by Tomas Ries, Associate Professor of Security and Strategy at the Swedish National Defence University in Stockholm
The world currently faces two distinct crises. One is the direct danger from COVID-19 to the lives of populations and the capacity of our health systems to cope with the infected. The second is the danger that our mitigation policy – seeking to delay the spread of the COVID-19 infection – presents to the global and national economic systems that states and societies depend upon for their very survival.
COVID-19 and our mitigation response to it are obviously linked but it is crucial to distinguish between the two. The pandemic presents a deadly threat to a minute fraction of the global population and to the functioning of our health care systems during the infection peaks, lasting from a few weeks to a few months. Our mitigation measures on the other hand threaten our economic base, and hence carry the danger of mass unemployment, bankruptcies and massive increases in national debt in the short term. In the longer term we run the risk of truly massive poverty, food shortages and violent domestic collapse.
And then there are the possible big political consequences of the above. Will the economic and social consequences lead to more democracies becoming authoritarian? How will it impact on the poor regions of the world and regional conflicts? Will it affect the cohesion of the EU and NATO? What will it’s impact be on global power politics? Can it break the globalization agenda in favour of more chauvinistic nationalism? And many more possibilities.
There are of course huge uncertainties about the future consequences of both COVID-19 and our mitigation policies. But given the risk we must ask four questions. First, what is the basis for our security? Second, what is the threat from COVID-19? Third, what threat do our mitigation policies present to our economic base and hence our societies? And fourth, what are our options?
What is Security?
Security can and is be described in many ways. However one of the most profound definitions is simply “Functioning Vital Life Systems.” This is a generic definition that applies to all dynamic systems, from single-celled amoebas up to complex systems such as the global ecosystem or human societies.
The term ‘functioning’ implies that security is more than just ‘safety and protection’. To function, a system must both be protected sufficiently to allow its vital subsystems to work, but also be dynamic and vital in order to adapt and evolve. Security thus depends on a maintaining a dynamic equilibrium between stability and change, very much like the Chinese yin-yang concept.
The ‘Vital Life Systems’ (VLS) that humans depend upon can be divided into six major types, in three big dimensions, with each dimension driven by a different basic energy. The Social Dimension is driven primarily by human energies. It includes two VLS. One is Governance, or the wisdom of our leaders. This matters because their decisions have huge consequences such as war or peace, poverty or prosperity, sustainability or depletion and so on. The other is ‘Social Health’, which is to say a society in which a sufficient majority are both satisfied enough not to want violent change, and sufficiently vital and dynamic to provide the labour and creativity that is needed to sustain social life.
The Functional Dimension includes the Economy, defined as the production and distribution of the vital commodities that societies depend upon to survive and function, starting with food, and the Technical Infrastructure on which the economy and our daily lives depend, such as shelter and tools. This dimension is driven by interaction of the human spirit with our natural environment.
Finally the Ecological Dimension includes the Natural Resources on which we depend upon to survive, starting with air, water and arable land, and the Habitat in which we can thrive, including such things as shelter from cosmic radiation, climate and so forth. This dimension is driven entirely by natural laws, but which can be heavily influenced by human activity. The Three Dimension and Six Vital Life Systems are presented in the Triangle below.
This is of course a simplification of a big picture that can be made as complex as one likes. However the simple overview the big picture is crucial for security analysis in general, and in particular in our current era. First, because existential threats can emerge in all three dimensions. Second because they are all closely interconnected, and can rapidly jump from one VLS to another, creating ricocheting threats. Pandemics are a typical example. They emerge in the ecological dimension and jump into the social VLS. From there they can affect both the economic and technical VLS either through lockdown measures, or directly by killing off the persons who need to keep those VLS going. At the same time attempts to prevent the spread of the disease can choke the free movement of goods and people, which, in an entirely interdependent world like the one we live in today, can also cause the economic and technological VLS to crash. This in turn would bounce back up to the social dimension, affecting both our societies and grand politics. It is in fact this sort of ricochets that we are witnessing now with COVID-19, albeit in a very mild form so far.
The third reason the triangle is important is because it illustrates the hierarchy of our security dependencies. The social dimension largely rests on the functional dimension, and the functional dimension rests on the ecological dimension. There is of course intense interaction in all directions, but the in the end everything rests on our planetary ecological foundations.
