The Good, The Bad & The Ugly -- Coronavirus Edition
It’s been two months since my last Musing, but it feels like two years. The world has dramatically changed for all of us in the last 60 days, and if you’re like me, you’ve been drinking from a firehose of information about the coronavirus daily – a lot of which is conflicting and some of which is downright bogus.
In this Musing, I will attempt to distill my own thoughts and learnings from voracious readings on this topic and also include a compilation of what I deem to be the best papers, presentations, and books. I am going to disclaim right off the bat that I won’t be sugarcoating anything and that some of my conclusions won’t be pleasant for some to hear, but my view is that it is better to sacrifice some near-term zen and be prepared than to be blissfully ignorant and woefully unprepared.
Because I like to disclose bad news first, I’m going to violate the sanctity of my title and attack “the bad & the ugly” first before ending on “the good.”
The “novel coronavirus” known as COVID-19 or SARS-CoV-2 originated in December, 2019 in the city of Wuhan, in the province of Hubei in China; by some reports, China may have known about it as early as September. Coronaviruses comprise a family of zoonotic viruses (animal-to-human) that include SARS, MERS, and now COVID-19. Zoonotic viruses “spillover” from an animal “reservoir host” (in this case believed to be bats) often by way of an “intermediate host” (possibly pangolins) to humans. China’s abundant “wet markets” which feature a myriad of animal species for sale in close proximity provide the ideal “petri dish” for these types of spillovers to occur, which is what happened with SARS in 2002. A great, prescient book on this topic that I am currently reading is Spillover: Animal Infections And The Next Human Pandemic by David Quammen.
Dr. Lu Wenliang warned fellow doctors about this new SARS-like flu and was silenced in December. The World Health Organization (WHO) didn’t learn about it until December 31. By January 4, 44 infections were documented, with more than half traced to a “superspreader” – the Huanan Seafood Wholesale Market in Wuhan. By January 23, 581 cases had been reported. The cases exploded to 2800 by January 27, and WHO declared the outbreak to be a “public health emergency” on January 30. Trump imposed travel restrictions related to the epidemic on January 31.
By February 2, global cases hit 14,557 with 305 deaths; China claimed that cases in China peaked on that day. February 6: 193 people from Wuhan landed in Auckland, New Zealand and were quarantined. On February 8, 2 New Zealanders boarded the cruise ship Diamond Princess and wound up infecting 64 passengers. Cases reached 43k by February 11, and deaths exceeded 1000, achieving in 1 month of SARS claimed in 2 years. February 17: cases jumped to 71k, and 60 million people were locked down in Hubei. Iran got its first case on February 19, and by February 22, there were 634 cases onboard the Diamond Princess and 50k people were quarantined in Italy.
Fast forward to March 9: global cases hit 109k with 3788 deaths for a case fatality rate of 3.47%. By today, March 20, that number hit 275k with 11.4k deaths for a case fatality rate of 4.14%. Italy deaths are now 4k vs. 3.1k in China. As of today, the US stands at 19,624 cases with 260 deaths.
Why COVID-19 Is NOT “Just A Bad Flu”
Just two weeks ago, while I was waiting for my yoga class (which I now regret attending) to start, I was listening to the banter between several other attendees: “Can you believe the hype?”, “This is just a bad flu – big deal.”, “I think all these people stocking up on everything are crazy.” I decided then and there to not come back to class for a while – little did I know that in just days, all gyms and studios would be shut down. Similarly, in various financial conversations I’ve had over the last several weeks with people whom I greatly respect, I’ve heard comments like the following: “This will all be over in a couple weeks.”, “This is nothing like 2008.”, “Everything will be fine.”, “Seems like a lot of ruckus over something that does not appear to be a big deal.” There is only one comment in there that I would agree with – “This is nothing like 2008.” My concern is that this could be much worse than 2008 in terms of economic fallout, but my even bigger concern is the potential for societal breakdown if our healthcare system gets overwhelmed and/or our food supply chains fail.
