Who to trust on the Corona virus pandemic?

During a pandemic people want answers. But who should we trust? What are the best sources of information on the Covid-19 pandemic? Media? Government health officials? Universities? Vaccine manufacturers? None of the above?

As most of us now realize, the Covid-19 variety of corona virus has spread to more than half the world and has, for all practical purposes, been a pandemic at least since March 1, 2020, meaning it is a widespread, global epidemic where an infectious disease is spreading rather uncontrollably. We will get into the specifics of that definition, and why it matters, shortly.

Covid-19 is a global pandemic, a fact CNN acknowledged on March 9th, which likely soon will lead CDC and WHO to do the same to avoid confusion of terms and to regain brand territory in this more than semantic definition.

Before we move to the somewhat academic point of where to find trustable information from first hand sources (academic, but it could save your life), let’s just briefly mention some of the symptoms of severe Covid-19.

Symptoms of severe Covid-19

There is so much talk of it being “jut like the flu”, but a percentage of those infected experience severe cases of pneumonia and shortness of breath; many have septic shock and organ failure, and the risk of death generally increases with age, and some die. We just don’t know exactly in what percentages and what groups are most at risk, although early evidence points to people with preexisting diseases.

Covid-19 might be a mild one among the serious pandemic viruses we know of so far (most virologists and public health officials agree), but it is definitely not the flu. Covid-19 and the common flue differ in severity and transmissability. Which is not to say that the flue is not bad enough (and curiously don’t get a lot of headlines). But the two points to be made are different.

Should media be the go-to source?

The mainstream media is often very quick to assert their voice. They not only want to be the first to report news, they also want to be seen as the most trusted. Many strategies exist to do so. One of them is to continuously bombard us with slightly different angles on the same issue, several times a day, until we give in to their claim to attention by sheer exhaustion. The exhaustion tactic is of course more pronounced in headline news-style TV but is also a common strategy on the web.

However, if you sit back and reflect for a moment, what are the two or three go-to sources you have used for updates on the Coronavirus? I’m willing to bet you quickly come up with at least one source. Now, are you sure they are the best, or are they simply the most convenient?

What media typically does is to lean on expertise from others. A true and tested approach is to have a shortlist of local experts mostly from academia, whose main characteristic is that they are willing to step in without delay and comment on absolutely anything that comes their way. Other, more niche experts, are typically in less demand, since they are less useful before a deadline.

That being said, large national media might have a medical correspondent, which obviously makes things slightly easier and potentially also makes them more credible as a media source. However, that person, typically either has a specific medical degree or simply has written medical stuff for a while, which does not make them domain experts on anything in particular. Whatever they did practice they typically don’t have much time to practice any more, so even their original source of expertise might be somewhat rusty. This is not to criticize that profession just to situate them properly in the debate.

The top sources of health insight

When attempting to obtain health insight, both the specialist and the layperson is confronted with a myriad of options: media, government, private sector, nonprofits and academia all claim relevance on the issue.

But since this is a very serious matter, let us take a slightly more structured approach. Let’s not go directly to public health authorities, whether they reside in government or in academia, because that is rarely the first place the public goes to inform themselves. And, as busy professionals, we sometimes also allow ourselves the shortcut of letting a more random set of impressions color our reality, even if we shouldn’t.

Given how little is known about the virus, a few sensible approaches would be: (1) seek sources in geographic proximity with the major outbreaks (currently in China, Iran and Italy) who presumably have personal experience with treating patients and might have accumulated some wisdom on the job (if not from the literature). Another approach would be to (2) look for experts in viruses, ideally on the Corona virus itself. A third approach would be to (3) consider this more of a public health issue and rather seek public health experts who can say more about the spread of the disease than its exact etiology.

How does Covid-19 spread?

Specific questions will also have different experts or responsible officials. If you are asking (1) how Covid-19 will spread or whether it is containable, this is a question for public health specialists. Insight on this question from a variety of primary sources, coming in the next blog post.

What to do about the pandemic? What’s being done?

If you are asking (2) what do do about the pandemic, this is increasingly a political question, given its massive policy ramifications and economic impact on our society (beyond the human consequences, which are, of course, also significant). If you are asking what’s being done, one would think that’s a question for government, but, in fact, mainstream media might have a better overview and definitely better infographics.

Should I travel?

If you are asking (3) should I travel, this is a complex question involving your health age (are you 70 but run marathons, you likely need not worry as much as a 55-year old with pre-existing lung conditions), but answering the question requires knowledge of what various countries will do in terms of containment, your risk profile, your budget and so on.

The interesting game playing out right now seems to be that politicians want to delay the exposure until they have more of their test kits, supply chains, and coordination in place, whereas the public don’t necessarily gain as much on that same strategy.

