The Tsunami After the Tidal Wave

The pain of COVID-19 is real and knows few boundaries. It has not only crossed oceans and age groups but also social strata, with 5 year olds, inmates, doctors, and the British Prime Minister all finding themselves in the ICU. It is simultaneously hard to watch and hard to tune out the crisis in New York City, which is straining not only the health care system but also every known assumption we have about American resilience, wealth, and compassion. 

Now that there is somewhat qualified talk of New York being at its apex, California, Washington and Oregon donating ventilators, and China returning to normal, it is easy and completely understandable to start discerning that faint glimmer of light at the end of the tunnel.  

Unfortunately, from a global perspective, that light is an oncoming train -- maybe a tsunami warning light to stick to the metaphor in my title -- specifically of cases in the developing world, where resources are far more stretched and governments far more strained to respond than in New York City.

It has been hard for us to wrap our heads around exponential growth in something bad like COVID-19 -- we have probably looked at more log graphs in the last few months than we have throughout our entire life, and still rising case numbers make the news each night. It is going to be even harder for us to wrap around how this may take shape in highly populous countries like Brazil and India. BCG has tried to help us with this with some useful slides:

You’ll note that the range of lockdown end dates in these cases are quite large -- 4 months in the case of India -- and the charts don’t extend beyond the peak, so the pace of the recovery is unknown. The “spray” diagram is pretty ominous, especially once you realize the graph is logarithmic and the cumulative case range for India is 100K - 10m at peak, and of course much more if you look at the total number of infected (are under the curve). The a recent projection shows 1.3m cases by end of May. And then you look at a recent simulator published by India Today and realize the feasibility of 13M hospitalizations and 5m dead.

Having spent time in many emerging markets -- and a significant amount of time in India -- I can share that my intuition is that this will be far bigger and more disastrous in these populous emerging markets than the US, Italy, the UK or China. As Raman Laxminaraya of the Center for Disease Dynamics shares in his New Yorker interview, India has about a fifth of the hospital beds per capita that the UK has, has much more density, and has limited capabilities to do widespread testing and tracking. Most of the ventilator projects I have been focused on domestic shortages in Ireland and the US, which will leave these countries high and dry.

So the contagion -- viral and economic -- will be severe in these emerging markets. The political will of world bodies to help may be limited, as they may be physically or bureaucratically exhausted from having traversed their own curves. And many of these countries will likely have to find their own solutions until a therapy or vaccine is developed in the next 12-18 months.

If you live in Brazil or India, or know about it, I would love your views in the comments on when you think this will peak, and if I am being alarmist.