The Coronavirus Pandemic Part II: Waging the War

The coronavirus pandemic has swept across most of the world, leaving a trail of human and economic destruction in its wake. While the US and Europe have borne the brunt of the economic and human toll over the last two months, all countries have been impacted and the virus is rapidly establishing a foothold and spreading in less developed countries, with Turkey, Brazil and India all seeing a rapid increase in confirmed cases. Economically, it has led to a near complete shutdown of public life and economic activity across major industrial countries over the last two months, with c.195 million jobs potentially lost or ‘furloughed’1, global GDP is expected to contract by 3% in 2020,2 and US$15 trillion of investor wealth has been destroyed.3

The ‘enemy’ in this crisis is a silent, invisible and deadly pathogen which does not recognise borders, religion or race, and operates by stealth. It has exploited the world’s interconnected and networked economies and societies to spread around the world and now threatens people’s way of life, testing the resilience of public health and economic systems. The evidence to date suggests that defeating it requires mass mobilisation of healthcare resources and economic tools, as well as community and individual action within and across countries of the kind that has usually been seen only during periods of war or significant economic dislocation.

Analogies and the language of war is often used by the public and the press to describe large scale mobilisation efforts by the state or society: for example, the “War on Drugs”, the “War on Terror” or the “War on Poverty”. Of these threats, few rises to the level of an actual war in terms of their human and economic devastation, and among these, the current pandemic comes perhaps closest to a large-scale physical war in terms of its destructive potential for the world. Given this potential and the speed with which it is unfolding, international leaders will need to adopt a war-time mentality to successfully contain and eventually defeat this virus. And like previous world wars, there is no established playbook for fighting this one, with the world still in the early stages of understanding the enemy, its strengths and vulnerabilities. Any successful strategy will need to rely upon and consider the principles of warfare which rest upon millennia of experience, as well as incorporating any successful strategies and actions by countries to date in fighting the virus.

This month’s Sign of the Times, following the first in the series last month on the pandemic, seeks to outline what a global war on the coronavirus could look like, applying the primary principles of warfare to outline a plan to contain and eventually defeat the current pandemic. It seeks to establish reference to a well-tested framework of relevance to the on-going fight as well as the fights against similar challenges to come in the future.

 

Knowing the Enemy as a Critical First Step

The ‘Fog of War’ – Uncertainty on the Threat Posed by the Enemy

In any military campaign, the first task is to understand the enemy and its capabilities. Those that fail to achieve this rarely succeed and often pay a huge price. In the case of the coronavirus, many believe that this enemy is not dangerous. Examining the data, what is clear is that the scope and scale of both the coronavirus, as a single unit, and the pandemic, as a legion, does make for a formidable enemy. The virus is highly contagious and has spread to virtually every corner of the world within a space of three months with over three million people confirmed to have been infected to date. If this were an idea, some religious fundamentalist idea for example, and it could spread to millions within months, it would certainly be seen as formidable. In parallel to the human cost, there has been an accompanying impact in terms of panic and uncertainty, a loss of people’s livelihoods, a strain on food and other necessities, the ensuing damage to healthcare and related infrastructure, a breakdown in people’s rights, a collapse of economies and markets, a growing loss of confidence in some governments and a fracturing of relationships between countries too.

So, the virus and its impact are no doubt of critical importance. And the art of waging the war against it is too. In the words of the ancient Chinese military strategist, “The art of war is of vital importance to the state.” This is how most of the world has seen it and so harsh measures to counter its spread have been taken. Even with this harsh containment, which has not been enacted for lesser enemies (such as the seasonal influenza), the official death count has thus far still been over 230,000.4 The estimates of death without such harsh measures was much higher, with estimates as high as 40 million deaths. 5

The question remains in the minds of many as to whether this virus justifies the response it has been given and whether the nature of the counter-attack – lockdowns and quarantines - is misconceived. This comes back to the fundamental question of the nature of the enemy. A number of facts are critical:

  • Firstly, of the three million people infected, an estimated 80% cases are mild or asymptomatic cases,6 allowing the virus to spread widely undetected in many cases.
  • Secondly, with long incubation periods relative to previous coronaviruses,7 combined with inadequate testing capacity, it has been difficult for many large countries to measure its full extent and lethality, with fatality rates, hospitalisation rates, and the demographic and medical profiles of victims and patients varying widely across major nations.
  • Thirdly, particularly in the US, the political divide has been extreme with the President likening it to the common flu,8 some of his supporters have been inclined to believe that this is not a serious threat.9

Such factors have given the virus an important element of confusion and uncertainty, allowing the creation of a ‘Fog of War’10 which has resulted in many countries, particularly in the US and Europe, being caught off-guard and ill-prepared, with the virus spreading rapidly and overwhelming their healthcare systems before they have a chance to contain it.