If what some experts say pans out, namely that 40-70% of the population in most countries could eventually get Covid-19 (you can see who says so below, including the Harvard epidemiology professor Marc Lipsitch in an interview in The Atlantic), does it really matter when? The numbers are so staggering that it is unlikely that any kind of public response would be able to cope with such numbers, no matter how many weeks or months they delayed it. If it goes that way, the discussion should, already, take on a different tone: what does this mean?

In reality, Covid-19 is perhaps the world’s lucky break. As counter-intuitive as it seems right now, a moderately severe pandemic might be just what the world needed as a wake-up call.

Trond Undheim, futurist

Can you imagine what would have happened if Covid-19, with its current spread, had EBOLA’s mortality rate. We clearly were not prepared for a pandemic. Not that this is a surprise to anyone, just that our current crisis simply proves it out in very clear, empirical terms.

But back to our current crisis, which is serious enough, to say the least…

Geographic proximity to the ongoing crisis

If we use the geographical approach, we might come across the following: Iran news, Iran govt, Iran NGOs etc.

However, the issue is of course that Iran is not a major source of transparent public health information right now, given the political climate. It would have helped if Iran was on speaking terms with the US right now.

From China, we do actually get a lot of information, just not all completely reliable. We do get numbers out of Wuhan, but not much more. Given the poor record of foreign journalists in China, we have little reporting on the ground. What we assume is this: China has somehow still got an iron grip on its people and society and are able to contain this disease by keeping people indoors. It almost sounds too good to be true. And, it is completely unrealistic as a strategy for the rest of the world, although Italy seems to be trying it out right now in Lombardy. I know enough Italians to know that this is going to be hard to pull off culturally.

The Italian doctors leading the effort to combat Covid-19 in Northern Italy issued grim advice recently, essentially saying to the world: “be prepared”. As with all such advice, it seems theoretical until you suddenly wish you listened. Many countries and cities are simply trying to hope this does not become necessary. And maybe it won’t.

Virus experts–the researchers

If we use the virology approach, we’d have to find the world’s top virologists. Where to find them? Well, they have associations, they can be found in academic departments and at university or research hospitals.

In the US, the immunologist with the highest public profile is Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases.

Fauci is not alone. The American Society for Virology was founded in 1981 as the first scientific society in the world dedicated exclusively to virology. The American Society of Virology’s 39th annual meeting, ASV2020, to be held at Colorado State University in Fort Collins, Colorado, is bound to be an interesting affair for specialists as well as the general public at this point.

A retweet that appeared on their website on Feb 29 stated: “Right now, I’m most worried about our front line healthcare workers – if they go down our whole system implodes.” The ASV (@AmerSocVirol) was retweeting Prof Peter Hotez MD PhD (@PeterHotez), but the point is this: that tweet is not exactly the kind of reassuring and boring research banter that should go on around a scientific conference. Now, there is also a World Society of Virology and a bunch of other associations.

There are few corona virus experts even in western countries like Sweden. What do you think that means for Africa?

Trond Undheim, Futurist

However, don’t assume there are the right virologists everywhere needed. Not even top western countries all have their own Corona virus experts. For instance, it turns out there are virtually no Swedish virologists doing research specifically on Corona virus, according to Swedish virologist Niklas Arnberg (quoted in Svenska Dagbladet, in Swedish).

Hard to believe, but seems to be true, although nobody told the team of scientists at the famous Swedish Karolinska Institute who according to Radio Sweden now are trying to develop a prototype vaccine against the virus. Either they just started or one of these facts are wrong (or perhaps no previous experience with this exact virus is needed given that what they seek is a broad spectrum antiviral anyway, or perhaps they have called in global experts?).

See how complex reporting on this virus can be? Karolinska is among the few that could rapidly kickstart something, since a secure facility is needed, and few hospitals have the permits or facility required.

I haven’t checked every other Scandinavian country, but would be surprised to find many Corona virologists there either. What do you think that means for countries in Africa? Now, obviously many countries have virologists, just not Corona virus experts, meaning they have not worked in any meaningful way on any of the Corona virus strains. This just proves what kind of a special expert niche a pandemic caters to. We should perhaps from that angle be happy that there is collaboration across borders, to which we will turn now.

Networks of virologists collaborating

There are outfits like the Global Virus Network (GVN, https://gvn.org/), a coalition comprised of leading virologists spanning more than 20 countries worldwide. The “GVN brings the best medical virologists together to leverage individual strengths and to focus global teams of scientists on key scientific problems” through research, public education and advocacy. At least that, but what do they know about Covid-19?

