One of the better discussions available on the coronavirus is the CFA Institute interview between Laurence B. Siegel and Andrew “Drew” Senyei, MD.

The most important point to take away is the concluding remark “the advances in medical knowledge and molecular biology, especially in the last decade, and with the full focus of the world on this one challenge — we will get through this.”

The discussion is wide ranging and will help in providing clarity on several issues e.g. the importance of testing, how the virus impacts on the body, and the trade-off between preventing or slowing the spread of the disease at all costs versus the cost on the economy and people’s mental health, including what testing is required to get people back to work.

 

The interview begins by acknowledging that although our knowledge of the virus is increasing there is still lots to learn about it. It is evident that this coronavirus is different from previous coronaviruses.

One important unknown is how lethal it is. This relates to the case fatality rate (CFR). This is the number of people who die of the disease, expressed as a percentage of the number of people who have it.

As you may be aware, there are a number of problems in measuring this currently:

• More testing is needed to know how many people who have had it, especially asymptomatic patients – tested positive for the virus but showed no symptoms.
• The reporting of deaths has also been problematic, did they die because of the virus or was there an underlying ailment e.g. cancer or heart disease. The difference between died with and died from.

The best estimate currently is that the CFR of the coronavirus is higher than the flu, but it is unlikely to be as high as SARS.

Also, the CFR for the coronavirus is likely to fall as further testing is undertaken, this was the experience with SARS.

The experience on the cruise ship, The Diamond Princess, provides an insight into the likely CFR, and interestingly, over half those tested were asymptomatic. This is discussed in more detail in the article.

The issue of incomplete statistics is highlighted in comparing the outcomes between Italy and South Korea. This comes down to the level of testing and the variations in the way different countries are testing.

Social distancing is having a positive impact. Particularly from protecting the health care system. Ideally, we want “the density of new cases presenting in any geographic area at any given time to be as low as possible and over as long a time period as possible to prevent a surge on the health care system.”

There is a great discussion around the issues with testing. There are a lot of variables.  At the risk of sounding repetitive we need lots of testing, “We need to know how much of the disease is out there so we can have the health care resources and physicians to respond to that surge, where and if it occurs.”

 

Economic Trade-off

The latter half of the article covers the issue of the trade-off between preventing or slowing the spread of the disease at all costs versus the cost on the economy and people’s mental health.

The argument being, should we ease up relatively quickly on policies that discourage work and income and social interaction, otherwise we will severely injure the economic life.

Is there an optimum or balance between the two extremes?

 

Initially, given the unknows, erring on the side of caution would appear appropriate.

Nevertheless, there is an argument for considering “a rational middle ground and that is: We have to first understand if this is peaking. And remember when you look at new case rates, you’re actually lagging by two weeks.”

Understanding more about the virus will help in getting the economy back up and running.  More testing is needed.

“I would look at those [new case rates], and then at hospitalizations and intensive care utilization, and see if that’s peaking because that is the most pressing problem. Then I would look at the rates by population density and see where the wave is happening more locally and usher resources there.”

The discussion comes back to more but different testing, to get a better sense of who’s had the infection, who’s over it, and who’s protected at least for a while.

This is an interesting discussion and highlights a likely path to getting people back to work. .

The key is to identify those individuals already immune and not likely to get infected or infect others back to work.

Protecting the elderly is important, therefore it is suggested “to look at the density of the elderly and make sure resources are adequate for that particular region — not just equipment and supplies, but personnel.”

Senyei concludes “I would invest really heavily in the basic biology and in vaccine development which is two years out. I think you’re going to need a vaccine and you’ll probably need a new vaccine like you do for the flu every year. This virus will mutate.”

“Now all that takes money, time, and coordination — but people are working on it and I think, if we did that, we could sort of get back to the economy being an economy.”

As highlighted above, they conclude by acknowledging that we will get through this.

 

Stay safe and healthy.

 

Happy investing.

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