To cut to the chase, let me say that I consider the risk to my life from this virus to be very low. Even lower for my children. There’s probably a higher risk to my parents who are in their seventies, but the odds of them surviving even a serious global pandemic of this virus are very high. There is cause for concern, but absolutely no cause for panic based on the current estimates of the Infection Fatality Ratio (IFR - the percentage of people infected who will ultimately die) of somewhere between 0.3-1% (this is by no means an academic paper so I will not unduly burden this text with links to sources - contact me if you’re interested - but see this 19 Feb WHO situation report and this initial pandemic risk assessment of the same date from the privately funded Institute for Disease Modelling).
The Case Rate Fatality Ratio (CFR - the percentage of lab-confirmed cases resulting in death) of around 2.3% remains a concern, but what have been truly troubling over the past several weeks are two principal factors. First, the R0 (reproduction number - the number of further cases generated by one case) is currently estimated as higher than the 1918 H1N1 pandemic (so-called Spanish Flu) which infected around 30% of the world population. Prof Gabriel Leung (University of Hong Kong) has suggested that given the current estimations of R0, 60%+ of the world population could be infected in the absence of effective containment measures (there seems to be good evidence of effective containment in China to date).
The second factor is the number of patients requiring hospitalisation for severe and critical illness, which seems to be around 15%. (I'll leave aside a third factor which is the growing uncertainty surrounding the period of incubation, which may be well beyond 14 days).
Where I live, in the French “département” of Finistère, there is a population of 900,000 and we are served by two main hospitals and several smaller clinics (although serious cases are often evacuated to our only university-level hospital in Brest). We probably have somewhere between 3-4000 hospital beds, and I guess most of them are occupied.
If there is an epidemic in this area of France, in an optimistic scenario (where extraordinary containment measures and our advanced epidemiological knowledge allow us to keep the number of infections down to, say, just 20% of the population - bear in mind that many of these will be asymptomatic cases) then out of 180,000 total viral infections perhaps 27,000 (15% of this number, based on current estimates) would require hospitalisation for severe conditions. I will not labour the point, but leave you to your own calculations for your specific locale, and to your own suppositions about how many of these individuals might survive and what the social consequences of such a situation might be.
But what about my upcoming trip to the Holy Land (more specifically, to Israel/Palestinian territories)? I would say that, while I am slightly uncomfortable at the prospect of the heavy use of public transportation and frequenting busy tourist venues, I believe that the risk of contracting the virus on this trip is tolerably low, probably no different to a weekend in Paris, London or New York.
We humans all take calculated risks, but we’re not all armed equally when it comes to informed decision making. (You may enjoy this research questionnaire devised by Dr. Edward Cokely from the National Institute for Risk & Resilience at the University of Oklahoma) to see how you fare.
In the last few days I have been reminded of a question posed by Dr Scott Gottlieb (not an epidemiologist):
It seems clear now that the outbreak in Hubei started in November and by end of December it was probably epidemic in that region. If the time of first introduction to epidemic spread is about 8-10 weeks, a question is: When was it first introduced, undetected, into the U.S.?
Of course, I don’t know the answer to this question, but I’m guessing it might be as early as the end of December/early January. And not just to the US of course. This would be consistent with the “lighting up” we’ve been seeing in certain countries in the past week.
As a tourist, what concerns me most about the upcoming trip specifically is whether I have time to get there and back before (possibly retrospectively excessive) containment measures are in full swing. As I write, Austria is reportedly considering border controls with Italy (after a brief suspension of rail travel between the two countries) where at the time of writing nearly 50% of the 200+ cases are hospitalized, with 10% in intensive care.
Israel, I would suggest, is a country likely to adopt aggressive containment measures to protect its citizens. I suppose these might include restricting access to certain busy sites I might be planning on visiting, but more perturbing is the following report from The Times of Israel:
Israel's Health Ministry on Saturday said Israel could soon close its borders to all non-citizens, but later appeared to backtrack. A notice on the Health Ministry’s website posted Saturday read that “It’s likely that soon borders will be closed for anyone who is not Israeli”. The sentence was later deleted with no explanation.
Potential translation issues aside, this premature announcement may have occurred due to an overzealous functionary who has since had their knuckles rapped, but it does raise the question in my mind of the lengths Israel might go to in terms of containment and, more selfishly, of the availability of the flight which I’m counting on for a safe and timely return to my family.
So while I’m only very mildly concerned about picking up the virus during the trip and passing it on to a family member, I do now have significant organisational concerns, while my deeper worries are reserved for a time beyond the trip, in the face of a looming pandemic.
“Pandemic” is a scary word, but they can be “mild”. Still, it’s best to be prepared and I’m wondering if, rather than swanning off on vacation, my time in the next few weeks might be better spent at home, enjoying my family and bodyboarding and making prudent preparations, just in case. It’s always good to have supplies on hand to deal with disruptions to our “just in time” supply chains, and mental preparation is important too (I’m a big believer in the Stoic practice of Negative Visualization)
A “bucket list trip” is, according to my definition and life philosophy, an important project worthy of timely execution (especially this one, because I’m due to travel with my father who shares many of my interests, who I love dearly, and who I would love to spend a week with, especially at this time in his life), so postponing it is not a decision to take lightly.
As a person who has from a young age enjoyed independent travel and adventure sports, I think of myself as a relatively risk-tolerant individual. To be sure, I am known to my friends and family as someone who worries about things and sees the glass half-empty. I often waste valuable time by gathering far too much information before coming to a decision. But I’m also a person who has, after careful consideration, indulged in quite risky behaviour, while endeavouring to mitigate the risks to myself and others through purchasing expensive insurance and by designing over-elaborate back up plans!
We’re also - all of us - subject to influences from cognitive bias (including sunk cost and plan continuation biases which are relevant in this case), persuasive discourse, revenue-hungry mass media discourse, and “alternative” information sources with more subtle institutional or individual agendas. (Here's an excellent Scientific American article on How to Report on the COVID-19 Outbreak Responsibly, which is also targeted at the general public to "help [us] understand the different sorts of knowledge we can talk about").
As someone with a long-standing personal (and formerly academic) interest in these topics, I try hard to maintain a critical distance and check the facts (often at the expense of timely decision-making). Please forgive any factual or other errors in this text, and kindly point them out to me.
A final reading recommendation: Past Time to Tell the Public: “It Will Probably Go Pandemic, and We Should All Prepare Now” by renowned risk communication experts Lanard & Sandman, should I think be required reading for all citizens, business owners, and government officials. The authors explain that containment initiatives (such as quarantine and contact-tracing) will inevitably come to an end in favor of measures to slow the progression of infection, and people need to be prepared for this. But we're clearly not there yet. They also undeline the importance of emotional preparedness and point to their concept of "OMG" adjustment reactions ("better to get through this OMG moment now rather than later"). Indeed, what do we have to lose by preparing ourselves?
Finger's crossed, this coronavirus will fizzle out in the coming months, and by next year we'll have a vaccine. Now go wash your hands and have a great day :)
I wrote this five days before the trip to help me come to a decision and, more generally, to explore my thinking about the notion of risk and the impact these thoughts have on the way I plan and live my life. What do you think? Would you take a minute to share your thoughts with me and/or offer some feedback?
A further note on sources: I have a curated list of a small number of journalists and scientists who I believe have impeccable credentials and seem to show restraint in their reporting, and I follow their leads to original sources.