COVID-19: Why things are not as bad as they seem – and where we might go from here. Insights from the scientific evidence available to date
In the German language there are two words for fear. One is ‘Furcht’, the other one is ‘Angst’. ‘Furcht’ is a productive and healthy feeling. It enables you to react adequately and proportionately to a threat. Say you are standing on the road and see a truck racing towards you. Fear saves your life. Its key defining element is a close and undistorted perception of reality. ‘Furcht’ empowers you.
‘Angst’, in contrast, is a construction of our minds that lacks a proper basis, in reality, e.g. you are lying in your bed and you imagine trucks racing towards you. Angst destroys your life. It tends to make you freeze or take disproportionate action. ‘Furcht’ stops when the danger has passed – ‘Angst’ stays on and on and on. As a side effect it also puts your body into a constant state of alarm that weakens your immune system.
A lot of what the current reporting on COVID-19 is creating is ‘Angst’, a massively distorted perception of what is really going on and how bad the situation really is. To put it in a nutshell: yes, we need to be careful right now, but the situation is by far not as bad as the news make it look like. We will go back to normality – it just takes a bit of time.
The purpose of this article is to review the up-to-the-minute scientific literature on COVID-19 and to evaluate the situation based on that. In other words, the purpose of this article is eliminating ‘Angst’, leaving behind only what is action-enabling and well-founded in reality.
At the end of 2019 a novel human coronavirus emerged in Wuhan, Hubei Province, China, now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It belongs to the same family of viruses that caused the SARS-epidemic in 2002/2003 (SARS-CoV-1) and the MERS-epidemic in 2012. Another virus from the same family causes the common cold.
COVID-19 is the respiratory infection caused by the SARS-CoV-2. Neither the virus nor the disease were known before the outbreak in late 2019. One reason it took governments substantial time to react was that many symptoms of COVID-19 are deceptively similar to those of the flu.
On December 31, 2019, the China office of the WHO was informed by Chinese officials about the spread of a new virus. On January 7 the virus was identified as a novel coronavirus. Over the course of January and February 2020 it quickly spread from China to the rest of the world and was officially declared a pandemic by the WHO on March 11. As of April 5, 2020, there were 1,205,801 confirmed cases worldwide. Figure 1 depicts the countries with the most confirmed cases.
Figure 1: Countries with the most confirmed COVID-19 cases as of April 05, 2020
On average each infected person infects 2.5 other people if measures for physical distancing and quarantining are not taken. To neutralize the virus in the medium term this value needs to be below 1; in the best case, converge towards zero.
The virus is transmitted via droplets in the air we breathe in or via surfaces we touch. Outside the human body it can survive and be found up to three hours in the air within a closed room, up to 4 hours on Copper, up to 24 hours on Cardboard, up to 48 hours on Steel, and up to 72 hours on Plastic or glass.
According to the Robert-Koch-Institut in Germany the virus can NOT enter the skin, it needs to have contact with a mucous membrane to be able to enter the human body.This means that touching a shopping cart that has recently been used by an infected person is NOT a problem in and of itself – the virus might be on the handle and it might be transmitted from there to your hands. But this is where it stops, provided you don’t touch your face (rub your eyes, etc.). The problem is that we tend to touch our faces all the time. One recent study showed that we touch our faces 23 times per hour on average, of which 44% is direct contact with a mucous membrane (e.g. the mouth and eyes). That is why hand hygiene is so essential.
The main effect of wearing masks and gloves is not so much that they really keep the virus out – the main effect is that they create a consciousness for touching your face. You reach for your face without realizing it… and then you stop yourself.