I have many concerns over some of these lackadaisical comments: 1) these well-meaning folks, in their true belief that “everything will be fine,” will not be taking prudent financial measures to hunker down their businesses aggressively enough, and 2) more importantly, they may not be taking the health safeguards seriously and unwittingly aid and abet the contagion. Case in point: because younger people have read that this virus takes its biggest toll on the infirm and elderly, many are still going to parties, parades, mass gatherings with reckless abandon. The same argument potentially goes for businesses who are anticipating a "V"-shaped recovery – especially those businesses with high, fixed obligations. Normally, Darwinian self-selection takes care of stupid, reckless behavior; unfortunately, because of the disease dynamics here, these behaviors endanger us all, both in terms of physical and financial health.
I believe there are two main reasons why doubters doubt: 1) recency bias, and 2) one-dimensional comparisons.
In terms of recency bias, let’s face it: life has been good for those of us in developed nations for a long time. It’s been a 20-year bull-market, it’s been 75 years since the last World War, it’s been 100 years since the last global pandemic. But history can be a good teacher: the Spanish Pandemic of 1918 is the best historical parallel to the current COVID-19 pandemic, and that pandemic killed 50-100 million people between a two-year period (1918-1920) on a global population of 1.9 billion for a mortality rate of ~2.5%-5%. For perspective, WWI claimed an estimated 30-50 million lives. Two reasons why the experience of the Spanish Pandemic might be worse than today: 1) WWI created uniquely bad conditions that accelerated the spread of the virus, and 2) we have much better science today in 2020 than we did in 1920. On the flipside, however, two rebuttals to those rebuttals are: 1) we also have a much larger global population of 7 billion today, and 2) we are far more globally interconnected, with an estimated “2.8 million people flying each day” (quote from Larry Summers in a recent Goldman Sachs deck).
The other sobering lesson we can glean from 1918 is that the pandemic came in multiple waves, with the second and third waves (coming 5 and 10 months later, respectively) being far more lethal than the first wave. Three reasons for multiple waves include: 1) seasonality pattern of influenza viruses in general, 2) mutations (there already have been 100+ mutations of COVID-19, but they’ve generally been fairly stable -- so far), and 3) early relaxation of mitigation protocols (more on this later). In any case, we are only in the early innings of the first wave of COVID-19. See Exhibit 1: Spanish Pandemic Came In Multiple Waves.
Exhibit 1: Spanish Pandemic Came In Multiple Waves
For additional perspective on the Spanish Pandemic of 1918, I recommend the following book, Very, Very, Very Dreadful: The Influenza Pandemic of 1918, by Albert Marrin.
The second reason why doubters doubt is due to one-dimensional comparisons, which in my opinion, drastically understate the danger of COVID-19. By one-dimensional comparisons, the main example lies in people comparing the “low mortality rate” of COVID-19 as only “slightly worse” than a bad case of influenza. Some presentations I’ve seen (like McKinsey’s) attempt a two-dimensional comparison by plotting contagiousness as captured by the R0 (“R-naught”) reproductive factor vs. the case fatality rate (CFR), showing how COVID-19 is kinder and gentler than a myriad of other notable outbreaks like SARS, Ebola, measles, smallpox, Influenza of 1918. I argue that this analysis also understates the danger of COVID-19. At a minimum, I think we need 4-dimensional space to do a proper comparison: 1) R0, 2) Fatality Rate, 3) Incubation Period, and 4) Hospitalization Rate. Piecing together various charts from various studies I’ve read, I think that COVID-19 may have one of the worst profiles of any of these outbreaks when you factor in all 4 dimensions.