 

Assessment and Comparison of Enemy Capability

So, what is the nature of this enemy and is it a “common” variety or something far more deadly? Given the assessment is being made in the midst of the war, its potential is of far more importance rather than the outcomes (infections and death count) after a massive containment phase of the war. Though the world’s understanding of the virus is still unclear relative to other better-known ailments, a few facts about the potential impact of the coronavirus are already clear:

  1. COVID-19 spreads 2-3x faster and is 5-20x deadlier than the seasonal flu. COVID-19 is estimated to have a ‘reproductive number’ – the average number of people that an infected person in turn infects – of 2.0 – 2.5 (and as high as 3-4 in some studies), vs. c.1.3 for the common flu and can therefore spread much faster, aided by the lack of immunity in the general population, considering that this is a new pathogen. While the current mortality rate (deaths/confirmed cases) certainly over-estimate the true fatality rate due to widespread under-testing and the large number of asymptomatic cases, studies suggest that the CFR for COVID-19 ranges from 0.5%11 to up to c.2.0%. Even at the low end of is range, this would suggest that COVID-19, which spreads exponentially faster than the common flu, is five times more lethal. Further, COVID-19’s danger cannot be assessed by comparing its actual deaths to that of the flu since this ignores that these deaths have been incurred despite 60% of the world being in a state of more or less total lockdown. The true measure of deadliness would be the death toll incurred had no measures at all been taken, leading to the aforementioned estimate of 40 million casualties.
  2. COVID-19 deaths are under-counted and are estimated to be up to 50% higher than official estimates.While the number of confirmed cases is certainly under-counted by a significant extent, and would imply a lower mortality rate, numerous recent studies suggest that the number of deaths attributed to COVID-19 could also be significantly under-counted by up to 50%12 due to the different methodologies in various countries and the failure to account for deaths at home, or deaths being attributed to co-morbidities rather than COVID-19, with the actual global death toll accordingly as high as 354,000 as of the end of April.
  3. COVID-19 is an exponentially spreading agent. The metric being used by most observers to track the growth of the virus is the number of days that it takes for the number of infections or deaths to double, implying that despite unprecedented global lockdowns, COVID-19 continues to spread at an exponential pace, and hence measuring the impact at any point in time provides only a fraction of the indication of its full potential impact. Therefore, comparisons of COVID-19’s impact in the last 2-3 months to other sources of death such as the 1.35 million road accident deaths13 or 9.6 million cancer deaths14 annually provides a misleading picture considering that those figures are more less static from year to year.
  4. COVID-19 is deadly to the elderly and frail and it can be dangerous for younger and healthier adults too. While it is clearly known and understood that COVID-19 is potentially lethal for elderly patients and those with co-morbidities, several recent studies from the US suggest that the virus can have significant adverse health impacts for younger and potentially healthier patients as well. Approximately 55% of COVID-19 related hospitalisations and c.20% of COVID-19 attributed deaths in the US have been in people between the ages of 20 and 64. Further recent reports suggest a number of younger COVID-19 patients who have no or mild symptoms are having lethal strokes at a disproportionately higher rate.15
  5. COVID-19’s fatality cannot be discounted by those that might have died of seasonal influenza or a pre-existing illness or fatal condition.The US death toll of 60,000 from COVID-19 (95% of which occurred in a single month) is almost twice as high as the average number of annual deaths from influenza over the past ten years, c.35,000. With these numbers the argument that COVID-19 deaths are largely simply ‘replacing’ what would otherwise be influenza is clearly not the case. Similarly, others have sought to calculate a ‘net’ death toll that excludes victims that were statistically likely to die in the short term of other causes (e.g. age or pre-existing conditions). It its however highly doubtful whether those putting forward such calculations would agree to adjust the precisely known 2,977 victims of 9/11 in the same manner, perhaps starting with the first responders, ‘netting down’ the 414 lives lost to account for the riskiness of their jobs and then the aged and those with pre-conditions, effectively giving the terrorists a pass on those lives.