There is no known cure or vaccination available. All that we can do is support the body in healing itself and help those who develop pneumonia to keep breathing. Overall there have been 64,975 deaths caused by COVID-19 to date. Figure 2 shows the distribution of the absolute numbers by the countries that have been hit the worst:
Figure 2: Countries with the most confirmed COVID-19 deaths as of April 05, 2020
This is what you see in the news: army trucks carrying away corpses because the public health infrastructure cannot cope with the onslaught anymore. Thousands dead, making it feel like Zombieland, Armageddon, as if life will never go back to normal again. Even the mundane task of grocery shopping now feels like it poses the major risk of leaving us dead… You might ask, “how will we ever live again normally?”...“will we ever again embrace, kiss, shake hands, dance together?”…“how can work/life continue under these conditions?”…“How long will this go on?” …and so on.
Yes, we will. We will dance, kiss, hug, shake hands, do business, and go back to living a normal life again. And the ‘Angst’ that seems to have a good grip on the heart of many people is unfounded.
The following elaboration will show why.
2. The case fatality rate is likely massively lower than what we see in the news
By now it almost seems politically incorrect to make this statement. But I will show you why I am convinced that the real case fatality rate of COVID-19 might be overestimated by a factor of 10. The case fatality rate (how many of those known to be infected have died) varies widely between countries as can be seen in Figure 3:
Figure 3: Case fatality rate COVID-19 infected patients as of April 05, 2020
You would expect to see much less of a difference between the various countries. Why should there be a difference by a factor of 8 between Germany and Italy? We will look into the reasons for these huge differences later. For the time being, another aspect is much more interesting: Where does this case fatality rate come from and what does it really tell us?
The case fatality rate is a quotient, comparing the number of total documented cases (i.e. tested and confirmed) with the number of deaths seemingly caused by the disease.
But testing is being conducted at a slow rate in most countries and test systems have partially been unreliable. The total number of tests conducted in Europe are shown in Figure 4
Figure 4: Total number of COVID-19 tests conducted by country in Europe as of April 5
Germany and Italy have tested ca. 1% of their respective populations, Spain roughly 0.7% and the UK less than 0.3%. How many cases do you think have gone unnoticed due to the mild or entirely asymptomatic nature of these cases and/or tests not being conducted on the respective individuals? And what does this tell us about the case fatality rate? Not everybody infected gets documented, yet practically everyone dying from the disease is (because they visit the hospital to get help) which massively skews the numbers.
The case fatality rate gets reported in the news as ‘this is how many people die from the disease’ – and that is just plain wrong and vastly misleading. In three recent studies, all published in top-tier academic journals, the number of undocumented cases of the virus was estimated at 20 times the amount of confirmed cases, 11 times the amount of confirmed cases and 7 times the amount of confirmed cases.
This means you need to divide the case fatality rate by ca. 10 to arrive at a more realistic number, which would bring it down to 1.2% for Italy or 0.2% for Germany. Now we are talking. Suddenly COVID-19 does not look that devastating anymore. Still bad. But not the end of the world!
My conclusions are fully supported by a study done in a little village in Germany, called Gangelt, which had a particularly high number of COVID-19 cases. Since the area is relatively small it was possible to document a large share of the cases, i.e. analyze the real case fatality rate. In the report dated April 9, 2020, the case fatality rate in Gangelt was ,37%. This is the value for a population that has never been exposed to exactly this virus before. But once a large portion of the population has antibodies a next outbreak is likely to result in a substantially lower number of deaths since many people just don’t get sick from the virus anymore and there will be isolating effects of herd immunity. The number will decrease further once we have treatments. This means with a high probabilitythe true case fatality rate of a population that is ‘acquainted’ with the virus will be similar to the one of the flu!
In the USA in the current flu season (beginning October 2019) the total number of estimated cases was 36-51 million (depending on categorization); the number of flu-induced hospitalizations was 370,000-670,000; and the number of flu-caused deaths was 22,000-55,000. That means that the case fatality rate for the flu is around 0.1%., i.e. one in a thousand of those who get the flu die.
This is not a particularly bad year, i.e. it happens regularly. How often does this get reported? How often do you think about that? How often does it cause you to question the future of the planet?