Here’s a quick explanation of each of these 4 variables:
- R0 (pronounced “R-naught”) denotes the reproductive factor and signifies the number of people 1 person is likely to directly infect. The “naught” designation is something used often in physics to denote the initial state of a system. If R0<1, each inflection causes <1 new infection, and the virus starves out. If R0=1, each infection causes 1 new infection, but an outbreak/epidemic is unlikely. If R0>1, each infection causes >1 new infection, and the higher the number, the higher the likelihood of outbreak. According to various sources, R0 for COVID-19 is 2-3, whereas the R0 for Seasonal Flu is 0.9 to 2.1 (with 1.3-1.5 as the most commonly quoted range), depending on the strain. Taking the low end of these ranges and rounding R0 for Seasonal Flu to 1, we may be tempted to conclude that “COVID-19 is only twice as contagious as Seasonal Flu.” Alas, that would be a gross misunderstanding of exponential math; whereas an R0=1 virus could still spread linearly, an R0=2 would explode exponentially as each infection would in turn infect 2 more and so on and so forth. The Spanish Pandemic had an R0 of 1.4-2.8, which is very comparable to COVID-19 in terms of contagiousness. Basically, anything with R0>2 is extremely contagious, and even the hypothetical virus in the movie Contagion had R0=2 (that eventually mutated to R0=4). Like that fictitious virus in the movie, COVID-19 spreads both via airborne transmission as well as fomite transmission (via surfaces), which accounts for the extremely high R0.
Related to the R0 is the concept of attack rate which is basically the probability of infection of a given population (the infection percentage of the population at risk). According to Professor Jeremy Farrar (see the entire transcript of his 2/25/20 Wellcome Trust COBIT Conference Call), an expert on infectious disease from Oxford, the attack rate is about 5-10% for Seasonal Influenza and only slightly higher at 16% for H1N1 Swine Flu. Ominously, he is estimating a 25-40% attack rate for COVID-19, using 30% as a base case. Essentially, this means that up to 30% of the global population may be infected.
2. The Fatality Rate (sometimes called Case Fatality Rate, or CFR) is the percentage of total deaths within a diagnosed population. The problem with this number is that it’s only as good as testing data can provide, and we all know that the world is woefully under-tested. According to the CSSE/Johns Hopkins dashboard today (3/20/20), the global Mortality Rate is 4.4% based on the latest data. As more and more of the world gets tested, this number likely drops dramatically as the denominator swells. Looking through the overstatement due to inadequate tests, Professor Jeremy Farrar estimates an ultimate CFR of 0.5-1%, with Seasonal Influenza at only 0.1%; takeaway – COVID-19 has a fatality rate that is 5-10x that of Seasonal Influenza.
3. Incubation Period refers to the amount of time elapsed between exposure to first symptoms. This is where COVID-19 is extremely pernicious. Whereas Seasonal Influenza has an Incubation Period of 1-4 days, COVID-19 could be 2-24 days (although CDC is only estimating 2-14). In other words, by the time you become symptomatic, you may have already inadvertently been transmitting this virus for 3 weeks – this alone makes COVID-19 far more insidious than most outbreaks of the last 100 years.
4. Finally, as if we don’t have enough to worry about, the Hospitalization Rate for COVID-19 is estimated to range from 10-20%, and the Critical Car Rate is estimated at 3%-5%; for Seasonal Influenza, the Hospitalization Rate is only about 2%.
The bottom-line here is that when people brush off COVID-19 as “just a bad flu,” they are grossly underestimating the danger of the combined quadfecta of COVID-19. If there was a way to plot COVID-19 in this four-dimensional space against the other significant outbreaks of the last 200 years, I would guess that COVID-19 emerges as one of the most serious contenders for the crown of "most dangerous disease."
Now let’s apply some of these numbers to the world population of 7 billion. If we use Professor Jeremy Farrar’s attack rate of 30% and CFR of 0.5-1%, we get 0.3 x 7 bn = 2.1 bn infected. Of this 2.1 bn infected population, 0.5-1% equates to 10.5 million to 21 million deaths globally! Closer to home, assuming a population of 325 million, we get 0.3 x 325 mm = 97.5 mm infected and 0.5-1% of that number resulting in 487k to 975k deaths. In my home state of California with a population of 40 mm, we get 12 mm infected and 60k-120k deaths.