Another important consideration for governments and peoples is that regardless of whether this virus is the most fatal or not of diseases to ravage the world, it has exposed a lack of preparedness, resilience and leadership both within countries and internationally. These are vital matters to address in preparation for a more severe enemy in the future, either one that is a biological agent of war or a naturally occurring pathogen.

In considering the nature of the war on the virus, the style of this paper will give the virus a persona, with capabilities, forces and the objective of defeating the human population.

 

Knowing Oneself to Not Mis-Calculate Strengths and Vulnerabilities

The second critical task is to know oneself. The first paper in this series, published last month16, was an assessment of the capability to resist and act against the enemy, with a primary focus on resilience of 8 major countries. The analysis revealed that several large countries are significantly under-prepared for the potential impact from COVID-19 from both a healthcare and economic perspective. Some of the key findings are extracted in the table below:

The analysis suggested that when the resilience indicators are looked at as a whole, they reveal that the world is critically ill-prepared for Covid-19, creating major risks to human life and severe damage to major economies. While there are large gaps between the levels of resilience of individual countries, all major countries lack preparedness to deal with a pandemic on the scale of Covid-19, along multiple fronts, including:

  • The US is severely exposed due to systemic shortcomings and structural factors. Large segments of the US population are critically exposed due to a lack of adequate long-term healthcare cover for much of its population. In addition, US economic stability rests on its ability to increase money supply (and co-opting its banking system, subject to its markets playing along). Given its near zero interest rates, a high fiscal deficit and indebtedness at the level of the Global Financial Crisis, the US will likely need to rely on effectively printing money in a heroic fashion to shore up its economy.
  • Aside from Germany, Europe was also exposed, with the UK’s situation appears to be particularly vulnerable and has since been exacerbated by poor policy execution.
  • India emerged as the most exposed given its size, population density and development stage. So, it needed radical solutions perhaps the most.
  • China’s overall resilience is one of the strongest and stands to emerge in a relatively superior position from this crisis.

The analysis revealed major gaps in resilience and preparedness for countries, which can only be addressed by working together and effectively within countries cooperating to galvanise the vast body of knowledge in the world on: medical illnesses, managing crises (most recently, from the Global Financial Crisis, 9/11, multiple wars from the last century too), the on-the-ground peace and aid experience of multiple international institutions and the strong legacy of allied post-war leadership. Hence, the urgent need to wage an effective war on the virus.

 

The Success of the Enemy to Date

With an assessment of the capabilities of the virus and of the world’s resilience, it makes sense to take stock of the status of the conflict to date; the damage done, the success of the enemy, the counterattack and the successes in doing so and the gaps.

Any assessment to date would rightly conclude that the virus had been deeply successful to date with the advantage of being greatly under-estimated, and therefore having surprise on its side, it faced little resistance in penetrating deeply across country lines and into regions, cities and homes. It also overwhelmed screening procedures and healthcare facilities designed to contain it and caused panic and confusion.

Human Casualties. In terms of human casualties, while the full extent of infections and deaths is not known due to the factors outlined above, the number of officially reported deaths due to complications from the virus, and the clear pattern of the exponential rise in those, provides a best available picture of the impact of the virus in absolute terms to date (see chart below).

What the world knows for certain though is that over 230,000 people have died to date due to complications arising from COVID-19 (of which c. 190,000 deaths were in April 2020 alone and c.90% of these occurred in the US or Europe), and that the number of deaths every week has continued to increase from c.17,500 in the last week of March to over c.44,000 deaths in the last week of April. To put the scale of the reported number of casualties into perspective, COVID-19’s death toll in a single month is roughly equal to the total number of people who have died in terrorist attacks globally during the past five years. This has happened while governments across much of the world have implemented aggressive policies to counter the virus including lockdowns and social distancing measures.