Please note: Yes, COVID-19 needs to be taken seriously. Yes, the measures (like lockdowns) are adequate for a number of reasons. Yes, for the time being you need to be careful and stick to the guidelines outlined by the WHO (washing hands, covering mouth, keeping a distance etc.). But it is not the end of the world as we know it. The panic I am seeing in so many people is just totally detached from reality. It is ‘Angst’. And it’s time to turn it into ‘Furcht’, i.e. time to do what you can do, act on what you can control – and forget about it beyond that.
This argument leads to the obvious next question:
3. If COVID-19 is not that lethal then why are we seeing these heartbreaking images from New York, Wuhan, Rome, Madrid and other cities?
There are five main reasons why COVID-19 is still a dramatic challenge in the short run and therefore the lockdowns are fully justified and necessary.
Reason 1: It is additive, not in place of. Meaning we already have the challenge of coping with the flu and all the other ‘normal’ (meaning we are used to them so don’t freak out about them) diseases. COVID-19 comes on top of that. The disease itself is not as bad as it looks, it is rather that our systems run at capacity – you add another big weight and they break down. And this is what we are seeing. It is a bit like having a second type of really bad flu around in addition to the seasonal one. If COVID-19 would have been around for 1,000 years but the flu was not, we would be shivering at the thought of the flu – but in reality, it is not that dangerous. That is the way to look at it.
Let’s consider the following: what is the usual operational capacity of the company you are working for? If the season is unusually slow, it may be 80%. Under normal conditions, it will be somewhere between 90%-110%. If your company is under severe cost pressure or growing fast, it might be 120% or more.
This is the situation that our health care systems are currently facing. For most of them at least. Severe cost pressure and a lack of qualified personnel (so much for unemployment…). Just as an example, in Germany in 2019 more than 20,000 positions remained open in the health care system (doctors and nurses).
The dramatic pictures we see from Madrid and Rome are more severe than usual, but we should not forget they look bleak every year! It is just that nobody ever looked closely – now everybody is looking, and we have the additional weight of COVID-19.
Reason 2: Nobody has antibodies. Since COVID-19 is new, nobody’s immune system is prepared to cope with it and therefore most who get exposed to it get at least somewhat sick. That is substantially different from the flu which has been around for thousands of years. In other words, the virus is not as bad as it currently seems – the total number of cases is just vast for the time being. But this will change over time. Please note: This means we will go back to normality – just not in a few days yet. It takes a bit longer.
Reason 3: There is no medication available yet. Nowadays you can live with HIV for decades. And we will also see medicaments that help alleviate the symptoms of COVID-19, i.e. lower death rates.
Reason 4: Too little testing too late. The reason South Korea fared relatively well was that they rolled out a massive wave of testing which helped to isolate the infectious individuals relatively quickly.
The US and South Korea reported their first cases nearly at the same time (January 21 vs. 20) but while South Korea had tested about 6,000 inhabitants per million by March 20, the US had tested 317 (yup, not a typo. Three hundred and seventeen). Really? The richest country on the planet and all? Just one more of Trump’s misguided policies, denying reality as a policy paradigm. Take a look at the following figure:
Figure 5: Number of tests conducted per one million inhabitants by country as of March 20
The US had tested less than Iran…
In a recent Harvard Business Review article Prof. Stefan Thomke (the William Barclay Harding Professor of Business Administration at Harvard Business School) wrote about the reasons why the US reacted so late:
“Testing early and often is often viewed as wasteful in the eyes of
organizations that emphasize efficiency and predictability. That’s until, of course, the opportunity cost of not testing becomes blatantly obvious and precious time and lives have been lost.”
How unnecessary considering the genome of the virus had been available since January and scientists had figured out the diagnostics not long thereafter.
Reason 5: Based on the current knowledge the virus appears to be particularly infectious before any symptoms are developed and shortly after symptoms start which contributes substantially to its dissemination. This is the main reason why widespread testing not only of symptomatic individuals but of the broader population and resulting isolation of the infected people are necessary.
All of this results in the following conclusion: given we do things right we can cope with the existence of the virus and live our normal lives. But substantial changes are needed in many countries to adjust to the challenge.
