Lessons from Covid in Europe for my friends in the USA

Policy recommendation:

Lockdown only for those over age 45, then slowly lift the lockdown for those aged 45 to 65. Keep those over 65 in lockdown until treatment or vaccine is developed or most of the population is immunised.

The reasoning:

The first and most relevant data on Covid that my friends in the USA seem to be unaware of is the age group with the highest death rate:  91% of those who died in Europe from Coronavirus were over the age of 65 and 87% were over 70. People under 40, on the other hand, have a mortality rate of less than 1% and are therefore much less likely to die from Coronavirus. In fact, people under 40 have the same chance of dying from Covid than they do of dying from the regular flu.

Secondly, Covid is extremely contagious and one would need to live a life of tremendous isolation in order not to get Covid. The official European data on how many people have been diagnosed with Covid are not accurate and the reality is probably 50 times greater. This would mean that Italy and Spain do not have a combined amount of 250k people who have been been infected with the virus, they actually have millions each. Imperial College estimates that in Spain, a country with as many people as California, 7 million people are infected.

Thirdly, Covid is nowhere near as lethal as people think. When people read published figures, namely that Spain has 125K infected and 12K dead, they conclude that around 10% of those infected die and thus panic over this high mortality rate. However, if the real numbers follow Imperial College predictions, then Covid actually kills 17 people in one thousand or as many people as a bad flu would. The difference being that bad flus kill children too, whereas Covid in Spain has killed just 2 people under the age of 20 and 10 under the age of 30.

So what should the USA do to fight Covid? It should gradually lift the lockdown according to age groups. First, lift the lockdown for those under 45 years of age (without any pre-existing medical conditions). Though those under 45 do get infected, it is extremely rare that someone without pre-existing conditions die from Covid. Especially with the caveat that the very few under 45 who might develop severe cases of Covid would have access to medical care. In order for the health system to be able to provide medical care to this age group not in lockdown, a complete lockdown with food and medical deliveries to all other age groups over 45 (who represent 99% of the fatalities) must be ensured. Younger people who live with people over 45 will have to be homeschooled for another month until the lockdown for those aged 45 to 65 is lifted.

Achieving herd immunity for those under 45 makes sense because of the incredibly low death rates in that group. Next, the question would be, what to do with those aged 45 to 65? These individuals are a key engine to the economy and an age group that does die more frequently from Covid than from the regular flu. In my view, they would have to wait for those younger than them to obtain herd immunity. This 45 to 65 age group would continue lockdown for another month after those under 45 have become immunised. Once this group’s lockdown is lifted, they will find themselves among two groups of people: older ones, who are still in total lockdown, and unable to infect others, and young ones who have become immunised. This 45 to 65 age group will also find an unburdened health care system as those over 65 have not required it for Covid and those under 45 have already been through the worst.

And what should be done with people over 65? This is an unresolved issue. In Spain, the average age of mortal victims is 80. Therefore, a month after those under 65 have been exposed to coronavirus, the lockdown of those between 65 and 75 should also be lifted. Having said this, I don’t see a way for those over 65 to safely leave lockdown until we have a vaccine or effective treatment. In Europe, it is very rare for Covid to kill a healthy, young person. Even though it has happened, it is extremely rare. We don’t know why this occurs: some speculate it is because of certain genetic predispositions, or because of viral load. What we do know is that once infected with Covid, the chance of dying for this age group is the same as your chance of dying in the next 2 years. So for example, if you are 30, the chances of dying from Covid are the same in the weeks after the exposure as the probability of dying between the ages of 30 and 32 for any medical reasons. And that probability is very low. However, if you are 80, the chances of you dying between the ages of 80 and 82 are quite high, and are similar to the ones that Covid patients of that age have. Therefore, there is no safe way to recommend that a 75 year old come into contact with the rest of society openly. Though this same 75 year old could lead a life where an App based system puts her in contact with those who are already immunised. If my recommendation is followed, there will be plenty of immunised people by the time 75 year olds leave lockdown.

