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In the coming days, the deaths registered worldwide by Covid-19 will exceed one million. Perhaps another million have not registered. Since the start of the pandemic, nine months ago, weekly cases registered by the World Health Organization have had a very slow upward trend and, in the seven days to September 20, exceeded two million for the first time.
The virus is sweeping parts of the emerging world. India has registered more than 90,000 cases a day. Some European countries that thought they had suppressed the disease are in the middle of a second wave. In the United States, the official death toll has exceeded 200,000; the seven-day total cases are increasing in 26 states.
Alberto Pezzali / AP
A man wears a face mask in London’s Leicester Square. British Prime Minister Boris Johnson announced that pubs and restaurants will close at 10pm, due to the increase in coronavirus cases in the UK.
Those numbers represent a lot of suffering. About one percent of survivors have long-term viral damage, such as crippling fatigue and scarred lungs. In developing countries especially, grief is compounded by poverty and hunger (see article). The northern winter will force people to stay indoors, where the disease spreads much more easily than outdoors. Seasonal flu could increase the burden on health systems.
In the gloom, keep three things in mind. The statistics contain both good and bad news. Treatments and drugs are making Covid-19 less deadly – new vaccines and drugs will soon be added to its effects. And societies have the tools to control disease today. Yet it is here, in the basics of public health, that too many governments continue to fail their people. Covid-19 will remain a threat for months, possibly years. They must do better.
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Start with the numbers. The increase in diagnosed cases in Europe reflects reality, but the overall effect is an artifact of additional tests, detecting cases that would have been missed. As the Report in this issue explains, our model suggests that the total number of actual infections has dropped substantially from its peak of more than five million per day in May. Additional evidence is one of the reasons the death rate from the disease appears to be declining. Furthermore, countries like India, with an average age of 28, suffer fewer deaths because the virus is easier for the young than for the elderly.
Dita Alangkara / AP
Indonesian Muslim women walk near the grave marks in the special section of the Pondok Ranggon Cemetery, which was opened to accommodate the surge in deaths during the coronavirus outbreak in Jakarta.
The drop in deaths also reflects medical progress. Doctors now understand that organs other than the lungs, such as the heart and kidneys, are at risk and treat symptoms early. In British intensive care wards, 90 percent of patients were on ventilators at the start of the pandemic; in June only 30 percent were. Medicines, including dexamethasone, a cheap steroid, reduce deaths in seriously ill patients by 20-30%. Deaths in Europe are 90% lower than in the spring, although this gap will narrow as the disease spreads again to vulnerable groups.
More progress is expected. Monoclonal antibodies, which inactivate the virus, could be available by the end of the year. Although expensive, they promise to be useful after someone is infected or, for high-risk people, prophylactically. Vaccinations are almost certain to follow, possibly very soon. Since different drugs use different lines of attack, the benefits can be cumulative.
However, in the best of all possible worlds, the pandemic will remain a part of everyday life well into 2021. Even if a vaccine does emerge, no one expects it to be 100% effective. Protection may be temporary or weak in the elderly, whose immune systems are less responsive. Making and administering billions of doses will take much of the next year. The first vaccines may require two shots and complex “cold chains” to stay cool. Medical glass could be an understatement. There can be fights over who gets the supplies first, leaving pools of infection among those who can’t elbow their way to the front of the line. Surveys from several countries suggest that a quarter of adults (including half of Russians) would reject vaccination, another reason why the disease may persist.
Therefore, for the foreseeable future, the first line of defense against Covid-19 will continue to be test and trace, social distancing, and clear government communication. There is no mystery as to what this entails. And yet, countries like the United States, Great Britain, Israel and Spain persist in being disastrously wrong.
One problem is the desire to escape a compromise between closing to keep people alive and staying open to keep life going. The right wing praises Sweden for allegedly letting the virus spread while prioritizing the economy and freedom. But Sweden has a death rate of 58.1 per 100,000 and saw a GDP drop of 8.3% in the second quarter alone, worse on both counts than Denmark, Finland and Norway. The left praises New Zealand, which has been closed to save lives. It has suffered only 0.5 deaths per 100,000, but in the second quarter its economy contracted 12.2%. By contrast, Taiwan remained more open, but has seen 0.03 deaths per 100,000 and a 1.4 percent drop in GDP.
General blockades like the new one in Israel are a sign that the policy has failed. They are expensive and unsustainable. Countries such as Germany, South Korea, and Taiwan have used fine-grained testing and tracking to detect individual super-spread sites and slow the spread through quarantines. Germany identified slaughterhouses; South Korea contained outbreaks in a bar and churches. If the test is slow, as in France, it will fail. If contact tracing is not trusted, as in Israel, where the job fell to the intelligence services, people will avoid detection.
Governments must identify the tradeoffs that make the most economic and social sense. The masks are cheap and convenient and they work. Opening schools, as in Denmark and Germany, should be a priority; opening noisy and uninhibited places like bars shouldn’t. Governments, like Britain’s, barking out an ever-changing series of orders that are violated with impunity by their own officials will find compliance low. Those, like those in British Columbia, who establish principles and invite individuals, schools and workplaces to design their own plans to carry them out, will be able to sustain the effort for months to come.
When Covid-19 hit, governments were caught off guard and pulled on the emergency brake. Today they don’t have that excuse. In the race to normality, Spain lowered its guard. Britain’s tests are not working, although cases have increased since July. The US Centers for Disease Control and Prevention, once the world’s most respected public health body, has been plagued with mistakes, poor leadership and presidential denigration. Israel’s leaders were victims of arrogance and infighting. The pandemic is far from over. It will decline, but governments must control it.
© 2020 The Economist Newspaper Limited. All rights reserved. From The Economist published under license. The original article can be found at www.economist.com