4. Why are the case fatality rates that different between countries?
We are still in a very early phase of analyzing the patterns. Since so many different variables might play a role in such a complex process, we may never have a definitive, fully elaborated answer to this question. But the following four aspects undoubtedly play a key role:
Reason 1: Intensive Care Units (ICUs)
As hard as it is, Spain and Italy are staring at least partially into a self-created abyss. Let me explain: ICU beds usually come with equipment for mechanical ventilation and/or so-called ECMO devices. Mechanical ventilation is a type of machine that helps people breathe if they cannot do so on their own. ECMO devices are even more sophisticated and take over the function of the heart and lungs for the person (the blood is lead out of the body, enriched with oxygen and led in again).
Since most COVID-19 patients who become critical die of pneumonia, the availability of ICUs is a key bottleneck in keeping patients alive. For those in the most critical condition caused by COVID-19 this often means: no devices, no survival.
The country with the most ICUs per 100,000 inhabitants is the USA (34.9) followed by Germany (34). The number in Spain is at 9.7 and in Italy it is at 12.5. It is only a slight overstatement if one were to say, “If you only have one-third of the ICUs, you only save 1/3 of the patients”. This is amplified by massive shortages for protective gear in the health care systems of Italy and Spain (gloves, masks, suits) and the number of total hospital beds available where the relation between the numbers is not that different.
A self-created abyss caused by misguided distribution and absurd public health policies.
Reason 2: Swift, drastic action
China’s health care system is surely not on the level of, say, France. But its case fatality rates of COVID-19 are much lower. Why? Drastic, swift action to contain, to isolate. Not beautiful. Not very democratic. But the virus does not really care about political convictions. China tracked down everybody who came in contact with an infected individual via their mobile phone data and quarantined them ruthlessly – or shall we say with adequate discipline? Your choice of words on this issue will depend on your perspective. Mine is more on the Chinese side in this respect. There are times for freedom, and there are times for decisive action.
This will be something to think about in the medium term once we get through this. We need to become much more disciplined, much more brutal and much faster in our actions in a case such as this. How can we combine our way of life, our convictions about freedom and civil rights with the adequate reactive capacity? We are not good at this yet, as can be taken from this crisis. It could have been much easier, much lighter.
This is not an easy question. But it is important, and we need to answer it.
Reason 3: Age
Italy suffered a double blow: a relatively old (as measured by median) population and an over-proportional infection of their older population. The majority of infected people in Italy have been over the age of 70 (with the median age of infected individuals being 80.5). I am not sure why and how this happened, but since the fatality rate explodes above 70, we can conclude that it is one of the drivers of Italy’s Italy’s incredibly sad numbers.
Reason 4: Population density and global connectivity
The higher the population density, the higher the rate of infection will be, on average. If your closest neighbor lives 5 miles down the road, you are not going to breathe on each other. Even if you do, if you both have no outside contact with the rest of the world, you can expect to not get the virus. In contrast, imagine being in the New York Underground at rush hour…
NY is very global, very dense and very big. Higher density means easier and more frequent transmission. NY has an average of 27,000 people per square mile. That means it has a 75% higher population density than London(15,400) or Tokyo(16,095) and more than three times the density of LA (8,484)or Frankfurt (7,600).
If you look solely at Manhattan, the number skyrockets to 71,000 inhabitants per square mile putting it in the ballpark of Mumbai.
With 8 million inhabitants it is also the largest city in the US, so its high number of total cases is also a reflection of its sheer size.
There is another aspect. Since the total number of tests conducted varies greatly between countries, cities and states, one has to be careful how to interpret the numbers. Just imagine, if you don’t conduct any tests, you would report zero cases… but New York has tested a lot. This influences the perspective too. The city has conducted more than 300,000 tests for the virus to virus to date.. Therefore its total number of reported cases is high too.
Overall, the conclusion we can draw from this section is that we need to build more absorptive and reactive capacity so that the next time we are in this situation we don’t look like schoolboys – which, unfortunately and dramatically, was the case this time, with deadly consequences for many.