Already on Jan 7, they had a press release about an “unknown viral outbreak in Wuhan, China”, on Jan 10 they had a statement on the new strain, which was updated on Jan 21 followed by a PR statement of their resources on Jan 30, and expert discussion on Feb 6, and a short briefing on an international coordination effort on Feb 18 with work on antibodies, diagnostics, a new genomic sequencing method, antiviral testing, vaccine testing in both cells and mice, as well as sharing advanced diagnostics kits with African nations, among other things.

Right now, I’m writing March 8, almost a month later, with no new public notice of significant additional contributions). This should tell us a little bit about the speed of state of the art science at the moment. Even the best of the best do not operate at the speed of this virus nor at the speed of the media reports asking for expertise and certainly not at the speed affected individuals or worried bystanders need. GVN’s media contact is Nora Samaranayake (see GVN’s Feb 18, 2020 press release).

Government public health experts–the planners

At Yegii, the first question we would ask is this: what are the top publishers of information related to public health (see Yegii’s list of top web publishers, requires creating a free login).

We might, early on, come up with a few large and fairly reputable national health agencies, perhaps National Institutes of Health (NIH) in the US or the National Health Service (NHS) in the UK. Then, the next question would be, what are the biases of those institutions.

Very quickly, we’d realize that given that they are each part of a national political structure, their advice is not objective. Rather, they are representative of the current public policy regime of that given country. However, they are often not led by political appointees, so they are less blatantly political than, say, a President or a Prime Minister.

Trump says he has a “”perfectly coordinated and fine tuned plan”, and downplays the risks and contradicts his own public health experts, although his own Vice President who is in charge of the US government’s strategy on Covid-19 openly has admitted testing kits for all who need it should be available “soon” (implying that all is not perfect).

UK Prime Minister Boris Johnson has (seemingly) taken a more Draconian approach and warns both of coming restrictions on public life including no-go zones and potentially banning mass public gathering as well as economic consequences. Admittedly, the timing presents a double whammy for a UK just out of the EU. The UK government’s action plan has four stages: contain, delay, research, and mitigate, but the question is whether any meaningful containment has taken place (not that it is very realistic, anyway). Johnson has made it a point to continue to shake hands (and, very likely, bragged too soon about shaking hands with Covid-19 victims which were likely nothing of the sort), but immediately wash hands. The UK message is for people to wash for 20 seconds, which at least is fairly concrete.

However, the issue facing the UK is grim if the pandemic continues to spike. Notably, data from New Statesman (article) suggests there are some 100,000 hospital beds in the UK and only 9000 are routinely free on any night. A reminder: The UK is situated on an Island that just marched out of the EU which might have had spare capacity somewhere on that sizable continent.

On March 9, Italy announced the whole country is under lockdown. On the same day, Israel announced that everyone who travels to the country, Israeli citizen or not, will be requested to do a two week voluntary quarantine. In the coming days, similar announcements are expected from around the world. National authorities are starting to take the disease seriously, perhaps too seriously?

Different national regulatory regimes are culturally specific, which also means that the degree of adherence to them varies, as is commonly known. Trust in government varies (see studies). Quarantines will not always be adhered to. China is quite unique in that respect.

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Mainstream Media–the brand watchers

In the US, obvious sources of televised insight comes from the two opponents, CNN and Fox News, which both have around the clock news coverage. CNN’s Chief Medical Correspondent, Sanjay Gupta, has been highly visible in the Corona virus story, often with a quite sensible, thoughtful approach, but not without teeth, such as when he disagreed with President Trump on the air during an interview session on his death rate “hunch” that it’s lower than the flu. On March 9th, Gupta (and CNN), as stated above, declared Covid-19 a pandemic–perhaps not revolutionary, but bold, nonetheless.

Fox News Medical Correspondent Marc Siegel has had a different tone, as late as on Feb 28, 2020, calling the World Health Organization (WHO) “a bunch of alarmists” (see article) and more recently on March 6, “we can get a vaccine to fix all of these strains” (see article).

The question we all have to ask is, beyond creating good TV, what are they actually contributing to the discussion? Does it make us feel safer? Does it contribute to the intellectual debate? Does it push policy forward? Does it provide personalized advice apt to our own situation? If it does none of the above (and I’m not saying it is), or even if it only does some of the above, we should look elsewhere for insight or guidance. I know I do, most nights.

