Updated: March 2, 2020
On February 21st, a 38 year old man, who became known as ‘Patient One’ was diagnosed with coronavirus in Codogno, Italy, a town that’s just 24 miles away from where I am right now. Currently, more than 1,600 cases have been diagnosed.
In this blog, I’ll share some things I’ve learned and predictions I have from being at ground zero. (To learn how the coronavirus will affect the poker world, click here).
My ideas are based on my years of playing poker professionally, in which I thrived by betting on how people are likely behave in a situation before they were actually put there (for example, when deciding whether or not to bluff, I had to place a wager on the
probability that my opponent would fold before I knew the outcome.)
In poker, this process is done by observing my own emotional patterns and then projecting that onto others. In this situation I did the same thing, only this time I’m attempting to project it on society at large.
In this particular case, I have the foresight of seeing how people actually have behaved since the virus was first discovered in Italy.
That said, I’ve been wrong many times in my poker career. Sometimes I’m convinced someone will be fearful of a bet I make, only to find they defend with pride. It’s every bit as possible that some or all of my observations are wrong.
Do your own research and place your bets accordingly.
1. Be Informed
According to Walter Ricciardi, member of the WHO Executive Committee, 95% of cases heal. Of 100 diagnosed patients, 80 heal spontaneously, 15 are serious but heal in the hospital and 5% are grave of which 3% are fatal.
My thoughts: Given that 80% of cases are benign, I believe it’s highly likely that many people who have coronavirus aren’t being tested because they experience so few symptoms or those that are misinterpreted for the flu. On the contrary, since the people who die are much more likely to be accurately accounted for, the true percentage of deaths and severe cases is likely less than what’s being reported.
2. People Are Underestimating the Effect of Coronavirus
I’ve spoken with many of my friends and family in the States, and even though they’re aware the virus could spread there, most people seem unfazed. Life continues as normal.
I’m confident I couldn’t have fully understood the ramifications of coronavirus in Italy until I lived it first-hand. It’s one thing to read about an entire country like Japan closing their schools, and have people avoid public places, it’s another to go out in my town here in Italy and see almost no people having ‘aperitivo’ or their morning espresso in a bar.
It makes me believe that if this does spread in the U.S., the effects are more dramatic than most people are predicting.
3. Why This Is Different Than the Flu?
One common objection I’ve heard amongst my American friends is how this is a slightly more severe flu. According to Fabrizio Fregliasco, a virologist from the University of Milan and director of health at the Galeazzi Institute of Orthopedics, here are the unique similarities and differences between Covid-19 and the seasonal flu. (Note: I have translated what he originally said from Italian to English)
Flu and Covid-19 are alike because they have very similar symptoms but the only way to distinguish the two diseases is to perform the swab test. For the seasonal flu, which affects millions of people every year (and for which there is a vaccine), the mortality rate is 0.001 (0.1%) while for coronavirus it is around 2%, although for those over 80 the percentage rises to 14.8% (international data).
The incubation period is also different: the flu develops within 1-4 days while Covid-19 has an average latency of 5 days (maximum 14) but cases have been recorded even 22 days.
Finally, the duration: 5 days for the flu in the absence of bacterial superinfections, 2 weeks for Covid-19, which become six in the most serious cases.
There is also another similarity: contagiousness, or the basic reproduction number. The flu stands at 1.5 (one infected person can infect another and a half). The medical value for Sars-CoV-2 is roughly 2.5.
I’d like to highlight two key points here.
One, coronavirus is 20 times more deadly than the flu. (Again, let’s hope this is wrong based on my theory above)
Second is the medical value of 2.5. That means that for every one person who is infected with coronavirus, they can spread it to an additional 2.5 people. This means there is exponential growth of the disease.
Exponential growth is an incredible phenomenon. Einstein called it ‘the most powerful force in the universe.’ Still it’s widely misunderstood as most think in linear terms.
For example, 30 steps in a linear manner (1, 2, 3, 4, etc.) will end at 30.
30 steps taken exponentially (1, 2, 4, 8, etc.) will end at 1,000,000,000.