The last, but not the least, reason the simple triangle is important is because it is comprehensible. It allows decision-makers and the grand public alike to perceive both the range of potential threat areas, and how they can interact.
When faced with severe threats it is natural for us to develop a tunnel vision, focusing narrowly on the immediate danger. This is an evolutionary trait, and helpful when there is one largely isolated threat at a time. However if there are several threats, and especially if they are closely interconnected, then tunnel vision can be fatal. For in focusing on the most immediate and apparent threat we can miss out a range of more severe threats that it, or our reactions to it, can generate. And this could be the case with COVID-19.
1. The Threat from COVID-19
Most data for COVID-19 are uncertain simply because we do not know how many are infected globally or nationally. First because we cannot test every inhabitant and most states have trouble testing even those who show symptoms. Second, because it is estimated that some 18% of those infected show no symptoms, and so would pass testing. Thus all estimates based on numbers of infected are uncertain. Yet knowing how much of the population could get infected is important, so even uncertain estimates are valuable.
1.1. How many could be infected and killed
The European Centre for Disease Control (ECDC) offers one estimate for total reported infections for the EU/EEA and UK: (www.ecdc.europa.eu)
Date 11 March; Cases per 100,000 pop.: 3.3
Percent of population: 0.0033%
Date 25 March; Cases per 100,000 pop.: 36.1
Percent of population: 0.0361%
Date 31.3 – 15.4; Cases per 100,000 pop. 100 (expected)
Percent of population: 0.1 %
The last figure is based on the situation in Hubei at the peak of the infection there, when it is estimated that 0.1% (100 cases per 100,000) were infected. However the share of population that could be infected is one of the most uncertain variables. There are estimates that up to 60% of the population could be infected, but in this case with a large majority showing no symptoms. This multiplies the spread of the virus, but reduces its severity.
Though uncertain the data indicates two things. First the small part of the population that would be infected even at a possible peak infection period in April. Second the rapid increase in reported infections in the two weeks between 11 and 24 March.
A second critical factor is how severely the virus would harm those infected. Here the data are more certain since they are based on actual observation. Here the ECDC reports the following: (www.ecdc.europa.eu)
Impact as percent of reported cases of infection
80% mild (do not require hospitalization)
14% severe disease (require hospitalization but not in critical condition)
5% critical illness (require intensive care units)
However these figures are only based on numbers of reported cases, not on all cases. The good news here is that the actual percentage of mild cases is therefore likely to be greater than 80% since the reported number is likely lower than the actual number of mild cases. However the data does provide a rough picture of what we face. The vast majority of the population – over 80 % – suffer a non-life threatening influenza which does not require hospitalisation. Some 20 % suffer severe illness. Of these some 14% require hospitalization, while 6% require Intensive Care Units (ICU). And of these last, some 17% can expect to die.
Thus of the total number of infected some 1% can expect to die, which is about ten times the mortality rate from a normal seasonal flu, such as we get each year, which is roughly 0.1% of infected cases. Here one should note however that mortality estimates vary and the World Health Organisation (WHO) has estimated that 3.5 % of all infected with COVID-19 may die. https.//www.worldometers.info/coronavirus (26.03.20)
If we combine the two tables above the total mortality rate of COVID-19 would lie someplace between 0.01% and 0.035% of the population as a whole. (0.1% of total population get infected, of which 1 % to 3.5 % die.) This is obviously a rough estimate based on uncertain data, but it gives us an idea of the scale of the direct threat to life from COVID-19.
On the other hand the 20% requiring hospitalization will come as a wave in which the peak can last from a week to a month or more. During that peak national health care will be severely strained, as in the dramatic pictures we currently see from Italy and New York.
1.2. Who could be killed
To this we can add three factors that narrow down what type of person is most at risk of death from COVID-19. One of these is comorbidity, or whether one has a pre-existing chronic illness. This data indicates that healthy individuals only have a 0.9% risk of dying from COVID-19:
Fatality by comorbidity https.//www.worldometers.info/coronavirus (26.03.20)
10.5% Cardiovascular disease
6.3% Chronic respiratory disease
0.9% No pre-existing conditions
The second key indicator is fatality by age group. Here persons over 70 years run the highest risk of death if infected: 14.8% mortality for those 80 years or more, 8% for those between 70 and 79. Anyone under 50 on the other hand runs a low risk of death if infected (0.2%).