However, the actual death toll of the pandemic is likely significantly higher than the officially reported numbers due to undertesting, reporting delays and the official count in many cases only capturing hospital deaths. The mortality statistics across a set of 20 European countries and the US major countries showed that the actual number of excess deaths above long-term averages was actually c.50% higher on average than the number of officially reported COVID-19 deaths. If this rate of under-reporting were to be occurring worldwide, the global death toll from the pandemic as of the end of April would rise from c.230,000 to over 350,000.

Economic Casualties. The lockdowns currently in place across nearly 100 countries and the accompanying restrictions on travel, transportation and various forms of economic activity – deemed necessary to prevent even more widespread devastation – have caused severe economic damage, with over 26 million people in the US and c.11 million people in Europe losing their jobs.32

While the full extent of the economic destruction may not be apparent for some time, the economic impact has been broad-based, the crisis is sure to lead to a deep global recession, with global GDP expected to contract by 3.0% in 2020 (vs. 0.1% during the Global Financial Crisis), with the impact on certain countries expected to be even more severe (see charts below). These are also not unfamiliar to those in war zones and of the previous world wars where GDP per capita has declined from 16-24%33. This economic destruction is expected to occur despite the largest global bail-out in history, which at over US$8 trillion (and counting) already dwarfs the US$2 trillion spent globally during the Global Financial Crisis.

The Psychological Damages of the War. In addition to the observable impact on countries’ physical and economic health, the pandemic and the ensuing lockdowns, are together having a significant impact on social and psychological health, leading to an increase in fear, anxiety and a loss of morale, and exacerbating loneliness and depression, substance abuse, domestic abuse and a range of other psychological and social issues.35. In their focus on containing the spread and limiting the economic damage, few countries have had the resources to focus on these issues yet. Further compounding these effects is the global rise of connectivity and social media over the last two decades, which has further fuelled panic and anxiety, both by providing people a real-time window to the virus’ impact across the world, while also obscuring the facts due to the inability to control ‘fake news’.

In some countries the crisis has also taken on a political dimension, further exposing deep domestic political divisions. These divisions have been exacerbated by populist politicians who have been dividing the population by playing to people’s economic anxieties and framing a trade-off between saving lives and saving the economy, rather than uniting the populace for the battle. Further compounding this is the global rise of connectivity and social media over the last two decades, which has helped fuel panic and anxiety, both by providing people a real-time window to the virus’ impact across the world, while also obscuring the facts due to the inability to control ‘fake news’.

And finally, at the international level, the crisis has exposed the fissures between the world’s major powers due to declining multilateralism and trade wars. While many seemingly “isolationist” moves initially implemented such as travel restrictions and export bans on healthcare equipment were arguably justifiable to contain the virus, more recently leaders have sought to place or shift the blame for their national outbreaks to others, and to leverage the crisis to achieve narrow political objectives such as restricting immigration, polarising communities, or destabilising political opponents, rather than seeking to coordinate at the global level to develop a common strategy.

If COVID-19 were a traditional sentient enemy, we would point to it winning the psychological war and being well positioned to exploit the world’s political fault lines given the US, the usual leader in any major conflict, and its main rival, the sole superpower, is irreconcilably divided and internally focused.

 

Waging War: The Need for a Wartime Approach

Overview of the Scale, Scope and Pattern of the Assault on the World

The scale and scope of both the human and economic impact to date suggest that humanity is facing perhaps its biggest crisis since the Second World War, with data in country after country showing the same pattern of exponential growth in the spread of the virus across the world in multiple fronts and, given it is not eradicated, in successive waves, with countries that defeated earlier waves through coordinated and proactive actions now facing secondary assaults for which their previously successful defence strategies are inadequate.

For this reason, and given the uncertainty around the development and timing of weapons – vaccines and treatments in particular - that can provide the long-term immunity needed to defeat COVID-19, the virus becomes increasingly more difficult to defeat as it spreads and grows. With most of the world planning to emerge from various lockdowns and curfews in the coming month(s), it will not be able to lower its guard against the virus, else they are most likely to find themselves back in lockdowns quickly, particularly in the absence of comprehensive identification, tracking and containment capabilities.