Next, we need to talk about Hospitalization Rates and how that compares with our ICU surge capacity. For the purposes of being optimistic as well as opting for simple math, let’s assume 10% of those infected require hospitalization (the predicted range is 10-20%). This equates to hospitalization needs of 210 mm people globally, 9.75 mm of which are in the U.S. and 1.2 mm of which are in California.
How do these needs compare with hospital capacities? This is where things get Ugly, with a capital U. According to various sources (this article is one of them), the U.S. is estimated to have only 1 mm hospital beds in total, of which 68% are already occupied, leaving 300k beds available nationwide against surge demand of up to 9.75 mm; put another way, surge demand outstrips capacity by 32.5x! Quoting this article:
At a 10% hospitalization rate, all hospital beds in the U.S. will be filled by about May 10. And with many patients requiring weeks of care, turnover will slow to a crawl as beds fill with COVID-19 patients.
If I’m wrong by a factor of two regarding the fraction of severe cases, that only changes the timeline of bed saturation by six days (one doubling time) in either direction. If 20% of cases require hospitalization, we run out of beds by about May 4. If only 5% of cases require it, we can make it until about May 16, and a 2.5% rate gets us to May 22.
On March 16th, Imperial College in the UK put out a controversial yet alarming study entitled “Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand." The gist is that they modeled the effects of applying 5 different “non-pharmaceutical interventions (NPIs)” as strategies to mitigate/suppress R0; strategies include: isolation at home, voluntary home quarantine, social distancing, and closure of public schools and universities. Their paper came to the same conclusion that I reached above -- that surge demand could outstrip capacity by over 30x if no mitigation strategies are employed; however, if these mitigation/suppression strategies are implemented, they estimate that the surge demand would “only” exceed capacity by 8x.
Since then, Nassim Taleb (of Fooled by Randomness fame) published a pedantic critique of this study but did not offer any original insights of his own. Similarly, Bill Gates chimed in with an equally unsatisfying comment from this interview.
Q: What about this Imperial College study suggesting 1-4 million Americans will die with current approaches, but total shutdown would limit deaths to a few thousand?
Fortunately it appears the parameters used in that model were too negative. The experience in China is the most critical data we have. They did their “shut down” and were able to reduce the number of cases. They are testing widely so they see rebounds immediately and so far there have not been a lot. They avoided widespread infection. The Imperial model does not match this experience. Models are only as good as the assumptions put into them. People are working on models that match what we are seeing more closely and they will become a key tool. A group called Institute for Disease Modeling that I fund is one of the groups working with others on this.
Meanwhile in California, Governor Gavin Newsom just released statewide hospital metrics:
- 74,000 hospital beds at 614 facilities.
- Surge capacity of 8661 beds.
- 11,500 ICU beds (includes pediatric and neonatal).
- 7587 ventilators.
- EMSA has additional 900 ventilators.
- Procured an additional several hundred ventilators.
- Negotiations are underway to re-open healthcare facilities to significantly increase surge capacity.
- A minimum of 750 new beds will be added to surge capacity by end of the week.
If the above hospitalization need of 1.2 million is even half accurate, well, you get the picture.
Bottom-line: our (and the entire world’s) healthcare system was never designed to deal with a pandemic that could cause surge demand in hospitalizations to eclipse capacity by multiples. Although we are already hearing the anecdotes of wartime triaging in Italy and China as their healthcare systems get swamped, many here still brush it off as unlikely, citing that “hospitals are currently not that busy.” With all due respect, I think this blasé attitude will cause some rude awakenings here and around the globe in the next several weeks, as exponential growth socks reality in the face with a haymaker. Best thing to do: stock up as best you can and assume you may be limited to self-care if/when the system is overwhelmed.
