Subject: Coronavirus

The following is the first email I sent to the entire company on March 1st, 2020 regarding the Coronavirus / COVID-19 situation in Seattle, WA where TINYpulse is headquartered and the epicenter of the US outbreak. I've included the email in its entirety below.

All, I'm certainly not a trained medical professional, but I thought it was important for me to share my thoughts on the Coronavirus (note the disease is officially named COVID-19 and the virus SARS-CoV-2).

I will continue to monitor the extremely fluid situation with ELT and will provide updates as necessary. Of course, if you have any questions, please talk to me, your manager, or HR. I borrowed some of the following based on resources that I thought were credible and informative.

What is happening?

In December 2019, cases of a new respiratory virus emerged in Wuhan, a major city of over 10 million residents in the Hubei region of China.

Although information on this disease was initially suppressed by the Chinese government, the WHO was contacted on December 31, 2019 and a new virus was identified on January 7th.

The first non-China cases were identified on January 13 in Thailand and January 16 in Japan. On January 23rd Wuhan was placed on lockdown by the Chinese Government.

The virus is a coronavirus, which is a family of viruses that cause SARS and MERS, but also are endemic in people. Humans have at least 4 coronaviruses already that cause 10-30% of all seasonal colds.

At this point, over 80,000 people[1] are infected with the new COVID-19 virus and 2700 dead (mainly in China). Many epidemiologists believe these numbers from China are underreported by up to an order of magnitude, and it may be closer to 800,000 people infected in China alone.

There are major outbreaks happening in Korea, Italy (locked down 50,000 people in 12 small towns), Japan (Prime Minister asked people work from home and 38,000 person Tokyo marathon cancelled), Iran (deputy health minister infected and cases spread across middle east), and other countries.

What should we expect?

Despite the WHO’s assurances that things can still be contained, every epidemiologist I have spoken to thinks the virus has broken out and will spread around the world.

Many think >20% or more of humanity will be infected due to a lack of baseline immunity and therefore herd immunity for this disease (as an example, the 2009 H1N1 flu infected 16% of all humans)[2].

Data on the virus is quite preliminary. So far the following appears to be true (you can also play with primary data here):

• 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).

1. “"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.
2. 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.
3. 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.

In general, much of the western world’s policy to COVID-19 appears to be one of delaying arrival of the disease. In particular, delay the disease so that:

• 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.

From the CDC website:

What should we do at TINYpulse?

• In the absence of a vaccine or effective medicines, Wash your hands often and thoroughly. You can watch a video here for best practices. There is also a lot of hand sanitizer in the kitchen area.
• 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 and door handles 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. Still have time to get it.
• 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. Reconsider all travel in general. In particular, avoid countries where either COVID-19 has started to spread (China, Hong Kong, Iran, Italy, Japan, Korea, Singapore, Thailand). For example, for our upcoming trip to SaaStr Annual, I'm monitoring this closely.

As I mentioned, I want to be as transparent as possible on this fluid situation. Please reach out to me, your manager, or HR if you do have any followup questions / comments. Thanks!

To happier employees,

David