balaji srinivasan covid-19

Exploring COVID-19 | Balaji Srinivasan on The Knowledge Project with Shane Parrish

Check out The Knowledge Project Episode Page & Show Notes

Key Takeaways

  • Definitions:
    • SARS-CoV-2 is the formal name of the virus (it’s a member of the coronavirus family of viruses)
    • COVID-19 is the official name of the disease caused by SARS-CoV-2
  • In the U.S., COVID-19’s doubling rate (how fast cases double) seems to be ~7.4 days
  • ~89% of infected individuals exhibit fevers
  • SARS-CoV-2 seems to spread asymptotically
  • “This could be as much as an accelerant for biomedicine as the internet was for software” Balaji Srinivasan
  • Second-order effects of THE COVID-19 outbreak:
    • Massive supply chain shocks
    • People will begin to view remote work not as an auxiliary, but as a primary. EVERY job going forward must be remote-capable.
  • Let’s say 100 people in San Francisco have the coronavirus (San Francisco has a population of 880k). Now, imagine you have an office with 1,000 people. Given this, there’s about a 10% chance someone in that office is infected (if there are 1,000 people in San Francisco with the virus, the probability that someone’s infected jumps to 60%).

Intro

  • Balaji Srinivasan (@balajis) is the former CTO of Coinbase and Counsyl, a genomics company
    • He holds a Ph.D. in electrical engineering and an M.S. in chemical engineering from Stanford University
  • Host: Shane Parrish (@ShaneAParrish)

Let’s Define Our Terms

  • SARS-CoV-2 is the formal name of the virus (it’s a member of the coronavirus family of viruses)
  • COVID-19 is the formal name of the disease caused by SARS-CoV-2

Epidemics vs. Pandemics

  • An epidemic is the widespread occurrence of an infectious disease
  • A pandemic is when an infectious disease spreads across multiple continents (as of March 13th, COVID-19 has NOT yet been declared a pandemic by the World Health Organization)

Where Did SARS-CoV-2 Come From?

  • According to molecular phylogenetics, it appears to be similar to coronaviruses found in bats from the Chinese province of Yunnan
    • Specifically, many believe it originated in the Wuhan seafood market (the virus seems to be zoonotic, meaning it leaped an animal to a human)

How Did We Find Patient 0?

  • In early December 2019, patients in Wuhan began popping up with symptoms similar to SARS (meaning the virus started infecting people in late November)

What’s All This “r0” (r naught) Stuff?

  • A virus’ r0 = the average number of cases directly generated by one case in a population where all individuals are subject to infection (AKA there’s no immunity)
    • If a virus’ r0 is 3, on average, every infected person infects 3 additional people
  • To help reduce a virus’ r0 (and thus, the spread), perhaps the best thing to do is cancel large events
    • (Viruses love crowds, as well as chokepoints: door handles, faucets, and other things many people touch)
  • It’s yet to be precisely determined, but COVID-19’S r0 seems to be ~2.5-3.5

What Are the Long-Term Effects of SARS-CoV-2 Infection?

  • We’re don’t yet know
    • Polio, for instance, didn’t kill everyone, but it paralyzed a lot of people
    • “The folks with severe conditions may have long-term impacts we’re not aware of” – Balaji Srinivasan
    • A few possibilities: impaired breathing & neurological effects

COVID-19 By the Numbers

  • ~7.4 days: COVID-19’s doubling rate (how fast cases double) in the U.S.
  • 1-14 days: the range of time from infection to symptom onset
  • 2-8 weeks: the average time period from symptom onset to death
  • ~89% of infected individuals exhibit fevers—it’s the most characteristic symptom

COVID-19 Spreads Asymptomatically

  • There are many reports of asymptomatic spreading (this is terrible news—you can spread the virus without even knowing you have it)
  • Because of this, in the future, we might see things like:
    • Home sequencers hooked up to your plumbing (you’d be able to pee/poop and see if you have the virus)
    • Being able to test yourself (somehow) and have the results pop up on your smartphone

“This could be as much as an accelerant for biomedicine as the internet was for software”