At the end of the day, mainstream media is mostly a game of maintaining and staying on brand. It is in their interest to protect the main message that fits with their style of media, whether it is to sound alarm on the sitting administration, particularly if it is Republican (CNN) or to defend it, particularly if it is Republican (Fox). Having said that, in Yegii’s analysis of the quality of mainstream media, CNN and Fox have radically different scores (you can check this on Yegii’s list of top web publishers, requires creating a free login)

Medical & Health Correspondents in mainstream media or online

• CNN’s Sanjay Gupta (@drsanjaygupta)
• Fox News’s Marc Siegel (@drmarcsiegel)
• ABC News’s Jennifer Ashton (@DrJashton)
  The New York Times’ Science & Health reporter Donald G. McNeil Jr. (@nythealth)
• NPR’s Global Health and Development Correspondent Jason Beaubien (@jasonbnpr)
• The Guardian’s Health Editor Sarah Boseley (@sarahbosley)

See a large list of Health Journalists on the Internet compiled by the Association of Health Care Journalists (AHCJ). Help a Reporter (H/A/R/O) is another resource often used by journalists to find experts.

International Organizations-the bureaucrats

This is not the best time in history for international organizations. Under threat from stifling bureaucracy, under-funded, and out of synch with the times, agencies like the WHO (and others) have had a hard time asserting any authority at all during the Covid-19 emergence and rapid pandemic status over the past three months.

The WHO has not declared Covid-19 a pandemic, despite massive evidence building up, and potentially wasting valuable weeks where that definition would release national emergency funds, change the tone of the debate, and would more appropriately characterize the situation.

The timelines of international institutions are not hours, not days, not weeks, the only two measures of time that counts is months and years. They need time to assemble committees, obtain evidence, discuss, have votes, and then, it has to be said: relatively poorly, attempt to communicate their disjointed messages that are no match for online click bait (the truly fake news) and mainstream news (the sensationalist coverage that inevitably follows the headline news cycle).

Tellingly, today, doing research for this article, was the first time I actually checked the WHO’s Coronavirus disease (COVID-19) outbreak page. What I found was not encouraging. The WHO’s top story page’s banner image is a crowdsourced version of The Beatles’ Abbey Road album cover, you know, the one where they cross Abbey Road. What’s the message here? Carry on walking, don’t panic, play rock music?

Just to turn insult into injury, the WHO’s Twitter page has a mere 5.7M Followers. Now, it’s more than mine, but does not scream they are a player in online debates. Even @realDonaldTrump has 73.5M Followers (well, glad to know he is taking care of business … “so much FAKE NEWS”, … is what the “world’s greatest President” tweeted 1h ago as world stock markets tanked with the oil price and the pandemic (which are related because they correlate, which is a statistical term for things that go up and down together in a pattern, and possibly even have a causal link–as in lower travel -> lower oil prices, just to spell that out, and the world’s population is going into a (much anticipated) panic.

An overlooked factor in why the World Health Organization is less effective in its communication than ever, is the fact that their abbreviation is a common word. In the age of Search Engine Optimization (SEO), searching for WHO, tagging something with #WHO is far-fetched, just try it yourself. Now, Google, with all its might is onto this and have put in place a temporary fix, but this will not be the case across the board and on other websites and search engines, and only works for the first 10 or so hits. As strange as it seems to many outside the online marketing field, changing the name of that organization is a must before the next pandemic!

An overlooked factor in why the World Health Organization is less effective in its communication than ever, is the fact that their abbreviation is a common word.

Trond Undheim, Futurist

How many of us known the name of WHO’s Director General Dr. Tedros Adhanom Ghebreyesus? Fair enough, his name is hard to spell, but shouldn’t he be a household name by now?

In defense of the WHO, their activity is evidence based. Their daily situation reports are thorough and high in meticulously collected statistics. The March 9 report contains numbers for total confirmed and suspected cases and deaths on a per country basis. However, these numbers are aggregates and say little about the actual activity on the ground.

In the following, I’ll consider a wide variety of organizations who are active in interventionist global health, whether they are fully, partly or not at all government funded. Think tanks and other types of more reflective, scientific and policy based nonprofits are considered in a separate section below.

Project Hope, with an annual budget exceeding $100 million, is the largest NGO devoted to international health in the United States. Worldwide, corresponding organization would be Oxfam, International. The Red Cross comes into play for disaster aid. Doctors without borders will deliver care to war-torn areas which typically are particularly vulnerable to infections. Care provides “care packages” with nutrition and will likely become instrumental if logistics becomes a bottle neck. Save the Children’s role is self-explanatory, yet highly important. Bilaterally, USAID is the most important.

The Surgeon General–the pointed fingers

Public health, however, is complicated. For instance, each country typically has a Surgeon General or a Chief Medical Officer, depending on whether it is a military role or not. In the US, their mission is “to protect, promote, and advance the health of our nation”. Which is great, except they are not infallible either. I happen to live in the US, and Jerome Adams, US Surgeon General appealed to the public last week pleading us “not to buy surgical masks” so as not to take them away from health officials who were in much greater need of such masks. Have you heard anything crazier than that?