 

The Elimination of Viable Options

In such an environment, the options open to governments to manage the virus and its economic fallout (not to say the massive knock-on effect on people and society) are limited, and the number of viable options even more so:

  • Option 1 - Herd Immunity, Survival of the Fittest: Inapplicable for Almost All Nations, Discredited. The lethality of the virus and the havoc it has wreaked on healthcare systems despite the implementation of restrictive lock-down measures makes ‘herd immunity’ strategies that limit social distancing restrictions in favour of continuing economic activity unfeasible in all but the medically best equipped and utilitarian of countries, like Sweden. But even if the entire world had same capabilities and resources as Sweden, a herd immunity strategy would cost an estimated 11m lives,36 and studies accordingly pointed to up to 40 million total deaths globally in 2020 if countries took no action.37
  • Option 2 - Starve Out the Virus: Unviable Timeframe. At the other end of the scale, a full lockdown until the virus is defeated by time or by vaccine is equally unrealistic given the potential timeline to a mass and well tested vaccine, likely leading to a total breakdown of economic systems, widespread social disorder and the potential failure of otherwise stable states.
  • Option 3 - Relax Restrictions with Vaccine Availability: Unviable Timeframe. Politicians have taken to hinting at the vaccine that will be ready in months or the repurposing of an existing treatment that will be the silver bullet. While there are some promising early developments, the candidates remain at very early stages and most experts continue to estimate a timeline to commercialisation of 12-18 months. As such, COVID-19 is likely to remain endemic until mid to late 2021, when vaccine is found and deployed across the world.
  • Option 4 - Containment and Management: Viable with Widespread Applicability. This leaves the middle ground as the only viable alternative open to governments, containing and managing the virus in a manner that balances national health and economic interests. In the absence of a well-planned and executed strategy however, this option will likely lead to countries bouncing back and forth between economic openings and lock-downs as governments react to poorly managed economic dislocations and uncontained new infections, respectively.

An effective ‘Containment and Management’ option that buys the time to develop a vaccine will require executing a plan that requires the mass mobilisation of resources, the participation of citizens, health workers, the corporate sector and government, and a significant impact on a country’s way of life (potentially for a prolonged period), similar to the ‘total war’ efforts in major confrontations of the past centuries. While the coronavirus is not a conventional enemy whose can be defeated with conventional (military means), the lessons and doctrines of traditional warfare can be applied in new and innovative ways in a successful plan to defeat the pandemic.

 

Waging the War: Applying the Principles of War to this Pandemic

Like previous epochal wars and crises, there is no established playbook or benchmark for how countries should manage the War on COVID-19. Nevertheless, there are some important lessons from past treatises on warfare which can inform the strategies for tackling the pandemic. These have been applied in modern warfare and crisis management for most of the 20th and 21st centuries and were adapted by the US Army in its Field Manual in 1921 in the form of nine principles (objective, offensive, mass, manoeuvre, economy of force, unity of command, security, surprise and simplicity) which were subsequently updated in 2011 with three additional principles (restraint, perseverance and legitimacy) to reflect the learnings from modern warfare in the late 20th and early 21st century.

The 12 principles, having been the bedrock of the success of the American military, will need to be adapted to recognise that the battlefield of the fight against COVID-19 is a civilian one in every nation and is specifically fought out in every city in the streets, parks, homes, work places, hospitals and laboratories.

Taking lessons from how various countries have successfully applied themselves to responding to COVID-19 as well as drawing on how the world battled against earlier viruses (including the Ebola Virus and HIV/AIDS), it is possible to identify the key principles of this war based on the 12 principles. This crisis is far from over and capturing and building on these lessons over the rest of the year will be critical to adapting and re-positioning in the face of changing circumstances.

 

The Campaign to Defeat the Pandemic

If countries can successfully translate these principles into an effective strategy, it is possible that both the human and economic toll from the virus can be radically contained over the next year. Developing such a strategy and planning a comprehensive campaign will require wedding a series of what may appear to be abstract principles to the underlying reality of capabilities and resources.

While the world has been badly hit in the last two months, the depth and breadth of the damage caused at least provides an indication of the areas over which the battle will be fought, and therefore of the elements that a successful strategy will need to contain.

Further, as the cases studies above highlight, there have also been a number of success stories of countries effectively managing the crisis, or certain elements of it, at least. These provide some critical lessons on potential actions and priorities that will need to be prosecuted as part of the larger plan over the coming months and years.