March 30, 2020

Tomas Pueyo

Coronavirus: The Hammer and the Dance

What the Next 18 Months Can Look Like, if Leaders Buy Us Time


There are a number of options governments can take against Covid-19 and it revolves around the principles of ‘proactivity’ and ‘reactivity’. The comparison measures drawn by the author predominantly are between the Asian countries and their western counterparts: 

1.      The first option is to do nothing, similar to what have been unfolding in the US. In the worst case scenario, the author suggests that the healthcare system in the US will be overwhelmed and explosions in both the number of infections and casualties. The healthcare systems are not equipped to deal with simultaneous infections and thus, it will put a large amount of stress in the intensive care units (ICU).


There are numerous discussions about ‘flattening the curve’ and this refers to the relationship between the numbers of available medical care facilities versus the amount of patients admitted to the hospitals with Covid-19. The idea is that the trajectory of infections can and will surpass the available facilities that will unable to keep up with the rate of hospital admittance. By staying ‘below the curve’, it will do two things: put less stress on the medical facilities and reducing collateral damage on other medical conditions.


2.      The second option is mitigation and an example of this is UK. The idea behind mitigation is to lower the peak infection and thus, flatten the curve under the recommended guidelines. This measure has similar effects to the first option, with the difference being it has a longer time to achieve peak casualties and will undoubtedly still put medical facilities under longer stress time period.

The presumption for mitigation lies behind ‘herd immunity’ – the ability for masses of people to be immune to certain diseases after certain amount of time passes. However, this runs the risk of having millions death. Presumably then, the virus itself, as any other coronavirus family including seasonal flu, will mutate. Although the rate of mutations in Covid-19 is much lower than ordinary flu strains, Covid-19 has mutated into several different strains from country to country. Mitigation strategy will prolong the exposure and thus, enabling the virus to gestate and mutate into another more virulent strains. 

3.      The third option is suppression strategy, which has been proven to be working in countries such as China, Japan and South Korea. The strategy mostly rely on doing some heavy order of social distancing and isolations. In relations to flattening the curve, suppression will  enable countries health facilities and services to stay ahead of the infection and thus putting less strain on the healthcare system. The resultant death is, therefore, will be in the thousands instead of millions.


Overall, while the suppression strategy seems to be the most effective because it allows for the functionality of time:

·         Fewer cases of Covid-19;

·         Immediate relief for the healthcare system and capacity to isolate and quarantine healthcare workers to get better and back to work;

·         Reductions in fatality rate;

·         Reductions in collateral damage.


Another important aspects of suppression is contact tracing and testing for the virus. There are needs to increase the ability for each countries to increase the rate of testing as what China and South Korea had done. Furthermore, by suppressing the rate of infections, it will also enable preparations of medical equipment to combat the virus.

At the practical level, suppression strategy – ‘the hammer’ – at societal level can be calamitous and outright undoable, particularly in the western countries. This will also have a dire economic impact. But the difference is stark – either hundreds of thousand if not, millions die by mitigations or sacrifice economy to safe millions. A stronger mode of suppression as seen in China have a drastic effect on the  rate of infections, in comparison with France and Spain. In Wuhan, during the lockdown, only one person from each household is allowed to leave every three days to get supplies. In short, suppressions allow for the maximum possible reductions in the rate of infections between people. This will lead to the next phase, ‘the dance’.

The dance period refers to the time whereby the slowing down of rate of infection and death will allow citizens to return to their pre-infection activities, albeit with restrictions on social gathering. This also includes social distancing and continual tests and isolations of cases.

You can find the full article on the following link

Coronavirus: Why You Must Act Now

Politicians, Community Leaders and Business Leaders: What Should You Do and When?


Tomas Pueyo here tackles the subject of Coronavirus; the speedy way in which it emerged and the exponential manner it behaves. Pueyo started his article by questioning the reader about their knowledge of this developing issue and how seriously they interpret its impacts; politically and financially.

Pueyo highlighted the importance of how as a politician or a business leader, one would hold the responsibility of handling and preventing this pandemic.

The writer started questioning the following;

1-      How Many Cases of Coronavirus Will There Be in Your Area?

As for the case in China, were the pandemic started it shows an exponential growth. The number of cases was not remarkable during the first the three to four months starting from January 22nd. Soon after that the number of cases escalated dramatically to double up within less than two weeks. After which period the graph took a sharp rise to double again within less than a month.  