Caught Between the Scylla and Charybdis
In Homer’s Odyssey, Odysseus at one point during his wanderings had to steer a narrow course between Scylla, a multi-headed monster, and Charybdis, a whirlpool-like creature who could devour whole ships. All world leaders are now caught in a similar quandary between the “Scylla” of letting the virus run rampant and eventually “burn itself out” and the “Charybdis” of enacting draconian measures to drive down R0 but at great economic/societal cost. Embracing “Scylla” will lead to overloading the healthcare system, likely lead to massive numbers of deaths and undoubtedly wreak societal havoc. Embracing “Charybdis” on the other hand may buy time in the short-term, but how long can a government enforce strict quarantining and the massive economic hemorrhaging that will result without even a guarantee that infections won’t spike again the minute vigilance is let up?
Goldman Sachs put out a very comprehensive update today (GS_3_20_20_Coronavirus_Call_5_Materials (2) which not only gave a status report of various promising initiatives, ranging from addressing various testing bottlenecks (kit availability, lab capacity, availability of swabbing technicians) to the various pharmaceutical trials and timelines (unfortunately all fairly far off). In addition, they showed how aggressive containment efforts can indeed “flatten the curve.” Despite China’s initial cover-up of their COVID-19 outbreak, their full clamp-down of Hubei province seems to have achieved the desired effect of compressing R0 quickly and “flatten” their infection curve – see Exhibit 2.
Exhibit 2: China Has Quashed R0 from 3.86 to 0.32 in One Month, source: Goldman Sachs
As a result, media pundits and friends alike seem to have limitless appetite to praise the efforts of China, South Korea and Singapore as the paragons of how to navigate the “Scylla/Charybdis strait” while lambasting our own efforts in dealing with this crisis. There are definitely best practices that we should be adopting – this blog post lists some good ones.
That all said, this story is far from over, and it is way too premature to declare that China/South Korea have found the optimal path through these dire straits. In fact, another paper authored by University of Maryland Professor Mohammad Sajadi entitled “Temperature and latitude analysis to predict potential spread and seasonality for COVID-19” found that the hardest-hit cities were all correlated by a tight temperature range (Table 1 on page 5), makes some interesting predictions about where the next “hotspots” will be (London and New York figure prominently in this list) and noted that the “marked drop in cases in Wuhan could well be linked to corresponding recent rising temperatures there.” That said, there seems to be conflicting evidence that warmer weather will help mitigate the spread, as there appears to be prolific transmission in currently warm places like South America and Australia.
If seasonality is an unlikely catalyst for resurgence and mutations have thus far remained stable, that leaves relaxation of lockdown protocols as the likeliest reason for an uptick. The 3 experts in the reports I have cited (Dr. Jeremy Farrar in the Wellcome Trust call, the authors of the Imperial College report, Dr. Barry Bloom in the Goldman presentation) and the history of 1918 all seem to point to relaxation of protocols as a key determinant of resurgence.
In addition, Professor Farrar hammers home just how difficult it is to put this genie back into the bottle:
But with this infection, with the amount, the degree of how infectious this is, the measures even in Wuhan can dampen the peak of the epidemic and they can spread out and delay the time to the epidemic. But given how infectious this is, you cannot prevent an epidemic with this level of infectiousness. So, the containment strategies of the moment are absolutely right and they've essentially bought other cities in China and the rest of the world time, but they will not be able to prevent it completely.
Taking this into account and noting the recent uptick in Chinese and Korean infections lately, despite their “best-in-class” protocols, I can’t help but wonder: did they relax their protocols too soon? See Exhibit 3.
Exhibit 3: Chinese and Korean Infections Are Ticking Up Again. Source: Goldman Sachs
Finally, I want to express my skepticism at the Chinese and Indian numbers in particular. China and India not only boast the two highest populations in the world, each with over 1.3 billion people clustered in many dense urban centers, they also have the dubious distinctions of having the lowest critical care beds per capita in the world. That is not a good combination. Given this and the fact that neither country is hermetically sealing its populations, I find it difficult to believe that we’ve seen the worst of it – especially when India is only claiming 250 infections! See Exhibit 4.