Fatality by age % of all infected https.//www.worldometers.info/coronavirus (26.03.20)
Here too however one should note that these figures can or will change as the pandemic evolves, and that the actual impact will vary between societies.
Finally one might also note that men run a slightly higher risk of death from infection than women:
Fatality by sex % of all infected https.//www.worldometers.info/coronavirus (26.03.2020)
Even if this data also is uncertain and will vary from case to case, it indicates two things. First, that persons with no pre-existing illnesses face little danger of death if infected (0.9%). Second, that persons under 50 are even less at risk (0.2%). This is tragic news for the elderly and chronically ill, but for the functioning of society it means that the vast majority of persons of working age and younger likely will not die. This in turn means that those persons who are needed to keep society, economy and technical infrastructure going are virtually not at risk.
If we apply the above data to the EU we get the following estimated fatality rates from COVID-19:
EU pop. 445 million
1% of 445 million = 4,450,000 infected
80% of 4,450,000 = 3,560,000 mild cases
14% of 4,450,000 = 623,000 severe illness
6% of 4,450,000 = 267,000 critical
1% of 4,450,000 = 44,500 dead (included in 6% critical cases)
1% of 267,000 = 2,670 critical without comorbidity
Furthermore, of the 1% dead over 90% would be elderly pensioners and/or persons with pre-existing serious illnesses.
If we look at a small to medium-sized country like Sweden the estimates are as follows:
Sweden pop. 10 million
1% of 10 million = 100,000 infected
80% of 100,000 = 80,000 mild cases
14% of 100,000 = 14,000 severe illness
6% of 100,000 = 6,000 critical
1% of 100,000 = 1,000 dead (included in 6% critical cases)
1% of 6,000 = 60 critical without comorbidity
In comparison the average number of dead per year in Sweden from various accidents (traffic, work, leisure, etc.) is 3,000. Those are however spread out over 12 months, while the 1,000 estimated COVID-19 fatalities would probably come bunched up in the space of 1-2 months. On the other hand the deaths from accidents include all age groups.
Actual figures from Italy from 27 March 2020 indicate even lower infection and mortality rates:
Italy pop. 60 million
0.136 % infected (81,340 actual cases 27.03.20)
0.014 % dead (8,214 actual dead 27.03.20)
However here the disease is not yet over and thus numbers are likely to increase considerably in the coming months, probably to at least the double.
1.3. Mortality and hospitalization per capita
However we also have more reliable figures for analyzing the impact of COVID-19. These include three types of data. First, the total population of a state. Second, the numbers of dead from COVID-19 recorded to date. And third, the number of patients in hospitals in severe or critical condition from COVID-19. The data for the 33 countries with the greatest number of dead per capita to date are listed in Table 1. The data for the 20 countries with the greatest number of hospitalized is given in Table 2.
The strength of this data is that it does not rest on estimates of the number of infected cases, but on actual observed cases as a percent of total population. However this data also has at least four weaknesses. First, that it is taken at varying stages in the progression of the pandemic, so the numbers of dead and hospitalised will still increase as the pandemic progresses. We are in fact measuring a moving target. Furthermore, if the pandemic involves a second wave of infections this fall, as is expected, then numbers will increase even more.
A second weakness is that the tempo and volume of infection varies from country to country depending on mitigation measures, social conditions and health care. Third, that different countries have different ways of measuring cause of death. Since a large majority of COVID-19 fatalities occur in persons with pre-existing illnesses, some countries will report the cause of death as the pre-existing illness, while others in the same case would give cause of death as COVID-19. Finally, the quality of the reporting varies from state to state, and a small number of states might deliberately minimize their numbers.
Nevertheless the reported numbers of dead and hospitalised are the most reliable data we have to work with. They indicate that the global average of fatalities from COVID-19 as a percentage of the total population is currently 0.0004%. This is a minute portion of the population, but since the pandemic is still in an early stage the actual share will still grow. However even if we multiply it by 1,000 we still get a conservative estimate of 0.4% dead of the total population.
While the actual fatalities will vary from country to country, the aggregate picture does offer a broad pattern from which one can draw one unambiguous conclusion:
COVID-19 in its current form does not present an existential threat to our states or societies.
