COVID Impact Levels

One of the most difficult things through the pandemic has been getting people to wrap their heads around the idea that there is a much greater impact than just deaths. While that is an easy metric to consider, it is only one of many serious impacts.

I have been looking at this through a framework of four levels of impacts, each with different degrees of severity on society.

Primary

The primary impact is sickness and death. This is generally limited to the immediate friends and family and those providing care. This also would include post-COVID syndrome and those who are afflicted as the “long haulers.”

Secondary

Secondary impacts are also relatively easy for most people to identify. This includes cancelled surgery, delaying medical or dental care, and other means needed to keep healthcare available for surges of patients, mental health issues, and the direct economic and social impacts on individuals and local communities.

While both of those are concerning, what tends to give me the most pause are tertiary and quaternary impacts.

Tertiary

I classify tertiary impacts as those that have much more widespread impacts which can be global in scale. One of the obvious ones that is somewhat predictable during a pandemic is social unrest. While it was impossible to determine what the trigger event would be, it was almost inevitable. During 2020, one of the ways that showed up was the global Black Lives Matter protests in response to the murder of George Floyd in Minneapolis.

One tertiary impact that many people seem to be missing though is the impact of the pandemic on supply chains. I would have thought that the incident with the Ever Given in the Suez Canal would have made people realize the vulnerabilities that exist today. That single event will have impacts for months.

There is much more to the supply chain story though. We are considerably MORE vulnerable than was the case during the Spanish Flu in 1918-1919. During that time, travel times were longer, which would keep any kind of mutations in the virus somewhat localized. Now, most places in the world can be reached within 24-48 hours.

Another bigger problem exists today compared to then. Warehouses filled with stock were the norm and much of what was needed locally was produced locally. That all changed with the development of the container ship and even more with air freight. Companies no longer had to keep large stocks of all of the materials they needed to produce their products due to “just in time” manufacturing. It reduced the need for large stockpiles of supplies and relied on shipping from upstream vendors to have the goods ready when needed on the manufacturing floor. This is a much more vulnerable approach to manufacturing. The surge in India is having a massive impact on the shipping industry, which will further complicate the supply chain problems.

This impact doesn’t just fall on general industry though. It can also impact healthcare. We have seen shortages of albuterol (used for patients on ventilators as well as in inhalers for those with asthma) as well as some types of sedation earlier in the pandemic. Personally, I would think it would be a nightmare to be face down, on a ventilator, and awake with COVID alone in a room in an ICU for much of the day.

The current surge of cases in India will impact the entire world. Currently, they are experiencing over 400,000 cases/day, which is likely a gross undercount of the true total.

India and neighboring Nepal are both surging in cases. As the incidence of the disease climbs, the chances of mutations increase, which can easily result in the emergence of new variants. A new variant which has enough of a mutation could bring the world right back to square one with what would be the equivalent of starting an entirely new pandemic. Fortunately, now that we have some of the vaccine infrastructure in place, creating a new vaccine for a variant should happen more rapidly if needed.

One big gap in vaccination though related to India is that India manufactures the majority of the vaccine for the developing world. That can cause more human tragedy, further supply chain interruptions, and more chances of new variants when this source is unavailable.

Pharmaceuticals are also likely to be impacted. About 40% of the active pharmaceutical ingredients (APIs) used globally originate in China. APIs are used during the next step of drug manufacturing, known as formulation. 75-80% of the APIs used in the drugs that are used in the US originate in China and India. Disruptions to the API supply chain could not only lead to shortages, but also to counterfeits that could enter the market to fill that gap, both of which can put people at risk. The US should have learned this lesson a year ago.

Other supply chains are being impacted as well. There is a semiconductor shortage, but many people only think of the impacts on computers and cell phones. It impacts many different industries, and the automotive industry is a good example. More importantly, the semiconductor shortage will likely take years to resolve.

Another big supply chain that is going to have a major impact is plastics. This was a result of the winter storm that impacted Texas. Beyond consumer goods though, think of how many plastics are needed in healthcare for things like syringes, ventilator tubing, and many other products.

There are many other sectors with supply chain problems, all of which will ultimately lead to increased consumer prices, which will impact those on the lower end of the socio-economic scale the hardest. Those kinds of issues can lead to further social and political unrest.

Quaternary

The worst impact by far though would be what I consider the quaternary impacts. As one can see, each level feeds upward into the next. The tertiary impacts are the kindling needed for major political and social disruptions. One cannot conclusively say that the coup in Myanmar was a direct result of the pandemic, but the pandemic certainly makes such types of moves much more likely.

There are many other areas of concern as the pandemic continues to grow, such as Israel/Palestine/Iran, India/Pakistan, China/Taiwan, Russia/Ukraine, etc. When the social and economic conditions are right, like are developing right now, a single event can start a war, such as how the assassination of Archduke Franz Ferdinand started the chain of events that led to WWI.

When I first started writing about COVID over a year ago, people thought I was crazy for suggesting that the best-case scenario in the US would be 500,000 deaths or that we would see footage of people dying in the street. Given that response, I knew it was probably best not to vocalize my much bigger fears at that time. Now, however, I think that there is enough evidence to at least get people to consider them. It’s what has kept me up most at night since this started..