The case took a different fashion outside China, i.e. the number was quiet low for a whole month and then it sloped up sharply afterwards. This was applicable to countries like Iran, South Korea and Italy. This pattern can be applied quiet similarly to the rest of other European Countries.

There are countries that showed a very rapid increase reaching an extant were the number of affected people doubles every two days, like Spain, UAE, Malaysia and USA.

According to studies performed since the outset of the pandemic, the reader can notice that by the time the authorities declare the number of the affected, in real point the number is much higher. The authorities don’t know that somebody just started having symptoms. They know when somebody goes to the doctor and gets diagnosed.

Countries that went into the epidemic SARS in 2003 did not show exponential rise as they have learned from their previous experience to take appropriate and speedy precautions.

The case in some United States

Washington State is considered the US’s Wuhan. The number of cases grows exponentially and at times the death rate was throw the roof. It is known from other places that the death rate of corona virus is between (0.5% to 5%), whereas it reached 33% in this state. Which can be explained that the virus spread undetected for weeks before it was included officially.

Pueyo assumes that by depending on the number of official cases we can guess the true number of those who are affected. I.e. if one death from Coronavirus is detected and bearing in mind that it takes an average of 17.3 days from catching the virus to dying, hence this means that the real number of the infected 17 days earlier is 100 assuming that the death rate from Coronavirus is 1%.  As well, we need to put in mind the average doubling time for the virus which yields the real number of the affected.


There is another point to notice. For the bay area for example there tested everybody who travelled or was in contact with a traveler, whereas they did not test the community so there will be a discrepancy between community spread vs. travel spread.

The Case in France and Spain looks somehow similar (1,200 cases vs. 1,400, and both have 30 deaths in the time of the currant report). But the estimated actual figure is tens of thousands in both regions.

2. What Will Happen When These Coronavirus Cases Materialize?

Speaking about fatality rate (% people who contract the coronavirus and then die) Pueyo depicted that there are two ways to calculate the fatality rate, i.e. Deaths/Total Cases and Death/Closed Cases. And in the article, Pueyo exemplified his calculations on South Korea, Iran and Italy.

Countries that are prepared will see a fatality rate of ~0.5% (South Korea) to 0.9% (rest of China). Countries that are overwhelmed will have a fatality rate between ~3%-5%. Which indicates that the earlier and the faster the action against the Coronavirus the less the fatality rate.

2.1 What will be the pressure on the System?

What is almost agreed upon is around 20% of cases require hospitalization, 5% of cases require the Intensive Care Unit (ICU), and around 2.5% require very intensive help, with items such as ventilators or ECMO (extra-corporeal oxygenation). Considering this it is clearly assumed that the healthcare system will be overwhelmed to fulfill this increasingly tremendous need in addition to the extraordinary physical and psychological pressure on the healthcare personnel.

3. What Should You Do?

Flatten the Curve which means reduce the infections as much as possible to handle the cases in a better way. And the second important point is to spread this over time, to reach a point where the rest of society can be vaccinated, eliminating the risk altogether. So the goal is not to eliminate coronavirus contagions but to postpone them.


Flattening the curve is the most important factor to control the pandemic, this can be accomplish by;

-          Social distancing

-          Learnings from 1918 Flu Pandemic

-          As for politicians, the only ways they have to contribute in social distancing are through; containment, mitigation or suppression.


Containment: making sure all the cases are identified, controlled, and isolated

Mitigation: requires a heavy amount of testing, contact tracing, quarantines and isolations to flatten the curve without stopping the outbreak

Suppression: tries to go one step further and quench the outbreak. It requires heavy social distancing, i.e. closing companies, shops, mass transit, schools, enforcing lockdowns.

Pueyo says that this is what supposed to be done in Wuhan, Italy, France, Spain, and many other countries; because when the virus is rampant, the only measure is to lock down all the infected areas to stop spreading it at once. So in order to lower the transmission rate, we need to flatten the rate.

4. When?

When to make each decision, or what triggers should be measured. Pueyo created a model were assess the likely number of cases in ones’ area, the probability that employees are already infected, how that evolves over time, and how that should tell whether to remain open.

Conclusion: The Cost of Waiting

This is an exponential threat. Every day counts. When you’re delaying by a single day a decision, you’re not contributing to a few cases maybe. There are probably hundreds or thousands of cases in your community already. Every day that there isn’t social distancing, these cases grow exponentially.

You can find the full article on the following link