? Pandemic prose, and waiting and watching for the ‘big one’  (https://soundingsjohnbarker.wordpress.com/2020/01/23/the-fire-this-time-pandemic-prose-and-waiting-and-watching-for-the-big-one/) where I wondered, “How quickly we could we make a trip back to a modern-day equivalent to the Dark Ages of the 5th to 11th centuries?” I think the early evidence we have seen in the 10 weeks since then suggests not so very long, and that the best parallel in modern times will turn out to be the “Spanish Flu” influenza pandemic of 1918, although it killed about 675,000 people in the United States, compared to COVID-19, which will likely kill about 10 times less than that.  The Institute for Health Metrics and Evaluation in Seattle projects 61,545 COVID-19 deaths by Aug. 4. Well less than then the 1918 influenza pandemic, but a greater number of Americans killed than in the Vietnam and Afghan conflicts combined.

The National Center for Medical Intelligence (NCMI) at Fort Detrick, Maryland warned as far back as last November that a contagion was sweeping through China’s Wuhan region, changing the patterns of life and business and posing a threat to the population. The report was the result of analysis of wire and computer intercepts, coupled with satellite images.

The medical intelligence (MEDINT) cell within Canadian Forces Intelligence Command (CFINTCOM) gave a similar warning in January.

In the summer of 2005, the Center for the History of Medicine at the University of Michigan in Ann Arbor was asked by the Defense Threat Reduction Agency (DTRA) to conduct research into and write a report on American communities that had experienced extremely low rates of influenza during the infamous 1918-1920 so-called “Spanish Flu” influenza pandemic.

They selected seven communities that reported relatively few if any cases of influenza, and no more than one influenza-related death while non-pharmaceutical interventions (NPI) were enforced during the second wave of the 1918-1920 influenza pandemic. The communities were:

• San Francisco Naval Training Station, Yerba Buena Island, California;
• Gunnison, Colorado;
• Princeton University, Princeton, New Jersey;
• Western Pennsylvania Institution for the Blind (WPIB), Pittsburgh, Pennsylvania;
• Trudeau Tuberculosis Sanatorium, Saranac Lake, New York;
• Bryn Mawr College, Bryn Mawr, Pennsylvania;
• Fletcher, Vermont

Over time, it will be interesting to see what, if any, COVID-19, outliers there are in the United States. Internationally, there are a few countries in Africa that still have no cases, but the bulk of COVID-19-free countries are in the Pacific. Nations such as Vanuatu, Palau, Solomon Islands, Tonga and Samoa have been protected to date by their remoteness.

According to the most recent Institute for Health Metrics and Evaluation projections, subject to the caveats and disclaimers mentioned earlier, deaths per day should drop to 976 in the United States by May 1; 47 on June 1, and none after June 19, as a dread spring gives way to a summer of hope.

Here in Canada, the Public Health Agency of Canada says that ‘Prior to stronger public health measures, each infected person (case) in Canada infected 2.19 other people on average.”  When each COVID-19 infected person infects fewer than one person on average, the pandemic will die out, the agency says. “Models cannot predict what will happen, but rather can help us understand what might happen to ensure we can plan for worst cases and drive public health action to achieve the best possible outcome.”

Any backsliding, of course, in April and May on physical (social) distancing, self-isolation of cases, quarantine of contacts, and preventing importation of infection from other countries internationally through border controls and nationally through domestic travel restrictions, and all bets are off.

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