Given the lethality of Covid, if our objective is to save the most lives, why not just keep everyone on lockdown indefinitely? Because the economic devastation of staying indefinitely in lockdown will kill many more people than Covid. Health does not only mean not getting Covid, it is also means not dying from everything else that could occur during lockdown: cancer, heart disease, suicides, murders. The only reason to keep everyone in lockdown would be if we believe that a vaccine is around the corner. But that is not the case. We don’t have a vaccine nor do we have an effective treatment for Covid.

I would like to end with some data on the Covid mortality rate, mixing Imperial College estimates of those infected of Covid with data obtained from the Spanish national Health system, Sanidad, regarding Covid deaths by age group. Imperial College estimates that in a country like Spain for every diagnosed case, there are 50 undiagnosed cases of people who have are asymptomatic or whose symptoms were not severe  enough to get tested. This is reasonable because in Spain or Italy your symptom have to be very severe to be tested. In Germany testing is more common and that is why the mortality rate is much lower. Around 10 times more people are diagnosed in Germany than in Italy and Spain, hence the mortality rate of these Southern neighbours is 10%  that of Germany. We can therefore estimate that the mortality of Covid in Spain is insignificant for people under 45 (with a total of 47 dead of that age group which is much less mortality rate than a regular flu). It is also very low for those under 65 (a total of 800 deaths for 7 million infected). And it is quite lethal for those 65 or over (a total of 11,200 deaths out of 7 million).

I imagine that when you read that the USA should now consider a lockdown only of those over 45 and the rest should lead mostly normal lives treating Covid as a normal flu (staying home if they are sick, going to the hospital if needed but otherwise taking their children to schools and going to work) you will think that I am exposing that younger population subgroup to tremendous danger. I do hope that after you read this data, you will agree with me.

https://www.mscbs.gob.es/…/do…/Actualizacion_65_COVID-19.pdf

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Forecasts are a risky business but in this moment of isolation and anxiety I want to share my optimism on the pandemia for Spain. This work is inspired by frantic reading about the pandemia since I first posted about its risks on January 27th and my work for the Spanish government at Coronamadrid.com.

Covid-19 Forecast for Spain

One week from now daily deaths will be down from the around 900 of yesterday. This week we will see peak daily deaths and peak hospitalizations. We will have spare hospital capacity in two weeks and enough supplies including masks.

Two weeks from now Spain will stop some of the most unusual and restrictive isolation measures like never allowing children out and forbidding isolated walking and running. These are allowed in most of Europe now.

Three weeks from now massive testing will arrive in Spain and show that the reason we had so many deaths is that there was a high level of contagiousness before lockdown and some during lockdown. Millions will be surprised to test positive in antibody tests. We will discover that Covid is much less lethal than what we thought in terms of percentage of infected population and mostly a risk to the elderly. We will also discover that social cohesion that had given so much support and care to the elderly and made Spain a world leader in longevity, is what sadly killed so many old in this pandemia: unusual level of contact between young and old.

Four weeks from now lockdown will end for those of working age. Schools will reopen. Those over 70 will remain in isolation as they make 90% of the deaths.

Social distancing and mask wearing will continue until June. Outdoor life will help lower contagiousness.

Weekly testing and isolation of positives will be implemented and managed via a geolocalization app.

By early July Spain will be where Korea is now. Monitoring testing but low deaths and hospitalizations.

Thanks to isolation and implementation of the above mentioned strategies post isolation, total Covid deaths in Spain for 2020 will be around 15k to 25k which is the same or slightly more than total flu deaths in 2019 of 15k.

Spain will win the war against Covid but we will not return to full normal until a treatment or vaccine is developed by 2021.

Spanish 2020 GDP will be down 10%, tourism will be especially hard hit. GDP of 2022 will be equal to 2019 GDP. And in terms of government damage and poor thinking what Pedro Sánchez did to fuel the pandemia by allowing demonstrations and large gatherings he will do to fuel bankruptcies by making it illegal to fire workers. Hence disproportionate economic damage.