Had he not realized that people are smarter than that? We are not stockpiling masks only because we want to wear them on the street or on airplanes (although some are), but rather in case a loved one becomes ill and we have to care for them. How on earth is that an example of protecting the nation?

It would seem that the government should have protected their own supply chain ages ago. Any great public health plan should have included ways to procure a sufficient number of surgical masks during a pandemic. In that interview the US Surgeon General simply became a mouthpiece for a failed US pandemic preparedness plan.

So far, Surgeon Generals’ advice boil down to wash your hands and carry on. So much for nuance.

Surgeon General offices

• US Surgeon General (U.S. Department of Health & Human Services (HHS), Twitter)
• UK Chief Medical Officer (CMO) – Chris Whitty
• Canadian Chief Public Health Officer – Theresa Tam

Political authorities–the talkers

In the US, Alex Azar, United States Secretary of Health and Human Services, is the highest ranking public health official with any kind of domain expertise. However, with his background as an attorney, politician, pharmaceutical lobbyist, and former drug company executive, his in-depth expertise on Covid-19, by any measure, is commonly thought of as fairly limited.

It is not that lack of domain expertise necessarily stops officials from making good decisions. There are plenty of examples of good politics being carried out by generalists (although the opposite is also the case). However, lack of awareness is slightly more worrying in the domain of health, given the myriad of concerns that necessarily are medical in nature or require an enormous amount of explanation for non-specialists to voice their informed opinion (present company included).

Azar is the overlord of The Centers for Disease Control and Prevention (CDC), which have been fairly visible in the US response, but have had a hard time balancing their science with Trump’s politics. However, that situation is understandable and typically understood by specialists who coordinate with them, but less so the public. CDC also has a large international role as the disease control agency with the biggest resources.

There is some indication they are not on top of things. For instance, their resource page is pegged Coronavirus Disease 2019 (which makes many miss the page, I was about to overlook it myself).

National Health Agencies–the doers

National Health Agencies are lower in the bureaucratic jungle and that is good in terms of objectivity. Because they have substantial domain expertise and operational teams, they are slightly removed from the political realities, even though they are, of course, part of government.

Shortlist of National Health Agencies and relevant outbreak info

• National Institutes of Health (NIH) in the US
• National Health Service (NHS) in the UK
• Public Health Agency of Canada (Coronavirus outbreak update)

Big pharma–the drug overlords

Sanofi, Pfizer (possibly partnering with German BioNTech) and J&J’s Janssen have all signed up in the battle for a vaccine. Among the smaller pharmas, Inovio, Moderna, CureVac, Applied DNA, Takis Biotech and Novavax are in the race (see WHO vaccine landscape blueprint), along with a bunch of universities we will get to next.

Interestingly, timelines for a possible vaccine vary wildly, which is somewhat surprising, given the express nature with which regulatory approval will take place in this case. Will it take 1 year? Will it take 8 months? Will it take almost 2 years?

Inovio has published a timeline which claims it will start human trials in April aiming to publish results in fall and to have a million doses by year end, unless they get additional resources. At that pace, we are nowhere near a global vaccination program which would need to reach billions of people, certainly hundreds of millions, in order to be effective (see HPN article).

Academia

What to expect from academia? Surprisingly to many, academics in the life science area are very proactive. Far from the theory-laden academics you might still find in other fields, life scientists are just that, they care about improving life both in the here and now and in the future. What this means is that they actively innovate, create startups, license technologies, and interact closely both with government funding agencies (obviously) and with private sector to get their projects realized.

Similarly, global health researchers are another set of highly engaged academics in the public debate. These are the folks that populate UN discussions, government expert panels and the like.

Trudie Lang, professor of global health research at Oxford University

In the US, the five best Public Health schools, according to the US News and World Report are:

• Johns Hopkins University in Baltimore, MD
• Harvard University in Boston, MA
• University of North Carolina–Chapel Hill, in Chapel Hill, NC
• Columbia University in New York, NY
• Emory University in Atlanta, GA
• the University of Michigan–Ann Arbor in Ann Arbor, MI

Johns Hopkins actually published a March 8 study confirming that the median incubation period of Covid-19 is 5.1 days, and that “about 97.5 percent of people who develop symptoms of SARS-CoV-2 infection will do so within 11.5 days of exposure”. This is useful info because it confirms that a 14 day quarantine period is reasonable. Furthermore, their 2019 Global Health Security Index is interesting in the virus context.

Global Health Security Index — who is prepared?

The GHS Index shows that “collectively, international preparedness for epidemics and pandemics remains very weak”, which we now know to be true. However, the US overall score of 83.5/100 is questionable, the UK’s 91.9/100 score on rapid response and mitigation is downright laughable (they have a full-fledged outbreak in the making), although perhaps it means they can rapidly recover lost time.