It does constitute a temporary threat to our health care systems by overloading them for limited periods of time, estimated at between 1-2 weeks to 1-2 months from day zero (date that infection rates start increasing drastically), depending upon size of population and mitigation measures. Second, COVID-19 is a tragedy for the roughly 0.4 % of the population that might die from it and for their families. This also includes the health care workers which, unlike with a normal influenza, are now also at great risk. However with a 0.4% death rate, of which the vast majority are elderly, the direct danger of COVID-19 to the survival of our societies as a whole is minimal.
2. The Threat from our Mitigation Measures
Suffering 0.4% of the population dead in the space of a few months is a tragedy, and translated into actual numbers it becomes dramatic. 0.4% of the total population of the United States is 1,298,000, and even with the lower ECDC mortality estimate of 0.1% it is still 324,500 persons, dead in the space of a few months. There would also be an estimated additional 2% infected requiring hospitalization, numbering some millions. These are huge numbers that would overwhelm health care. To which can be added the fatalities from those other patients needing critical health care for other reasons, but who could be crowded out.
This is a humanitarian tragedy, but nevertheless it does not in itself represent an existential threat to our survival. Furthermore, 0.4% is based on multiplying current morbidity by 1,000 which is probably erring too far on the side of caution. In addition, of those 0.4% that could die, the vast majority, between 80% to 95% would consist of pensioners over 70 years old with pre-existing chronic illnesses. This is tragic, but it means that the impact on the people that we rely on to maintain our vital life systems – the national and global economic flows and technical infrastructure on which we depend for our very survival – is virtually zero.
What could present a clear and present danger to our survival are our reactions to COVID-19. The approach that most states have chosen consists of mitigation efforts intended to slow down the tempo and scale of infection. The objective is on the one hand to buy time for us to develop a vaccine, and on the other hand to lower and lengthen the infection curve so that the wave of infections and numbers of hospitalized will be less difficult for our health systems to handle.
In order to delay the tempo and scale of infection various methods are possible, all focused on limiting the spread of the virus from one person to another. It is feared that the COVID-19 virus can be transmitted in three ways. First as airborne aerosols (minute droplets released by sneezing, coughing or even breathing) suspended in the air and inhaled by other people. Second, by indirect physical contact through objects such as a door handle. Third, though direct contact, by shaking hands, kissing, and so forth. Since it also is transmitted before an infected person shows any signs of infection it is highly contagious, and to prevent its transmission requires strict measures. One is ‘lockdown’ which consists of stopping the movement and mingling of the entire population so the disease cannot be transmitted any further. In its extreme form this means confining everyone to their homes and preventing all forms of physical interaction outside the home for as long as the incubation period of the virus. In other words until one estimates that the last person infected no longer can infect anyone else. In practice this means closing borders to human travel (and, for certain diseases but not COVID-19, to physical goods), shutting down public transport and stopping all normal functions of society: non-essential public services, schools, workplaces, public facilities, shops, cafés etc. During the time such extreme measures are imposed almost all economic activity that cannot be carried out through electronic means or by robots grinds to a halt. A milder form of lockdown is mitigation, where the objective is to limit and slow down the rate of infection but without choking all movement, by allowing person to shop for food to more general forms of mingling.
A complementary measure is through personal protection, notably by maintaining distance from others, washing hands frequently and well, and/or wearing face masks and gloves to avoid transmitting the virus from the hands to the eyes, nose or mouth, and avoid spreading it to others.
One example of a set of countermeasures, are the ‘WHO Strategic Objectives’ applied to the current COVID-19 pandemic. These include: www.who.int
– Interrupt human-to-human transmission
– Identify, isolate and care for patients early
– Identify and reduce transmission from animal source
– Address unkowns (clinical severity, transmission extent, infection treatmen options, etc.)
– Communicate critical risk and event information and counter misinformation
– Minimise social and economic impact through multisectoral partners
However there are degrees of lockdown and in practice most states have allowed varying amounts of mobility and contact between individuals, backed by hygienic measures. Only in extreme emergencies has extreme lockdown been applied. However even milder mitigation measures have a severe impact on both the global and national economies. Mitigation by limiting human to human contact reduces or shuts down production and consumption, and limits the global flows of goods on which almost all national economies and societies across the world depend.