Yesterday there was dramatic nonsensical violence in two cities I love: Paris and Buenos Aires.

In Buenos Aires it was an attack of River Plate fans against Boca Juniors players injuring them and destroying the Libertadores final celebration for Argentines and football fans around the world. Now Boca players are rightly fearful that they may suffer further injuries or death should they play against River Plate in their home “Monumental” stadium. The Argentine government is unable to guarantee the safety of the players and frankly of anyone who attends.

In Paris it was the French against themselves, against one of the most beautiful parts of the most beautiful city in the world. Unexplainable violence in a protest that could have been peaceful against a fuel price increase. Demonstrators went wild destroying the cobble stoned streets, restaurants, and scaring tourism off which is an essential part of the livelihood of the French.

Why do the French and the Argentine turn to violence in situations in which most of people in most other countries don’t? Argentines fans are not the only ones that use violence, but they are the world’s most violent. French demonstrators are not the only ones who use violence, but they are the world’s most violent.

In France, in Argentina, why can’t the rest of society condemn these acts? Why can’t there be large demonstration against the use of violence by extremists? In Spain for example when ETA would violently attack there would be huge demonstrations by the rest of society in which people would paint their hands white and say “they are violent we are not”. ETA was defeated peacefully. Why can’t they gather enough peaceful Argentine football fans who can defeat the small minorities who are not? Why can’t there be enough peaceful French who can massively demonstrate against random useless violence? The only solution to radical violent individuals is that the rest of us show them that their violence has no place in a civilized society.

NYC pros:

Massive and diverse, tremendous amounts of smart ambitious people.

It is the most beautiful city in the USA with great architecture and tremendous choice for different lifestyles. Every neighborhood has a personality.

Unbeatable cultural and entertainment offer. Fantastic night life.

Great educational institutions at all levels.

Extremely well located for travel to Europe, more central than Miami or Bay Area.

It is a walkable city.

It has tremendous study and work opportunities.

NYC cons:

Weather is awful, extremely hot, extremely cold for 8 months of the year, only 4 months of California type weather.

People put too much emphasis on themselves and their careers and less on family and friends.

Too many people are aggressive, arrogant, overworked and stressed out. Even the same people behave this way when they are in NYC and become more sensitive and considerate when they leave even to nearby East Hampton.

Taxes are extremely high and services poor.

It’s very hard to get in and out of the city, reach airports, etc.

Extremely expensive city, housing, transportation, dining, entertainment all unaffordable to many.

Too many lawyers and bankers, some are nice but as a group they are not my favorite people in the world to hang out with.

Bay Area positives:

People are brilliant and kind, a rare combination.

Entrepreneurship is everywhere, people are extremely creative and resourceful at building innovative companies.

Weather in the Peninsula is arguably the best in the world, you get seasons but not extremes, great number of sunny days.

Amazing nature, tremendous amount of green areas close to populated areas. Fantastic for outdoor sports.

Great quality of public services.

Fantastic job opportunities.

Best educational institutions in the world. Best public schools in the world, best universities.

Tremendous availability of VC money to start ventures.

The spirit of California is unique and unbeatable, anything is possible is the mantra.

Bay Area negatives:

Limited cultural and entertainment offer.

Nightlife is practically non existent.

SF weather is awful in the summer.

Incredibly isolated from the rest of the world, 6 hours to the East Coast, 12 hours to almost anywhere else in the world, if you live in California you have to love California because everything else is a day or two of travel away. If you run a global business from SF you will spend your life on a plane. Even if you run a US business you will spend much more time flying than people in NYC or Miami.

Mono thematic, if it’s not tech it’s not relevant.

If you are raising kids it is very hard to find help.

Miami Pros:

People have time for family and friends and are overall less stressed out, happy.

Fantastic weather 9 months of the year and the other 3 you can leave because kids not at school.

Unlike NYC or Bay Area everything is close to where you live. Except for a few weeks a year there is no traffic to speak of.