  • COVID-19 may lead to:
    • More prevalent hospital medical delivery robots 
    • Better at-home testing/diagnostic methods
    • Better wearables that continuously monitor for symptoms
    • Pandemic surveillance systems within cities
    • Better telemedicine systems
    • Faster clinical trials for drugs and vaccines
  • “This is going to be a significant scar on society. No one’s going to forget this. It’s going to be a significant part of all defense budgets going forward.” – Balaji Srinivasan

The Second-Order Effects (Part I)

  • As it is now, before you travel to certain countries, they want to know whether or not you’ve had certain vaccinations—this will change to real-time:
    • Imagine a next-generation TSA system which needs your biological information before you hop on a flight or enter a country
      • “Just like you have to make sure no one’s bringing guns or bombs on a plane that could kill hundreds, we need to make sure people aren’t bringing a deadly virus into a country that could kill thousands” – Balaji Srinivasan
  • “This is going to be a gigantic shot in the arm for every diagnostic and medical imaging company. All of those are about to get defense budget-level spending. Think of this as a world war in its scope, but its a world war against a virus.” – Balaji Srinivasan
  • “I think it’s definitely going to cause at least a recession, but likely something more severe than that” – Balaji Srinivasan
  • Massive supply chain shocks
    • If all these people in China can’t go to work, they can’t produce whatever the item may be (e.g., screws for your radiator, reagents for drugs, etc.)
      • “Supply chains are really complicated. People don’t understand how many parts go into a laptop, printer, or even a container of milk.”Balaji Srinivasan
    • “Hardware companies are going to die—many of them, because they can’t get the parts from Chinese warehouses” – Balaji Srinivasan
      • A similar analogy: if Amazon Web Services went down, many websites would follow suit 

This Isn’t the Flu

  • “Wuhan was a normal city on December 1st of last year, and by January 23rd, all 7 hospitals were filled, people were being sent home to die, and the entire city was put under quarantine—the largest quarantine in human history began. That was NOT a bad flu season.”Balaji Srinivasan
  • “The absolute number of hospitalizations and deaths when this hits an area is very high. Even if there’s lots of mild cases, the N is so large that it overwhelms the medical system.” – Balaji Srinivasan

How Does SARS-CoV-2/COVID-19 Spread?

  • By pretty much every means possible (even fecal transmission)
    • That latter point is essential—in MANY U.S. cities, you’re inhaling fecal matter as you walk outside & track it into your home

The Second-Order Effects (Part II)

  • Due to massive uses of hand sanitizer, microbes resistant to hand sanitizer will develop
  • The travel effects: airline travel, conferences, events, sports games—GONE (and this could last for a while)
  • Everyone will begin to look at remote work not as an auxiliary, but as a primary
    • EVERY job going forward must be remote-capable—not just legal work & programming. We need autonomous delivery, people able to operate factory forklifts remotely, etc.
    • As a second side-effect, work-from-home tech will improve
  • People will lean harder into offline socialization, social networks, and e-sports 
  • We’ll start to see “biotrust” communities develop—communities in which members trust other members to practice good hygiene

How Should Governments Respond?

  • “The single most important thing that the [U.S.] government should do is emergency expanded right to try laws”Balaji Srinivasan
    • Previously, there was a diagnostics bottleneck due to the CDC’s case definition (saying that only people returning from China were eligible for COVID-19 testing) and the FDA blocking tests
      • “That twin centralization bottleneck were two bad decisions that were an essential point of failure that led to the epidemic—or really pandemic—that we have now in the U.S.”
    • This would give every state the ability to clear anything related to the coronavirus, removing tons of bureaucracy and decentralizing the process
      • “In this case, the cost of delay is so high that it’s okay to have some false positives. It’s okay because folks will die otherwise.”

Wow

  • Let’s say 100 people in San Francisco have the coronavirus (San Francisco has a population of 880k). Now, imagine you have an office with 1,000 people. Given this, there’s about a 10% chance someone in that office is infected (if there are 1,000 people in San Francisco with the virus, the probability that someone’s infected jumps to 60%).

Additional Notes

  • A virus doesn’t mutate EVERY time it infects someone, but because viruses replicate at such high rates, it mutates to a large degree
    • Sometimes, for instance, a virus evolves to be less lethal and more contagious
  • As of March 14th, it’s safe to assume the number of infected individuals in the U.S. is astronomically higher than reported
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