I’m not a doctor, so I have to trust the source above and others like it, but what I can say with confidence is that nobody is behaving like this is a more severe flu. The flu doesn’t cause schools to close, people to avoid work and the economy to come to a halt.
The real concern is how many people require hospitalization, which can put an extreme strain on the system. The NY Times reports that a severe pandemic would require mechanical ventilators for 740,000 critically ill people. However, according to a 2010 study, only some 62,000 ventilators were in hospitals across the country.
4. Italy Is Handling This Incredibly Well
I’ve read mixed things in the U.S news, but Italy was extremely prepared and is doing a better job than what I believe will be done in most places in the States. I feel safer here and am incredibly impressed with the organization, mobility and hastiness of the
government’s response to coronavirus in Italy.
The CDC says they can only test 400 people per day. In a country the size of California, Italy has been able to do much more than that, and right away. They also immediately expanding testing to anyone they believe has been in contact with someone with the disease, a policy the CDC has yet to implement.
Also, there are no testing flaws with the coronavirus in Italy. All of this happened with less time to prepare.
My wife Ambra wrote an article about the subject with an interesting observation, comparing how the two ‘Patient Ones’ were handled in their respective countries. Here in an excerpt.
On the evening of February 15th, a woman from Solano County with flu-like symptoms walked into NorthBay VacaValley Hospital, where she spends three days. When her symptoms worsen, on February 19th , she is transferred to UC Davis Medical Center in Sacramento.
While doctors are concerned about a potential coronavirus diagnosis, the test for it is delayed by the CDC, since the patient “did not fit the existing CDC criteria for COVID-19”. On February 23rd , the swab test is sent to Atlanta to get analyzed, and by the time it comes back positive it’s already February 26th.
Compare that with the first case in Codogno, Italy. The swab that was taken at 4 pm, came back positive at 9 pm of the same day. In the region of Lombardy, which is a little bigger than the Bay Area, there are 3 regional labs accredited to analyze biological samples and test for coronavirus (2 in Milan and 1 in Pavia). Cases that test positive in one of these labs are sent for a second test to the ISS, the National Institute of Health.
In the US, a coronavirus test taken in Sacramento needs to be analyzed at the CDC in Atlanta. This process can take several days between packaging, shipping and analyzing, and just to give you a geographic reference, the distance between Sacramento and Atlanta is the same that separates Codogno from Syria.
It’s quite ironic that on the same day, February 19th, in two different parts of the world, an Italian manager and an American woman were admitted to the hospital in serious conditions.
The former was diagnosed with coronavirus on the 20th, the latter on the 26th.
The former caused an entire hospital to be put under quarantine, 10 towns (50,000 people) to be put on lockdown, the schools of 9 regions to be closed, over 15,000 swabs to be tested across the country and the economy to come to a halt.
The latter, did not provoke any of this at least for the first 10 days.
5. It Gets Worse Before It Gets Better
On the contrary, Italy likely has the most cases because they’ve tested some 15,000 people for coronavirus. Belgium on the other hand has run 150 tests. Not surprisingly, they have zero cases. In France, they’ve ran 453.
Furthermore, up until very recently, the Strict CDC Testing Policy only includes people who have been to China or been in contact with anyone infected, dramatically limiting the potential for cases to be discovered.
6. The Virus Seems Extremely Hard to Contain
In Italy, one man contracted the virus by running in the same marathon with Patient 1. He lives 200 miles away. Another one by stopping for coffee in the coffee shop ran by Patient 1’s father.
How many people has Patient 1 come into contact with from the time he contracted the virus and when he was first diagnosed? While quarantining is the best solution we have, it may be hard to implement effectively, in particular in the U.S., where they haven’t put
anyone on lockdown like they have in China and Italy. (In spite of this, the disease is still spreading).
7. How This May Play Out in the U.S.
Given the CDC’s lackadaisical approach toward testing, I believe the virus will spread and is already silently spreading in the U.S.
