Coronavirus (COVID-19) PSA for Startups

Coronavirus (COVID-19) PSA for Startups

Last updated: Feb 28, 2020. If I add updates, they will be here. (I originally sent this out to founders I know but was encouraged to publish this more broadly.)

• Most cases are mild. Most estimates suggest 80% of COVID-19 cases are mild and feel roughly like a flu. Estimates I have seen suggest that roughly 10-15% of cases will be more significant and may necessitate hospital visits (see also) with 1-3% potentially needing an ICU. The concern of many governments is the peak number of cases that occur in a given moment. For example, if 1,000 sick people show up overnight to a hospital that hospital would be overwhelmed. Many of the social engineering policies (shutting schools etc.) are focused on spreading infectious cases out over time, so hospital infrastructure can deal with all the sick. The higher death rate in Wuhan versus rest of China may reflect a local collapse of healthcare infrastructure.
• Death rate: The reported death rate has hovered around 2% but may in reality be 0.2% to 1% depending on country and healthcare system. Many estimates tend indicate an overall expected mortality rate of ~0.5% globally.  The current existing fatality rate is biased upwards by Wuhan cases dominating the mix (which are closer to a 3-4% death rate and make up most cases). It is possible the virus is being undertested for in China / rest of world driving the real death rate down (as many more people are infected than is reported).
  • “"My sense and the sense of many of my colleagues, is that the ultimate case fatality rate ... is less than 2%," Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, told CNN's Jim Sciutto on "New Day". "What is likely not getting counted is a large number of people who are either asymptomatic or minimally symptomatic, so the denominator of your equation is likely much much larger."” Source.
  • Outside of Hubei and in China, the death rate in other regions has averaged around 0.7% when I have run it on primary data. Wuhan, where most cases are, has been in the 3-4% range likely due to a collapse in healthcare infrastructure in the region.
  • Outside of China, the death rate has averaged around 0.6% when I have run it on primary data. This is now getting confounded by Iran, which has a higher reported death rate - probably due to dramatic undercounting of cases.
• R0 value: The spread rate of the virus seems to be well over 2 and likely ~3. This means for every person infected at least 2 to 3 more get the disease. This compares to the flu at 1.5 or so.
• Incubation period. Realistically, the incubation period (time from infection to symptoms) appears to be under 14 days and likely 5 to 7 days for the majority of people. People appear to be infectious rapidly after infection, potentially as soon as 12-24 hours. Many experience only mild conditions early, which increases spread rate of the disease as people go to work or otherwise continue with life unchanged.
• Elderly & pre-existing conditions. The elderly and people with preexisting conditions appear especially susceptible to disease and severity or death. It is possible the elderly are susceptible largely because they are more likely to have pre-existing conditions. In contrast, very few cases have been reported in young children.

• We are out of flu season and free up hospital beds and healthcare infrastructure.
• We have more time to prepare in terms of diagnostic tests for the disease and potential treatments.
• We can work on a vaccine.

• Encourage hand-washing. You can watch a video here for best practices. You may want to add a few purell dispensers around the office as a reminder.
• Wipe down work areas regularly. There is some evidence suggesting the virus may stick around for at least a few hours, if not more, on surfaces. You may also want to wipe your phone down on a regular basis.
• Encourage flu vaccination. This will decrease health burden on hospitals and also prevent people from getting the flu and thinking they have COVID-19.
• Zero tolerance sick policy. Anyone who is sick, or starting to feel sick, should take a sick day or work from home.
• Curtail travel and conferences and move to video calls. Your employees may generally want to decrease travel and in particular avoid countries where either COVID-19 has started to spread (China, Hong Kong, Iran, Italy, Japan, Korea, Singapore, Thailand) or if you want to be extra cautious, where it is highly likely to spread (Indonesia, much of the middle east due to Iran spread, most African countries with strong China ties). 
  • If an employee is returning from one of these countries, they may want to consider self-quarantine for 14 days. 
  • As a rule of thumb you can use the US CDC site to assess what countries should be on your no fly list. The CDC right now (Feb 28, 2020) lists China, Korea, Italy and Iran as the countries that are “level 3”.
  • The reason to avoid this travel is (a) so your employees can avoid getting sick and (b) so your employees can avoid the potential for quarantine upon return and (c) your employees can avoid getting stuck in a country if a region is shut down. 
  • Some countries, such as Israel, have asked its citizens to curtail all international travel entirely. Similarly, Nestle, which employees over 200,000 people has stopped all international travel.
• Curtail visitors from other countries. A number of companies are starting to adopt a “no visitor” policy for people traveling from the countries listed above and they suggest moving such meetings to a video call.
• Plan for the remote work contingency. It is worth planning how your company will work if the virus takes off in your country, or in countries where your employees work. Do you adopt a work from home policy or other approaches? What is the threshold for work-from-home? Coinbase has a guide like this.

• Make sure your family has 2-3 months of medicine. If a loved one is taking a medicine or drug regularly, you may want to ensure a few months extra supply. Approximately 60% of common pharmaceuticals are partially manufactured or packaged in China. FDA has just announced the first shortage due to supply chain issues in one drug.
• Plan for the unlikely event you can not leave the home for 2 weeks due to isolation or quarantine. This may impact food or other planning. Alternatively, countries may meter the number of people who can enter a supermarket at a given time.
• Plan for caring for a sick loved one. If hospitals are temporarily overwhelmed, family members who get infected, or who have pre-existing medical conditions, may experience delay in care. Plan ahead for your specific situation.