When did we know enough to act?

Some countries got ahead of the virus. Others did not. The consequences were huge.

Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on twitter (@joshgans) or subscribe to this email newsletter here.

The other day I looked at evidence that once the virus had been able to spread in a region for a month or two, it looks like policy interventions had little impact on transmission. Most regions ended up dancing around a steady-state with infection numbers constant over time. Actually, I did a simple set of calculations for Canada on this. If this situation continues and we don’t have an end to the pandemic say through an effective vaccine, it could take 35 years before we reach herd immunity (assuming that long-lasting immunity is possible). On the other hand, countries that managed to act while the virus was still in its infancy in a region, seemed to actually have a hope of keeping it at bay — at least, up until the moment. What this tells us is that there was a premium — a really, big premium — to getting ahead of this thing.

To get ahead of the virus, you had to know about it. In this regard, the region where the virus first appears is always going to have a problem. That is where there is maximal uncertainty and it may not be clear there is a problem until the virus has spread enough. So this post isn’t going to be about Wuhan. What we want to think about is everywhere else.

When did the President know

What prompted me to think about this issue was, of all things, Rage by Bob Woodward; the journalist’s latest book about the Trump Presidency. In my book and on this newsletter I have tried to steer clear of politics and I will be doing so here. But I was drawn to the opening chapter of that book that described the President’s daily briefing between the President, his national security advisor and his deputy national security advisor. This was January 27th after China had locked down Wuhan. At that meeting, Trump was told that the coronavirus represented an existential threat and would be the biggest national security threat of his presidency. It was only on January 31st that the President and VP met with his health security, Azar, CDC head, Redfield and Dr Fauci of the NIH. He was told to shut down travel from China to non-Americans and quarantine Americans returning for 14 days.

A friend of mine, who has predicted 6 out of the last 1 apocalyptic events, noted to me that by mid-January, he was already telling all and sundry (including me) that this virus looked like an existential threat. We agreed at the time that these messages did look like the first chapter of World War Z. He certainly had finally got that right. I didn’t remember all of the details. In fact, despite my memory being very clear from about the end of February in terms of my own transition to watchful and then panic, I didn’t remember much of my thought process from before that. This is important as our memory tends to re-write itself at moments like these and that is, of course, what we don’t want to do if we want to understand decisions taken at the time. Indeed, Tim Harford reminds us that the sheer dullness of our lives over the last six months will likely be hard to remember at all.

When did I know

To remember when I knew something was up, I went to my own Twitter feed. I found, for instance, on January 23rd, border control was asking me whether I had been to China. In mid-February, I was at a meeting where people were elbow bumping. Around February 24th, I had a discussion where I told my colleagues that they didn’t need to wear a mask on a plane because health experts had told us they were of no value. (Clearly, that was wrong). Other than that very little until clearly on February 28th we decided to start hoarding (2 full Costco loads) and implementing my household apocalypse plan of cornering the market on paper towels (the idea being you want to have something that people might need for trading purposes).

I then followed up with a tweetstorm later that day suggesting that if there was a recession it really would be different (something that became the very first chapter of the book I didn’t know I was going to write). By the next week, I had transitioned to panic and foreboding. The ramp-up was very quick for me. Interestingly, we appeared to have started hoarding pre-panic.

When did the experts know

What should we benchmark these timelines to? The answer is the public health community. For that timeline, I went to my goto expert on this side of Covid-19, Debra MacKenzie. In the first chapter of her book she notes the following:

  • 26 December 2019: Zhang Jixian, head of respiratory and critical care at Hubei Provincial Hospital, told reporters in February she knew on December 26th when three members of one family had pneumonia. She made staff wear N95 masks.

  • 30 December 2019: Post to forum ProMED claiming that “‘urgent notice on the treatment of pneumonia of unknown cause’ was issued.” There were 27 cases all with connections to a seafood market. On a comment to that post, someone noted that there was a ton of online chatter in Weibo (China’s twitter) about the cases.

  • 31 December 2019: Chinese authorities notified the WHO.

  • 3 January 2020: No test results were posted but China was claiming there was no person-to-person transmission identified.

  • 5 January 2020: Virus sequenced although it turned out the Chinese CDC had already done that.

  • 8 January 2020: The virus was identified as a coronavirus.

  • 10 January 2020: Hong Kong confirmed a case of human-to-human transmission.

  • 15 January 2020: Japan confirmed a case of human-to-human transmission.

  • 23 January 2020: Wuhan lockdown began.

From Bob Woodward’s book, we know that Fauci and others were worried about the virus from 30 December on. They were fully engaged with the national security offices by January 2nd. On January 6th, the CDC posted a travel warning about Wuhan. The US procedures were engaged by January 7th. On January 10th, Fauci activated work towards a vaccine. By January 13th, the US who had been sceptical about the information from China started to distrust it further and ramped up their alertness. By January 17, the entire CDC was working on the virus.

Syncing this all up

By mid-January, everyone who was supposed to know, knew this was going to be a problem. The fact that in Canada I was being asked about China travel then was a clue that there was some public knowledge of this. But it does seem extraordinary that the President was reportedly only told about the gravity of the situation by January 27th. It seems that there was enough information at least a week before that to be doing more. Indeed, that had already happened in East Asia and the countries that ended up keeping the virus largely at bay.

There are lots of missing details in these accounts. But it does seem that the usual procedures followed by the relatively independent public health authorities were being followed. So why did those not work? Many will recall testing difficulties, a lack of supplies and the like. But I travelled to and from the US in the first week of March and I have to say that in retrospect, that travel should have already been curtailed. And I had already transitioned to panicked by that stage. Why did I go? I had said I would for a conference. But that is my point. My own risk assessment to me was that it was safe enough for me but taking into account potential externalities that surely wasn’t my call to make.

Herein lies my point. We can actually rely on personal risk decisions quite well when a pandemic is already upon us. But in the early stages, the personal risk is low relative to the size of the potential externality. It is precisely when people will be most pissed off about having restrictions put on them, that governments need to put restrictions on them. For most of the world, that didn’t happen.

What did I miss?