Iran’s 37.7/100 overall score and 97 position, 452nd position on “prevention and the early release of pathogens” and 62nd position on “robustness of health system” is downright scary knowing what we kind of know (and don’t know) about the spread of corona virus in Iran at the moment (more on that in the geographical section). Compare that to Italy’s 31st overall score, and its 51th place for “rapid response and 54th place for “robustness”, which is also not fantastic, but much better.

My main observation re-reading the GHS Index in light of recent events is that theory and practice are vastly different things.

Having five or more top Public Health schools in the US is great for Americans, but it doesn’t help others much unless they have access to this expertise online or otherwise. Each country with an outbreak has their own list, but clearly public health is not an expertise that is evenly spread out across the globe. IF we look at Times Higher Education’s ranking lists for health subjects, we can add a few UK universities to the list:

• Oxford
• Cambridge
• Imperial college
• UCL

Further down that list, a few moure countries appear:

U Melbourne (Australia)

Toronto (Canada)

Karolinska (Sweden)

Think tanks & Nonprofits–out-of-the box thinkers

You might be used to thinking of nonprofits as partisan groups of private citizens with a pet cause. Yes, it is that, too. More often than not, though, these organizations have the freedom to develop much more fleible procedures to award money to bottom-up initiatives than government funding agencies.

One such initiative is Coalition for Epidemic Preparedness (CEPI), formed in Norway in 2017 to fund the development of new vaccines (@CEPIvaccines). However, with less than 10K followers on Twitter, they are hardly a crowdfunding force to reckon with for today’s crisis, even though Bill Gates is among the benefactors. In fact, one of the more justified causes for donor dollars this year might be just this group. CEPI says they need a mere $2 billion to support the effort–that tells me two things: (1) big pharma is typically needed for this kind of effort, not private or government money and (2) any other avenue will take some convincing.

Global Health Policy think tanks

The top Global Health Policy Think Tanks, according to UPenn’s Global Go To Think Tank Index 2019, include:

1. Bloomberg School of Public Health Research Centers (JHSPH) (United States)
2. Center for Strategic and International Studies (CSIS) (United States)
3. Health and Global Policy Institute (HGPI) (Japan)
4. Brookings Institution (United States)
5. Chatham House, Centre on Global Health Security (United Kingdom)

Brookings, arguably, the best overall think tank, and 4th on health has a Coronavirus topic page, which I found after a bit of searching. Upon further inspection, it reads more like an advertisement for eight of their Fellows who have more or less coherent arguments slash personal experiences to share abou the topic. For instance, in a Feb 5 post on What should a fiscal response to a COVID-19 outbreak look like? the advice is pretty pedestrian: spend money, help states, fix holes in the safety net, and finally, targeted lending. This is not a full-fledged policy response to the issue as a whole.

CSIS is slightly broader in its focus, tackling issues like the impact on the energy sector, they did produce an early video narrating the start of the outbreak, and they have an ongoing podcast, the latest being from March 9th (as I write these words). I listened to it, and they focus on the case of Italy, although the most interesting tidbit is how they emphasize the role of various US State governors who have declared state of emergencies to free up funds. Again, no earth shattering insight or research based views beyond basic punditry.

Just now, they posted a commentary claiming CSIS predicted a pandemic back in October 2019. That’s rich. What they are actually talking about is a scenario workshop where they simulated an outbreak. It is an insult to futurists to call scenarios predictions, in fact scenario planning was the breakout scientists who gave up on futurist prediction. You cannot have both. In any case, read the full Politico article if you want to know what they did, the punchline seems to be that “leaders simply don’t take health seriously enough as a U.S. national security issue.” Fully agree.

So, what has HGPI (Japan) contributed so far? Absolutely nothing visible to somebody visiting their website. Not even a mention of Coronavirus. Interesting. Are they afraid to say anything? Do they not have anything to say? How can this be the world’s 3rd most global health policy think tank? The only thing I could find was a short mention (in Japanese) about canceling their “Health Policy Summit 2020” (February 29, 2020) because “as you know, the new coronavirus is prevalent in Japan.” This is absolutely shocking.

Surprisingly, even the world’s top 5 global health think thanks are caught off guard by the speed of the coronavirus. Not all have a Covid-19 resource page and relevant content, but as it emerged (and it will), which we might assess in an upcoming blog post. I’m shocked to the bone, actually to see the state of affairs with these think tanks.