Soon the US will begin testing more patients. This seems inevitable. Given political pressure and the urgency, it’s likely this will happen all at once. Naturally, more cases will be discovered, creating the illusion there’s sudden growth, when in fact it was likely there all along. Nevertheless, people will panic.
As more cases appear, more will demand to get tested, thereby increasing the numbers. It will take some time for this to settle.
I believe this has the potential to create social unrest in the States, where people cannot afford to get tested, let alone hospital care.
Tragically, this may lead people who otherwise would get tested to simply avoid it altogether. Naturally, they may infect others during this time, further causing the disease to spread. This is the true wild card here in the U.S. and could expose a huge
vulnerability in our health care system (more on this below).
This is the opposite approach countries like Hong Kong have taken, who actually incentivize people to get tested by offering them a cash payout of $10,000 HKD (roughly $1,300 USD) in the event one tests positive, along with 100% reduction in profits on taxes and low interest loans. Or of what they are doing in Italy, where testing and treatment is free for all.
Finally, I said above that people are currently under reacting. The true political, social and economic impact can only be felt when this does hit home. It will change how people behave and interact in the short term, and perhaps for months to come.
One thing you can bet on is supermarkets being flooded as people not only worry about a shortage of food supply, but simply stock up on reserves for fear of anyone in their area being a potential carrier of the disease.
Schools will close, putting pressure on families to care for their kids during working hours. People won’t want to dine out in restaurants or shop, putting enormous strain on small businesses and the economy.
Travel will slow. All of this will happen in an extremely sudden manner (depending on how fast local authorities react), but surely within days of the virus hitting each town. Your way of life may change overnight, and it’s only when this happens will people really begin to feel the impact of the virus spreading.
8. The Markets Will React
I had originally written this when the U.S. markets dropped a mere 2%, so it seems my hypothesis is already playing out. The market is currently down 12% since word of the virus has spread through Italy. Imagine what will happen when it’s discovered that it is
stateside? How will investors react when they aren’t just afraid of this hitting home, but literally avoid contact with people for a period of weeks.
In spite of one of the worst weeks for the market, I believe there will be an even bigger pullback. In short, I think we’ve just begun (based on the assumption that this will hit the U.S. and spread, which I believe is inevitable). There is always a wild card here, which is how the government and central banks will react (for example, just today the Japanese Central Bank pledged support of the market, causing equity prices to rise).
As for the people, I believe when schools close, supermarkets are drained, people work remotely from home and public events are cancelled, people will panic, and they will sell.
How low we will go and how long we will last is anyone’s guess. If learning to manage my bankroll in poker has taught me one thing, it’s the importance of managing one’s risk. In poker that means you never bet more than you can afford to lose in any given game. In the real world that means diversification and not having all one’s eggs in the same basket.
9. An Opportunity for the Left
I believe the harder this hits the U.S., the more it will offer a political boost for the left. Regardless of your political belief, everyone suffers from the cost prohibitive nature of our health care system. Even if one can afford proper testing and care if needed, they are risk because of others who can’t.
This will, at the very least on a subconscious level, lean the population left on healthcare. As it seems likely Bernie Sanders will win the democratic nomination, and with Medicare for All being central to his campaign, this will benefit him come election time.
This will further be exacerbated if the economy is suffering and people are in panic, which is precisely when they want change.
It seems that Trump so far has downplayed Covid-19 saying ‘the Coronavirus is very much under control in the USA’. Now that the disease has hit the States, his approach may lead some to feel like more should have been done to prepare.
This may be in part because of Trump’s decision to cut spending for programs for the CDC for research on emerging diseases, a decision which could come back to haunt him if the virus spreads.
Inevitably, no matter how Trump handles this, the mere fact it hits home will reflect badly on him. If this becomes pandemic and is still relevant in several months, it will become a central topic of the debates. Naturally, the left will use this to gain favor, as
would any political party when their adversary is vulnerable.
Will it be enough for the democrats to take power in 2020?
Time will tell.
I’d be curious to know your thoughts. How do you think this will play out? Drop me your $0.02 in a comment below.