Exhibit 4: China and India have the lowest critical care beds per capita
What about a vaccine?
So far, every mitigation/suppression technique that’s been used has been non-pharmaceutical – because we don’t have a vaccine, and the consensus seems to be that we are 12-18 months away from one. The Goldman Sachs deck I referenced earlier has comprehensive lists of both potential therapeutics and potential vaccines. The good news? The lists are long, and the Who’s Who of Big Pharma around the world are on the case. The bad news? We are in the very early innings on almost every single one. Professor Farrar summarizes the challenges of fast-tracking vaccine development:
The Coronaviruses are a completely different challenge. And as I said, we don't have a vaccine for SARS, for MERS or indeed for the common cold. And so, the ability to make a vaccine and a strong immune response, the response that would protect you is a much bigger challenge in Coronavirus than it is in Ebola.
We are fast tracking. I mean to go from the sequence of the virus, which is what we needed in the first few days of January to having the first person received the vaccine in the first week of March has never been done in history before. I mean that process from sequence to first person would normally take somewhere between three and five years. So, we've brought that down to about five weeks. The other of course is when you're giving a vaccine, particularly to a disease, which for the vast majority of people will be mild, then you have to be absolutely sure of the safety of that vaccine. With Ebola I was much more gung ho. If you get Ebola, you've got a 70 to 80% chance of dying. And therefore, you'd take a pretty big risk to receive a vaccine that you hope would prevent you getting it.
With this Coronavirus you've got a less, in my view, less than 1% chance of dying. And therefore, you've got to be absolutely sure that that vaccine is safe before you roll it out to 350 million Americans or seven billion people around the world. So, the safety requirements and the threshold that you need to go through to prove that what you have is safe, let alone effective is very significant.
One more from Farrar:
And it won't be at least until 2021 until we have a vaccine that we can use as a public health measure. And that will assume good luck and good fortune all along the way. Just to again, underline the fact we've been trying to make a vaccine for SARS for 15 years, for Murs for seven years, and the common cold for about 50. And we've failed in each of those so far. So, although I'm more optimistic that science can deliver a vaccine now that it's not going to impact in 2020 on the public health outcomes of this.
What about those rumors that keep surfacing about potential vaccines in 2-4 months? I wouldn’t count on it.
As I write this missive on Day 1 of California’s lockdown, I find that I have far more questions than answers about the ramifications of COVID-19 on our society, economy, and politics. In no particular order:
- What happens to the fabric of society if our healthcare systems do get overwhelmed as the math suggests and/or our food supply chains fail? How will the government keep order if people are turned away at hospitals and grocery shelves are bare?
- What happens to our already serious homeless problem and the related health risks to themselves and to society at large?
- What about our crowded jails? Other countries have released criminals to stave off mass infections at jails. There are similar calls here to do that and at the same time for law enforcement to not focus on the “little stuff.” What constitutes “little stuff” and what happens when criminal elements are emboldened and their numbers are bolstered?
- What happens when one country embraces the “Scylla” path of letting the virus run rampant and “burn itself out” and a neighboring country embraces the “Charybdis” path of clamping down to stave off transmission? The two goals are mutually exclusive, so what do we do about our borders?
- Does this make people more xenophobic and socially distant or does it have a unifying effect?
- If the goal is to “starve out” the virus by driving R0 down, how far are we willing to go in terms of cutting into the muscle and bone of our economic engine, realizing that if we relax too soon, infection rates may spike back up?
- Unlike the 2008 crisis of confidence in primarily Wall Street (whose metastasis into Main Street was forestalled by massive injections of liquidity), here we have a severe supply shock and demand shock of Main Street (which will inevitably metastasize to Wall Street) which is not curable by monetary policy and maybe not even fiscal policy. What kind of deficits are we willing to incur and for how long? Will the markets even permit this?