Top global health think tanks are mostly in America

Let’s here more to a more long-term strategic challenge for the world’s pandemic readiness:

Note that the only countries represented is the US, UK and Japan. If we look at their full list, out of the 32 institutes that made the ranking list, the first Latin-American center is in 13th place, the first Asian is in 14th, the first African in 20th, a full 18 out of 32 institutes are located either in North America or in the UK. Leaving aside possible bias in this index (which is likely), the data is unequivocal: public health think tanks are not widespread and available in every crisis area of the current pandemic.

According to UPenn, the top think tanks in Global Health Policy provide “innovative research and strategic analyses on topics related to the health issues and challenges the global community faces, “excel in research, analysis, and public engagement” and “improving the overall quality of life in one of the relevant countries.”

Nonprofits, or charities, have other ways to contribute, too. One way to simply get “behind the science news” is through sites like UK-based Science Media Centre, an “independent press office” established in 2002 helping to ensure that the public have access to the best scientific evidence and expertise through the news media when science hits the headlines. This UK charity’s target group is journalists (to find quotes), scientists (to provide quote) and press officers (to provide quotes on a regular basis), but might as well a serve the general, informed part of the public. Curious how these quotes make it into the media–well this is one way. As of March 2020, everything on the site is about Covid-19.

Nonprofits are innovators in public health because they can afford out-of-the-box thinking, mostly because they are not beholden to a specific country or political regime. On the other hand, they scarcely have the muscle to do much on their own and are completely reliant on other actors as donors, multipliers, and implementers.

Technology

Lastly, let’s consider what technology and innovation can do for Covid-19 and where we should go to assess its potential. We’ve previously considered academia as such so what is specifically innovative would related to spinoffs or licensed technology that turns into startups or product lines in larger companies.

[more to come]

Journals

Top medical journals can be great sources for science and evidence based insight. The problem is sometimes that they are a bit dry (and expensive). Here are some of the absolute best ones (with the highest so-called impact factor):

• Nature Reviews Drug Discovery (no resource page, but recent issue covers Covid-19)
• New England Journal of Medicine (Corona virus topic page)
• Lancet (Covid-19 Resource Center)
• Science (no resource page for Corona virus but extensive coverage)

In addition, here is a brand new initiative, the Outbreak Science Rapid PREreview (founded by the Wellcome Trust).

Each of these journals’ coverage is interesting because they discuss anything from etiology to therapeutic options.

Which drugs have effect on Covid-19?

For instance, did you the four antivirals that show most promise at present? According to an article published in Nature Reviews Drug Discovery on Feb 10, 2020, it is favipiravir (approved for influenza, Ebola, yellow fever, chikungunya, norovirus and enterovirus), ribavirin (an experimental treatment for SARS and MERS), remdesivir (used for Ebola, MERS and SARS), and galidesivir SARS and MERS, in clinical trial for use against yellow fever). As you might imagine, with only four current contenders, these antivirals are in high demand and are likely to run short in many countries and hospitals.

Do travel restrictions have any effect?

An article published in Science on March 6, indicates that the travel restrictions imposed in Wuhan, China only delayed the epidemic with 3 to 5 days in China and that unless it is combined with a 50% reduction in local transmission, it is not effective at all, both because a lot of people move undetected. This is not an academic finding, it is a hard hitting, very policy relevant finding that, if confirmed, should sound the alarm among all those who think we can now contain the disease’s spread in any meaningful geographical way.

Magazines

A bunch of global public health magazines exist. The now defunct Global Health Hub still has a list of such magazines on its website, including:

• Kaiser Fundation Daily Global Health Policy Reports (daily)
• SciDevNet

Bloggers–a mixed bag

Blogs come in a variety of forms. The Milken Institute’s list of public health blogs is typically a useful resource. However, scanning through them, they are less useful on a specific issue such as Corona virus., in fact the list is highly US centric and focused on policy issues specific to the US health system. Right now, I can only think of these relevant ones:

Gates Notes (Bill Gates’ blog)

Quotes on Corona virus

“If we’re putting all our hopes in a vaccine as being the answer, we’re in trouble,”

Jason Schwartz, an assistant professor at Yale School of Public Health, quoted in The Atlantic on Feb 24, 2020

[to be expanded]

Conclusion

Having started to piece together the evidence from this myriad of top sources, conclusions are still nowhere near final. Hopefully, more true evidence emerges on the public health as well as political fallout, so that we can all ponder what it means.

To first answer the question I posed at the outset. During a pandemic people want answers. But who should we trust? What are the best sources of information on the Covid-19 pandemic? Media? Government health officials? Universities? Vaccine manufacturers? None of the above? Regrettably, the answer seems to be, none of the above.