Fantastic night life and restaurants.

Low taxes.

Easy to move around by bicycle or walking.

Fantastic homes and beach life.

Incredibly busy airport 15 minutes away from Miami Beach with flights to almost anywhere in the world.

Well located to travel to anywhere in the USA and Europe, Latin America and Africa. You can run a global business from here.

Affordable compared to the Bay Area and NYC.

If you are raising kids and can afford it, it is very easy to find help.

Great music, if you love music there are tons of music related events and music festivals.

Fantastic water surroundings, sailing, boating, beach life, water sports.

If you have your own professional path, and don’t depend in a city to give it to you like I don’t, living in Miami is great because when you are not working you can truly relax and have fun.

While many of your friends are probably somewhere else they all like to come and visit you.

Miami Cons:

Lack of intellectual stimulation.

Emphasis on “show off” shallow values which are bad for raising children.

People are less reliable vis a vis work.

It´s hard to recruit extremely talented people of the kind you find in NYC or the Bay Area.

Limited work opportunities.

During the summer you better find a way to get out, it’s awful.

Lack of great universities and intense intellectual life.

Lack of success stories which are so inspiring in the Bay Area and NYC.

Universities are mediocre.

Too much emphasis on real estate and tourism as the main two industries of the city.

Hurricanes and rising sea level are an imminent threat, you get a sense that this city will be the first casualty of climate change.

Miami Beach, South Beach where we are now is a mostly liberal open minded community. But in deep Florida you find alligators and their political equivalent.

As depressing as Trump counter factual populism is, there is something even more worrying: the conditions that made Trump happen are not going away. These are elite education and a deteriorating job market.
As Trump says he loves the uneducated. And by tying lower education to residence and higher education to income, our society can’t stop producing his type of voters. The best universities in the USA can only accept about 3% of those who turn 18 every year. So a country that provides elite education for only 3% of its population shouldn’t be surprised, that a candidate who preys on the rest with reality TV appeal and groundless proposals, can get elected. 
And then there’s deteriorating job quality. Yes we still have jobs, like we still have car owners. But the trend towards massive automation is about to take a few more exponential steps. And as cars will be mostly pooled and driverless, many of today’s jobs will also go the way of AI. First will be transportation, then hospitality, then health care.
The next Trump will not speak about Mexicans stealing our jobs and be wrong about them, he will speak about AI stealing our jobs and be right about it. So either we find a way to educate more people and provide occupations and basic income to all, or we will have Trump after Trump. And one day democracy will be a distant memory.

Last night I had dinner in San Francisco with an illustrious group of people. Some of them would arguably be perceived as the smartest people around. Yet their worldview was very biased by their life in Silicon Valley. 
Examples:
A lot of the conversation on inequality centered around how zoning laws are pricing a new generation out of the housing market. True here. Not true in Atlanta, Berlin, Miami. Are restrictive zoning laws a problem? Yes, but are they the reason why there is inequality? Only partly, and depends where. I have another explanation for inequality and that is: inheritances, elite education, uneven distribution of talent.
Another Bay Area centric explanation was that pervasive technology is causing violence. Do we believe that Syrians or Libyans are killing each other because they have Facebook or Twitter? Not really. Hutus and Tutsis killed each other without smartphones and with machetes. I see the violence in the Middle East as a resurgence of tribalism, fake us vs them. Religion being used for tribal purposes.
Then there was the belief that education is not what is needed to solve inequality, because many people with college degrees end up serving coffee. Yes this may be true here. But in most of the world access to education is indeed a ticket to the middle class. And less education will give us more Trumpism. As he said it he loves the uneducated. Moreover education is about being part of a culture, not only a way to get what job.
Lastly a very radical view, was that robots and AI are taking over the world, and hence, an experiment in basic income was started in Oakland to simulate a world in which nobody has a job. Could AI and robots leave many without work? Yes. But so did mechanized agriculture. 
In short all the problems were real. But the intensity attributed to each one of them and the proposed solutions were very Northern California.