- What sectors/companies are worth saving, and how will government pick winners and losers? What price will government exact for those bailouts?
- The Baby Boomer generation is a high-risk demographic. If a significant percentage of this cohort perishes, what are the ramifications of their wealth redistribution?
- What does this crisis do to global supply chains and logistics planning? Do we wind up seeing a wave of onshoring and redundancy in stark contrast to decades of offshoring and just-in-time?
- Does this crisis call into question the fundamentals of the “sharing economy” and being “asset light”? Is there a reversion to wanting to own versus rent?
- Similarly, the Baby Boomer generation wields an inordinate amount of political power in this country. If a significant percentage of this cohort perishes, how does that impact the power dynamics in Washington and around the world?
- Things are further complicated by an election year. What happens if any of the Presidential contenders gets infected? Can an election be postponed?
- Similarly, what happens if members of Congress get infected? Ditto for SCOTUS?
- Part of the secret to America’s success economically is its free-market system, which is inextricably intertwined with its federalist system of government, with each branch of government exerting checks and balances on the other two. Unfortunately, unless we mobilize into a full wartime mode, this federalist system is far more encumbered in its ability to respond quickly to crises than authoritarian systems like China and Singapore. So what course will we choose?
- Right now, certain states are on lockdown, but many are not. Meanwhile, interstate travel is still allowed, so what is the point of lockdown? Is martial law necessary and for how long?
As I write this, my closest friends are making some of the toughest decisions of their lives in a bid to survive this crisis. I feel privileged to witness such courage under fire and am truly inspired by these acts of leadership. I know of nothing else to say besides the adage: it is darkest before the dawn, and the dawn will come.
We are a tough, scrappy nation. Yes, we’ve made mistakes. Yes, it’s easy to Monday-morning quarterback those in power. Yes, it’s easy to say “the grass is greener elsewhere,” to say that other countries are “doing it right” and we’re “doing it all wrong.” Unfortunately, none of that is helpful. We are all in this together, and now is not a time to be divided. We have a common, invisible enemy that is the Great Democratizer. It does not care about your political affiliation, your race, or your socioeconomic background.
The US was criticized heavily in WWII, as it stood by and watched its European Allies get decimated and the Holocaust was carried out. Yet, when it finally did act, the US mobilized with decisive action, eventually turning the tide; not only did we end the war, we helped our Allies rebuild their nations and economies. At home, we had a multi-decade post-war boom – not just economically but in babies! I foresee the same thing happening again when this is over. We just need to keep our eyes on the long game while taking the steps now to make sure that we’re around to see that day.
Since the beginning of this month, I’ve started keeping a gratitude journal. When I reflect upon the common items that I personally am grateful for, the following themes come up for me:
- My family, and in particular, new-found time with my kids that I would not otherwise have given my recent empty-nest status
- My friends and the incredible support network they provide; new-found excuses to reconnect with people I haven’t spoken to in a while
- My health and a new appreciation for how precious this commodity is and how protective and vigilant we need to be to safeguard it
- My home and how lucky we are to have a place of refuge in this time when not everyone is so lucky
- My wonderful experiences and how they can be had even in the confines of home without the need to go anywhere or do anything
What’s notable to me is that even though I’ve spent my entire adult life in the pursuit of making money and despite the last several weeks not being fun financially (I am sure I am not alone), given the new-found time for reflection, the most important things to me are bubbling up, and – surprise, surprise – they’re not money! With that, I think I’m going to whistle my favorite Ennio Morricone soundtrack and watch my favorite Clint Eastwood flick.
Stay safe and healthy, my friends!
Spillover: Animal Infections And The Next Human Pandemic by David Quammen
Very, Very, Very Dreadful: The Influenza Pandemic of 1918 by Albert Marrin
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