5. The number of newly infected cases is vastly overestimated
What we get fed as ‘new cases’ every day in the news are NOT new cases – at least not all of them, maybe even only a fraction of them. This is why despite the lockdowns we still see growing numbers of cases. Imagine today 100 people are tested and 80 are reported to be infected. Tomorrow 1000 people are tested and 200 are reported to be infected. The day thereafter 10,000 are tested and 800 are reported to be infected.
What does this graph look like? Like an exponential explosion. But in reality, the number of tests has to be put in relation to the diagnosed number of cases and nobody is doing that!
You test many more people; you catch many more cases. Whereas in fact all of them might be old cases! The infection could have entirely stopped or massively slowed down and yet you would still see growth.
In the example the real percentage of infection in the tested population is 80%, 20% and 8%, respectively. While the percentage of the population being infected declines massively, the total number seems to increase exponentially. Bad statistics, bad journalism.
The reason why we are still seeing so many new cases despite the lockdowns and massive reduction in physical contact is the healthcare systems are only now catching up with the testing. In all likelihood we have a massively decreasing number of NEW infections – it is just that nobody does the hard work of carving them out. Instead, what is shown are the number of newly documented (tested) cases – whether they are new or were infected 10 or 20 days ago is entirely neglected.
In other words, the lockdowns are in all probability working, there is just a substantial time gap until it shows in the statistics.
6. What about mutations?
If toxic-waste-induced mutations in the canalization of New York caused harmless, cute reptiles to turn into vicious, crime-fighting teenage turtles then mutations of the virus must be something very dangerous and we should be afraid. Or not?
This question was addressed excellently in a recent article by two Professors from the Grubaugh Laboratory at the Yale School of Public Health. Petrone and Grubaugh explain that mutations in viruses occur relatively often since their replication mechanism does not entail a ‘spell-check’ as it does for higher life forms. In human cell reproduction there exists a mechanism that ensures that the ‘copy’ (=new DNA) equals exactly the original. Since this mechanism is absent in the so-called RNA-viruses (to which the coronavirus belongs) they make many copy-mistakes, i.e. mutations occur regularly.
Envision it like this: you have a perfect plan for your house from a competent architect – and now a chimpanzee plays around with the variables and just changes things as his banana tells him. This is a good analogy to mutations. How often will that result in a better house? Most of the changed systems will not be inhabitable or wouldn’t even stand the slightest wind, much less the hurricane of an immune system.
The vast majority of these copy-mistakes lead to the death of the virus or, alternatively, to non-relevant changes, i.e. neither its contagiousness nor its lethality nor the symptoms in humans change. These ‘neutral’ changes may circulate together with the original form without any noticeable change to humans. Petrone and Grubaugh write:
“ Viral traits such as infectiousness and disease severity are controlled by multiple genes, and each of those genes may affect the virus’s ability to spread in multiple ways. For example, a virus that causes severe symptoms may be less likely to be transmitted if infected people are sick enough to stay in bed. As such, these traits are like blocks in a Rubik’s cube; a change in one characteristic will change another. The chances of a virus navigating these complex series of trade-offs to become more severe during the short timescale of an outbreak are extremely low.”
Even if mutations occur and produce survivable forms of the new virus this does in all probability not decrease the effectiveness of future vaccinations or treatments. It can take many decades till a virus develops a vaccine resistance as can be taken from the fact that vaccines against other RNA-viruses were developed sometime between 1930 and 1970 and are still effective (yellow fever, measles, mumps).
It is, therefore, highly likely that a vaccine and/or treatment developed against the SARS-CoV-2 strain will also be effective against its mutations for a long time to come. The same holds true for the immunity developed by the people who had the virus.
7. Reality is not as dark as it might appear to you – what we experience is called an ‘Availability Bias’
If you feed yourself the news 8 hours a day, it takes over your reality and taints everything else. It becomes your entire reality instead of a portion of it.