And in today’s age, when almost every state and society in the world relies upon the hyper-effective global flow of goods and services, we are exceedingly vulnerable. With global flows of goods and services and just in time delivery, very few small, medium and even big states have reserves of for instance food, and very few are self-sufficient on basic commodities such as food and energy. And almost all industrial is globally inter-connected, from the supply of energy, raw materials, several layers of sub-components and to the finished product.
The result is that the current mitigation measures already have severe economic consequences. Businesses and workplaces are forced to shut down, with mass unemployment and possibly mass bankruptcies as a result. In the United States alone unemployment grew to a historic high of over three million in the week of 23 March 2020. This in turn calls for massive global and national financial aid packages. That same week the G20 allocated USD 5 trillion to support global trade and the United States allocated USD 2 trillion to help businesses and unemployed in the United States to survive. And this in times when most national economies are already struggling to make ends meet.
And that is just the beginning. The longer lockdown chokes production, consumption and global flows the more severe the economic impact will become. And this is where the second problem with our current response to COVID-19 kicks in. Our mitigation strategy does not eradicate the virus. It merely slows down the tempo and volume of infection, lowering the infection curve and thus reducing the burden on our health care. However after the weeks to months it takes for the first infection wave to pass, the virus will still be present and our populations will still be just as vulnerable as before. This means that the mitigation measures need to be maintained (in one form or another) until we have developed a vaccine, which is one of only two counters to the virus that we have. And according to Dr. Fauci, one of the lead members of the White House Coronavirus Task Force, developing a vaccine and mass producing it will take at least one year, even at a greatly accelerated pace, and probably longer.
Maintaining current mitigation measures for such a long time will likely have a massive impact on the economy, and hence on society and politics. If the lockdown lasts more than a few months we risk food shortages and mass poverty, leading to extreme desperation among unemployed citizens, and possibly a violent breakdown of societies. This is admittedly an extreme scenario and extended lockdown will perhaps not lead to that. Right now we simply don’t know, but we do know that the current economic situation is already severe, the social situation is getting worse, and a violent future breakdown is a real possibility.
Under these circumstances we must ask ourselves two questions. First, do the health benefits from mitigation against COVID-19 justify the price in terms of economic and possibly social collapse? Second, is there an alternative?
3. Alternatives to mitigation
The answer to the first question, as usual in a crisis, is that we do not know. We are beginning to get a rough idea of the health impact of COVID-19, but we do not yet know what the economic and social costs of mitigation will be. By all accounts the economic consequences will be enormous, but will they be bad enough to cause a long term global depression with mass poverty, and all the political consequences and the strains it will put on democracy and peace? Or could it even lead to food shortages and the violent collapse of our societies? The latter appears unlikely but we do not know.
Under those circumstances the risk that the consequences of mitigation cause far greater human suffering than that caused directly by COVID-19 is real. If so we must consider what alternatives we have.
One is clearly vaccination. However as noted creating a vaccine and mass-producing it currently takes at best months, and realistically a year or more. Thus while the vaccination approach is the top priority, it must be combined with some measures to protect the population until the vaccine can be distributed.
One way is the lockdown method described above. However as also noted this has a severe and at worst catastrophic impact on the vital life systems on which our states and societies depend, in other words on governance, social dynamics, the economy and the technical infrastructure. In certain cases, when facing a disease which in itself poses a truly existential threat to society because it is so deadly and contagious, we will have no alternative to lockdown.
However when facing diseases such as COVID-19 which do not in themselves present an existential threat, we must consider other measures. One such that has been suggested is imposing a very tight global lockdown, covering the entire world, the moment the disease is detected, but lasting as short time as possible, which means something in the region of a few weeks.
This approach clearly has a lot of problems. It would require a global agreement among all states and key parts of the private sector, both to report the disease and to apply a drastic lockdown at short notice. It also assumes that one can identify an incipient pandemic fast enough to permit isolating it, which is uncertain.
