The Elephant and the Virus

With respect to the coronavirus pandemic, I am concerned about India. Given their population density and more than 1.3 billion residents, the virus situation there could soon make what’s happening in Italy and Spain look tame.

Earlier this week India was reporting only 129 infections and 2 deaths. Today it’s at 249 cases and 5 deaths. While those numbers may seem ridiculously low relative to India’s population, they appear to be starting out much the same as any other country.

While mathematical illiterates might dismiss these numbers as trivial, fortunately India’s Prime Minister and their National Security Council are paying serious attention to what’s happening elsewhere. Consequently, India has been on lockdown since March 18 and plans to continue through March 31. I think they’ll need significantly longer, but it’s good to see them taking this step.

India’s director of the Center for Disease Dynamics, Economics, and Policy, Dr. Ramanan Laxminarayan, warns that India may have to deal with a tsunami of about 300 million coronavirus cases. He estimates that India has 70K-100K ICU beds in the entire country. Note that the total ICU beds in the USA are also estimated to be in this same range, and the USA is already on a path to overflow these beds in the weeks ahead but with a billion fewer people.

One of my concerns is that India may be severely under-testing. So I’d pay a lot more attention to the death count than to the infections reported and watch what that number does in the weeks ahead. When testing is weak, deaths are more likely to be noticed than infections, especially as more people who are struggling to breathe seek medical care.

If you look at other countries with death totals close to India’s, many are reporting significantly more infections. Austria, Denmark, Norway, Malaysia, and Portugal all report 3-7 coronavirus deaths so far, and their reported infections range from 1020 to 2491. Now there are lots of other countries with similar death totals but with lower infection counts closer to India’s, and by and large these are countries where testing appears to be very limited.

Since the death numbers are so low, they may not be significant right now, but this is something for people in India to watch carefully in the weeks ahead.

Note that just 25 days ago on February 24, Italy was at 229 reported cases and 7 deaths, which is very close to where India is today. Now Italy is at 47,021 cases and 4032 deaths – 5986 of those cases and 627 of those deaths in the last 24 hours – and still rising faster and faster. Also note that India’s population is 22 times the size of Italy’s.

That said, I am seeing solid evidence that India is being a lot more intelligent and cautious about this virus than many other countries. They’re way ahead of the USA, getting to lockdown much sooner. In the U.S. the inevitable lockdown is unfolding on a state by state and even city by city basis. California just went into statewide lockdown last night. Other U.S. states will soon follow. Slow-rolling a countrywide lockdown instead of going there immediately means more people will suffer and die, including more medical staff. This should be coordinated at the federal level like India has done. The leadership void at the top means that state governors have to step up now more than ever to help compensate as best they can.

Many countries are seeing their infections and deaths ramp up tremendously, and this will go considerably higher in the weeks ahead as we go higher up the exponential growth curve. In time this will reveal the price each country pays for underestimating this virus.

While practicing social distancing and going into lockdown are key steps that will save many lives, abundant testing is crucial as well to understand what’s happening and to know if measures are being effective or if more is needed.

One key risk I’m seeing in India is overconfidence. This is an easy trap to fall into when the numbers are still low and especially when you’re already in lockdown and practicing social distancing. While it’s commendable that India has implemented serious measures sooner than most, there’s still a potent risk of falling into the overconfidence trap by assuming that it’s enough.

Moreover, compliance can be a real problem too. In my home state of Nevada, we’re under partial measures for at least 30 days. The hotels and casinos are closed statewide, which hasn’t happened since President Kennedy’s assassination in 1963, and that was only one day of closure back then. As extreme as this may seem, especially for the 206K casino employees who are out of work now, we’re still just stair-stepping our way towards a full lockdown. Meanwhile it’s being reported that non-essential businesses remain open, including some restaurants and retail stores. Some businesses are still telling their employees to come into work, even where people must work in close proximity to each other, and the employees feel they have to show up because they don’t want to lose their jobs. Some will lose their lives because of it. So the existing directives aren’t being complied with yet. In fact, the Vegas police have been getting so many phone calls about these violations of the Governor’s order that they’re telling people to stop calling to report such businesses.

Even with really good government measures in place, the practical reality of this situation is that when we think we’re doing enough, it’s more likely that we’re being overconfident and not being cautious enough.

The challenge this virus presents is that in order to get aligned with its behavior and respond appropriately, we must consistently do more than we think is necessary, which is an uncomfortable place to be. When we think we’ve finally implemented what’s necessary and can settle in at that level because surely it’s enough now, we’ve succumbed to overconfidence, and the virus will make additional gains because of that, including overwhelming hospitals and medical staff.

So in this case, it’s good to feel like you’re overdoing it by being more cautious than you think is necessary. It’s also good to feel like you’re taking more social risk than usual to rein in sociopathic behavior.

The most caring and compassionate people I know are feeling very socially uncomfortable these days; they’re all getting some social blowback because they’re stretching themselves to do what it takes to save lives and reduce suffering. They can see plain as day that it’s the right response under the circumstances though. When they get overwhelmed, they do whatever they need to do to recharge, to accept reality, and to forgive, and they go right back into the fray. Heroes all of them. The people who’s lives they save may never know it, and the work they’re doing is largely thankless, but I want them to know that I personally appreciate and applaud their efforts.

Under current circumstances, the torrent of vitriol that was unleashed upon the Floridiot Governor for permitting spring breakers to crowd the beaches earlier this week was an appropriate response to sociopathic behavior. And it was effective. That Governor quickly caved to the onslaught of social and political pressure and shut those beaches down.

At the national and individual levels, we all need to stretch ourselves further into the zone of discomfort. For the next several weeks at least, we need to bid enoughness adieu and embrace the discomfort of toomuchness.

Perhaps India has achieved enoughness in their response, which may impress some humans but isn’t enough to earn the respect of this virus. This virus eats American enoughness for breakfast, Spanish enoughness for lunch, and Italian enoughness for dinner. And presently it seems to be developing an appetite for British enoughness at tea time. Along with the rest of us, India’s challenge is to push further into toomuchness and stay there for a while. Maybe they can teach this virus a thing or two about fasting.