In behavioral economics an ‘availability bias’ describes a tendency of the human mind to favor information that is exactly that, particularly available. Availability for the way our mind works is influenced by how recent, how vivid and how emotionally arousing a piece of information is.
If information is fresh in your mind and/or amply available, it tends to get an over proportionate amount of attention and role in your perception, evaluation and decision making. If you were robbed yesterday it is likely to influence your behavior today more than a robbery that happened 30 years ago. But the probability of the event happening has not changed.
Pictures of trucks full of corpses 20 times a day definitely fulfill these criteria. But this is NOT the entirety of reality.
China had 0.2 deaths per one hundred thousand people. 0.2 too many, I agree. But no reason to freak out or envision the end of the world. Spain and Italy had around 30. Terrible, yes. That’s not debatable. Devastating for those who get hit. Whenever you lose a loved one, it tears out a part of your heart. I know. I have been there.
Please take a look at Figure 6 which depicts deaths of COVID-19 patients per 100,000 inhabitants of the respective country (based on numbers provided by John Hopkins ):
Figure 6: Deaths caused by COVID-19 per 100,000 inhabitants by country as of April 08, 2020
But the question we are talking about is if there is reason to believe we have come to the end of the world as we know it, and this is NOT the case!
Assume you live in Frankfurt. 500,000 inhabitants. 150 die (Spain’s mortality rate). Should I really freak out? No. Not really.
Yes, we had 65,000 deaths caused by COVID-19. And the number will continue to rise. But we also had an estimated 9,600,000 deaths caused by cancer in 2018. How often does this freak you out? Do you avoid the major behavioral and dietary risks (being obese, low fruit and vegetable intake, lack of exercise, tobacco, alcohol) or even the ‘smaller’ ones like barbecuing? Once you put the numbers into perspective it will feel differently.
Too much of the daily news is pure poison. We shove too much of the same bad food in our mental mouth – and then are surprised when we feel like throwing up. Stop feeding your mind with poison and you will feel better. And more in touch with reality.
What you feed your body determines your physical health. And what you feed your mind determines how you feel. If you continuously drink from murky sources, you feel sick. But this is a choice, not destiny.
8.There is a lot you can do beyond hygiene and isolation – actually, the most important things are not about washing hands…
This section is an informed guess – there is not yet enough hard evidence available to show why certain people survive the virus and others do not. But some common sense might do…
What we know for sure is that the vast majority of people who die from the virus have at least one if not more pre-existing conditions and/or are relatively old (i.e. above 80). Only 2-3% of the COVID-19 related deaths occur in the age group below 60.
Now, in regard to COVID-19, what is the key difference between a person with pre-existing conditions like diabetes, obesity and cancer and a healthy person? And what is the key difference between an older person in comparison to a younger one? In all probability the answer is their immune system. As you get older your immune system tends to get weaker (e.g. less T-cells produced) and therefore you are more prone to infections.
But the important point is that your immune system depends to the largest degree on lifestyle choices more than any other factors! To date, there has been a mountain of evidence that proves that the strength of your immune system is NOT a genetic destiny. This holds true at every age. To give just on example, in a study lead by the UC San Francisco it was shown that sleep deprivation nearly tripled the susceptibility to catch the common common cold, as you can See in Figure 7
Figure 7: The effect of sleep deprivation on the susceptibility to catch the common cold
The scientists concluded:
“Short sleep was more important than any other factor in predicting subjects’ likelihood of catching cold (…) It didn’t matter how old people were, (…) statistically sleep still carried the day.”
I am totally convinced that the same logic also holds true in re to SARS-CoV-2.
There is so much you can do. Do you give your body the right nutrition and nutrients? Sugar and processed foods tend to cause inflammation which in turn weakens the immune system. It is common for individuals to be deficient in vitamin D, selenium, and zinc – but they are all essential for our immune systems, e.g. the best source of selenium are brazil nuts, but you probably don’t have that for breakfast, lunch and dinner every day, do you? Just one example of many. There is a lot you can do through your nutrition and/or supplements. Research it.