However it also has certain advantages. First, and most important, it is probably our only defence against a truly existential pandemic that is both highly contagious and deadly. And the odds of such a threat emerging in the coming decades are increasing. Second, it offers the chance to choke the disease though a lockdown that lasts a few weeks rather than years. And while the effects of a global lockdown for some weeks would be severe, they are calculable. This makes it possible for the private sector to calculate the costs of a lockdown in advance, reducing uncertainty and stock market panic, and to prepare for it by maintaining strategic stockpiles and so forth. It also makes it possible for governments to prepare measures to keep the state and society functioning during the lockdown. It would thus create far less economic, social and political disruption than the present COVID-19 crisis.
A second approach, which only works for less severe pandemics, such as COVID-19 is to aim for what has been called ‘Herd Immunity’. This consists of allowing the disease to run its course, like we do for the annual influenza epidemics, after which most of those infected would be immune and the disease would fizzle out.
This of course also presents problems. In the first place because it obviously depends upon the characteristics of the disease and identifying these early on. It would only work if the mortality rate was limited, and if we identify it as such before it has spread beyond containment. Second, the immunity could be only temporary. It also presents the moral problem of deciding what constitutes an acceptable mortality rate. Another problem is that the health care systems would become severely over-burdened while the pandemic lasted, as we see now.
However for milder diseases an herd-immunity approach has clear and strong benefits. In the first place because it allows economies and societies to continue to function as normal, even with a higher mortality rate than COVID-19. And most importantly, it does not risk damaging the economy so severely that we risk the violent collapse of states. Second, depending upon the disease, it permits selective lockdown measures to be concentrated to those groups that are most susceptible to infection, thus increasing their survival chances and care. This could also help reduce the burden on health care during the pandemic peak.
Which brings us to COVID-19. For COVID-19 appears to have all the hallmarks of a disease that would allow the application of the herd-immunity approach, and indeed make it necessary. First, because the mortality level appears very low, second because the consequences of our mitigation measures are very high and could become existential.
Under these circumstances herd-immunity could be the best way to go. It would entail limited costs in human lives and perhaps overloaded health systems, but these could prove to far lower than the coming economic and social costs of mitigation.
What we can be fairly certain of is that COVID-19 is merely a mild precursor of far more serious pandemics that will emerge in the coming decades. We need to start developing countermeasures to these before they hit us. And to do so we will need to go back to the drawing board and address fundamental, and often moral, questions. What is security? What do our states, and the global system, depend upon to survive? And especially, what good things must we be prepared to sacrifice if we need to, in order to save the fundamental things that we need to survive and to thrive?
Since the end of the Cold War 25 years ago, and up to about 2014, the Atlantic Community became spoiled, and stupid, from years of comfort, apparent security and a feeling of superiority.
During this time, with one or two exceptions, our governments became used to always being able to bad and less-bad options and to seek optimal solutions with limited trade-offs. However we are now entering an age when will face an increasing number of Wicked Problems. These are problems involving great uncertainty and with only dark options. Facing these we can no longer can choose between good and bad, but between bad and bad. In this case between saving the lives of a minute fraction of the population versus saving the economic foundation on which the survival of our states and societies as a whole depend.
Source: https.//www.worldometers.info/coronavirus 26.03.2020 Unless other indicated.
Death rate * (Seasonal flu: <0.1% fatalities.)
2% Estimated overall death rate
3.5% WHO global estimate
* Percent of all infected persons. Precise estimate impossible at present because total number infected unknown.
Percent infected Unknown. Hence very rough estimates.
In EU/EEA and UK www.ecdc.europa.eu
11 March 3.3 cases per 100,000 population 0.0033%
25 March 36.1 cases per 100,000 0.0361%
31.3 – 15.4 100 cases per 100,000 expected 0.1 %
Hubei peak 100 cases per 100,000 population 0.1 %
Ro Between 2.76 and 3.25
Severity of confirmed cases (www.ecdc.europa.eu)
14% severe disease
5% critical illness 99% of those due to comorbidity
1% fatal included in 6% critical
Fatality by comorbidity
10.5% Cardiovascular disease
6.3% Chronic respiratory disease
0.9% No pre-existing conditions
Fatality by age % of all infected
Fatality by sex % of all infected
Incubation period (Seasonal flu: 2 days.)
2-14 days But incubation period of up to 27 days reported in Hubei.
3 days Mean time. But varies greatly among patients.
Symptoms (Seasonal flu: 19.1% asymptomatic)
17.9% no symptoms (www.forbes.com)