Not because each actor does not have any answers, but because each answer is partial, situated, and somewhat partisan at the end of the day. Politicians are defending their legacy. Media is protecting their brand. Health officials (both domestically and internationally) are stuck in older patterns of thinking, outdated regulatory regimes (for vaccines, for drug development in general, for public policy) and struggle with the emergent nature of this situation. Universities are near absent in the debate, stifled as they are with protecting their own students. Even think tanks are somewhat challenged by the speed this is moving at–they scarcely have time to call a teleconference to discuss before the pandemic has moved to the next stage.

From a futurist’s perspective the Covid-19 pandemic comes at the worst possible time for the global political climate, which will likely lead to adverse outcomes. Having said that, there scarcely has been a time in history with more innovation in life science, so that will likely, eventually, counteract the political vacuum. But is there enough time for science and innovation? We cannot expect miracles, even from innovation. It still takes time to come up with and implement good ideas. And, as I point out in my newest book Disruption Games (in pre-order at Amazon now), learning from failure is often the best teacher. And, sometimes those lessons come with a price.

Given that this pandemic, all things considered, seems to be on the weaker side in terms of mortality rate, it will likely go down in history as a cataclysmic event of the century, not a cataclysmic event of the Millennium (as in it wipes out entire cities and population groups). That being said, the Covid-19 pandemic could still potentially be devastating for the elderly population, particularly those in poorly sanitized nursing homes who have an array of pre-existing conditions and are 80+ years old. It could also be a Millennium event for Africa, and the overpopulated urban centers of Asia, time will show.

However, any averted calamities will not be thanks to good governance, but rather thanks to a the moderately severe virus. It is too soon to speculate on the impact on global society, beyond making the observation that, in some ways, nothing will ever be the same.

Covid-19 will likely go down in history as a cataclysmic event of the century, not a cataclysmic event of the Millennium.

Trond Undheim, futurist

This is not to say that mainstream pandemic preparedness across the world will change in an instant. Rather, this will definitely serve as a wake-up call for countries with enough resources to stay in the top 10 percent of the global economy when this is over. The problem we all have to deal with, not just as experts, but as a set of political entities (voters, citizens, politicians, stakeholders, etc.), is what type of change are we ready for in order to make sure that a pandemic cannot spread in this way ever again.

I didn’t think I needed to formulate with so much hyperbole so soon, but it rings true now: we may not get a second chance to avert a pandemic catastrophe like the one we all know from the movies.

This time around, I’m fairly confident, society will rapidly recover. Next time, we need a strategy to deal with the emergent threats–not just of a viral pandemic, but likely also with other signs of impending end times, the climate change reality.

However, on Covid-19, at the moment my advice would be: trust yourself.

Disclosures

I find it helpful to provide a few disclosures, for a couple of reasons. One, there are reasons why I’m writing this blog post. Two, those reasons may or may not jell with yours, just so you know. I apologize that the disclosure is quite long (at least I’ve reduced the font size! Here goes: (a) I’m a very curious person. I try to reflect deeply about society. This seems to be a moment that warrants reflection. (b) I have a book tour that should bring me to London and Oslo two weeks from now, so should I still go? London and Oslo, both on the European side of things (if not in the EU), are two rapidly emerging epicenters of the Covid-19 disease, given my own projections. London being a global hub, will likely be hit hard. Oslo being the capital of Norway, an open, transparent society that refuses (so far) to quarantine travelers (or its citizens) or indeed to take this seriously, will also be hit hard. Given its trust in its welfare society and the overall health of its citizens (I happen to agree those are important mitigating factors), little is done and litlte is planned. Related to the above, (c) I have a new book out called Disruption Games: How to Thrive on Serial Failure, which seems to fit the emerging debate on reflecting around the failure to contain (or indeed any aspect of handling) the Covid-19 pandemic. Importantly, only reflective failure helps, just failing has negative value. Related to (c), I have a vested interest in sharing the messages in that book with anybody that might care as deeply as I do about the topics I address in my book. It would also be helpful if somebody read my book, so we can have a deeper discussion. (d)I have a startup, Yegii, which is building a collective intelligence solution with man/machine selected high quality content on technology, science, health and a myriad of other subjects. (e) I live in Wellesley, MA, where as a shocker to many, a parent with kids in elementary and middle school was just diagnosed with Covid-19 last week. Not truly a shocker in the overall picture, of course, but a reminder than even a wealthy town in New England is not immune to what is happening. What does it mean for everyday life? For my kids? For me? (f) My mother, who lives in Norway, is particularly susceptible to infection and is of the age that is within the concerned group of elderly people (although she looks and feels 60, when she does not have her recurring pneumonia). Should I be worried? Should she be worried? What can we do?

Please contribute comments or substance to this article and I commit to redacting possible mistakes, adding sources, and expanding sections that might be of strong interest, including going through the actual evidence on spread, mortality rates and other crucial data. Godspeed!