Cold showers and saunas have been proven over and over again to strengthen the immune system. So have getting the right amount of sunlight, exercise, touch, good hydration, intermittent fasting and meditation (inner peace changes your biochemistry).
The best thing you can do is to make your immune system so strong that you don’t need to think about whether you touched somebody infected by the virus – because it just does not matter if your immune system is strong enough.
9.Conclusion – will we ever dance together again?
It will take time and a lot of patience and self-restraint. But we will be back.
COVID-19 is here to stay like HIV. We will learn to live with it. Sex did not stop just because HIV exists… maybe a bit more care is taken. Not a bad thing overall. The same will happen with COVID-19. At least we all learned how to wash our hands properly.
Case fatality rates will continue to decrease as we see more and more people developing immunity. We will have treatments that help alleviate the symptoms, as for HIV. We will be better prepared to react to outbreaks of this magnitude. Our democracies will be a bit more autocratic during times like these – and we will be ready for it (the China-model has its strengths, actually…). We will also have more ICUs.
And then… COVID-19 will disappear from our public perception and be just another type of flu that we are used to. Some years bad, normally bearable.
All of this is not that far away. The road there is tough, bumpy and painful. But this is not the end of the world. We will dance, hug, kiss, play football (the real one, the one you play with your feet…), do business and shake hands again.
Just hang in there.
10. A last word (well three)
There are three shout-outs with which I would like to close this article:
We hear a lot about ‘social distancing’. I think this wording is severely misguided! It should say ‘physical distancing’ but ‘social cohesion’. Words create realities.
During the unfolding events of this crisis we have been shown how fragile life can be. How fragile our societies can be. How fragile our businesses can be. This is an opportunity to look inside and become a little humbler. Slow down. Reflect. Think about what is really important. And adjust. From a strategic level, to a personal level.
As the human race as a whole, we have to finally face the fact that the nation-state is no longer a functional unit when it comes to addressing our real problems. The risks and challenges posed by climate change, nanotechnology, biotechnology, artificial intelligence, and last but not least globalization and the potential spread of pandemics can only be addressed on a global level.
We need a much stronger form of global collaboration that goes far beyond the current tribal feelings associated with nation-states. We need to understand that in regard to our biggest challenges we are not Chinese, American, French, German, Italian or Nigerian – we are just human.
It should not say God bless the Queen (or America). It should say God bless humanity. Stay safe, be blessed!
 As far as possible I avoid using the word ‘coronavirus’ for two reasons: first, the virus is not our problem, the disease is. Secondly, I like Corona beer and they are unfairly severely hit by the naming of the pandemic. Just make sure nobody calls the next virus Chrysler, Paribas, Tata or Siemens…Anyhow, I avoid the word as far as possible.
 Read JM, Bridgen JRE, Cummings DAT, Ho A, Jewell CP. Novel coronavirus 2019-nCoV: early estimation of epidemiological parameters and epidemic predictions. MedRxiv. 2020.
 Nishiura H, Kobayashi T, Yang Y, Hayashi K, Miyama T, Kinoshita R, et al. The Rate of Underascertainment of Novel Coronavirus (2019-nCoV) Infection: Estimation Using Japanese Passengers Data on Evacuation Flights. Journal of clinical medicine. 2020;9(2).
 This will in all likelihood not be the entire explanation since this hypothesis cannot explain why small children are almost NOT impacted or why men are on average impacted much more than women (50%-100%) by COVID-19 deaths. There will, therefore, be other drivers at play too. More research is needed to answer these questions.
 This will in all likelihood not be the entire explanation since this hypothesis cannot explain why small children are almost NOT impacted or why men are on average impacted much more than women (50%-100%) by COVID-19 deaths. There will, therefore, be other drivers at play too. More research is needed to answer these questions.
 Prather, A.A, et al: Behaviorally Assessed Sleep and Susceptibility to the Common Cold, in: SLEEP, Vol. 38, No. 9, 2015.