Today Leo (9) and I were on Messenger, using video, he in Madrid and me in Miami. We were having a long conversation as he walked around Madrid doing different things and I was doing my work. So we were virtually together for quite a while, happy the other person was there, sometimes silently. At some point Leo said to me. Dad, aren’t you glad we live in the future and you and I can do this? My reply was that for a long time I had beeen dissapointed about the future. Fabrice Grinda and I debated this point around 5 years ago and he was the first person who alerted me that the future was finally arriving. He knows I felt that when I was at university in the 80s we believed that by the year 2000 so much would be different, and it wasn´t. But over the last 4 years, I realized, that the future that we were promised in the 80s indeed has arrived. Prelude, my new company that is focused on having babies with fewer illnesses and whenever people are ready, involves two technologies, vitrification and genetic sequencing of embryos that were not available a few years back. Fon and others have blanketed the world with WiFi making it easier and cheaper for hundreds of millions to connect. Tablets and smartphones have reached the masses. Driverless cars are already going around the streets and while they may not fly as we thought, they are radical. CRISPR has given us a real chance to gain control of evolution and my belief is that we will use this tool wisely as we now use genetically modified food. Living in a connected world is enabling us to stay in touch emotionally and intellectually with the rest of the planet. The app economy has given us knowledge and comfort in the palm of our hands, almost as a second arm and a second brain, always with us. Hyperloop is doing away with the connection between speed and the sound barrier getting rid of the atmosphere at sea level. So yes, I am very glad Leo that we live in the future. And while nothing will replace the hug I would love to give you, following you around Madrid today, made me feel very close to you.

My elevator talks to me. But doesn’t listen. It says  “8th floor” when we get there. But I can’t just say “8th floor” to go up, I have to press a button. And my elevator doesn’t recognize me, nor my voice. So anyone else who is not authorized can go to the 8th floor. I think it’s time that what Nest did to thermostats, somebody does to elevators. Have elevators respond to voice commands and only take authorized users to their floors.  And how about having elevators tell you if your little kids get in by mistake. Or they notice that you walked in and tell your Uber or Lyft “Martin is arriving in 1m”. Or have sensors in the front door that call the elevator down before you get to it.  Or use AI to learn building traffic patterns along the day and save energy and time for building occupants. There’s lots of cool things that a smart lift could do.

Unfortunately yesterday while on a road bike ride in Miami, I crashed. It wasn’t awful. I will be fine soon. But today I have pain in different parts of my body and stayed in bed. The last time I fell off my bike was in 1997. Back then all I could do while in bed was to read a book, speak on the phone and watch TV. 19 years later, in bed, I realize that a tremendous amount of technological effort has been invested in building what could be called the “life in bed” economy. And recovering from a bike accident is a world of choice.

-want to eat in bed? Seamless, GrubHub, Uber eats, and many others will make sure your recently cooked and warm food is home delivered.

-want to socialize in bed? Facebook, Instagram, Whatsapp, Messenger, Twitter, Skype, LinkedIn and many others will make that very easy.

-want to be entertained in bed? Netflix, Amazon Prime, Youtube, Showtime, HBO and many other digital services will give you all the movies and tv shows ever made on your iPad.

-want to shop in bed? there are so many services that will get you whatever you want while in bed! the most obvious ones Amazon, eBay, Apple.

-want to study in bed? Udacity and many other purely online or also online universities will help you get your in bed degree.

-want to read in bed? Kindle and the Kindle app will make that easy.

-want people to come home and give you a massage, manicure, or any other services while at home? TaskRabbit ThumbTack and all their competitors will basically get you any kind of service at home you can dream of.

-want to listen to music? no need to reach out for a CD anymore, Spotify, Soundcloud and others will give you all the music ever made at the touch of your smartphone.

As I recover I wonder if this life in bed economy is actually good for us. Not convinced. Certainly not good for social, for being fit, for socializing in the real world. Can’t wait to get out in the real world again.