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A Coronavirus Fix That Passes the Smell Test

Michael Lewis

(Bloomberg Opinion) -- A series of dispatches from America in the age of Covid-19.

My father now knows nine people who have been killed by the coronavirus. He’s 83 and entirely sound of mind and body. He rides his bike many miles every morning around Audubon Park in New Orleans and is as fun to talk to as he was when he was 40. His only response to the news that he and my mother would be confined to the house I grew up in was to call the liquor store and order seven cases of wine.

But now he finds himself watching the annihilation of what is left of his generation. Many of his old high school classmates and business associates and tennis partners live in the Lambeth House, the retirement community of choice for the New Orleans gentry. It’s a peculiar group, with its own customs and language, maybe the only American subculture to use “cocktail” as a verb. Up until a month ago, the few hundred New Orleanians living at Lambeth House cocktailed together nightly, without any idea of the risks they were running. On March 10, the first resident tested positive for Covid-19. At least 52 others now have it, and 13 have died, nine of whom my father knew.

Without more tests it’s hard to say how many people are likely to catch the virus — or how many will die. It seems amazingly well-designed to leap from person to person. People can walk around with it for days and even weeks, carrying the infection wherever they go, without knowing they have it. Young people are especially likely to remain oblivious to their infection, but if an 80-year-old man can feel well enough to cocktail and still be ill enough to give the virus to another 80-year-old man, who can’t?

The surprise, if anything, might be that the virus hasn’t spread more rapidly. “Why don’t even more people have it?” asked Richard Danzig, a national security and bioterrorism expert who served as secretary of the Navy under President Bill Clinton. “Early reports stated that only about 10% of family members of people who fall ill are infected. Possibly the numbers are wrong, but we need to focus on why so many people who are exposed don’t get sick.” The Lambeth House in New Orleans is a case in point. Even now there are a couple of hundred ancients still living there, virus free. How did it miss them?

One possibility — Danzig offered this up the other day at a virtual gathering of pandemic experts — is that the virus has a special need to be projected. “Shorter exposure in some contexts like church events seems to have more impact than prolonged exposure to infected family members at home even when no or few precautions were taken pre-symptomatically,” Danzig wrote to his fellow experts. “I am wondering if singing is the important characteristic of church events (the New Rochelle synagogue, et al), making them a major vector of transmission.”

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Another possibility is that a lot more people than we know — even 80-year-old people — have had the virus but never got sick enough to get themselves tested. That’s what’s so interesting about the simple, one-page letter written last week by two British doctors. Claire Hopkins and Nirmal Kumar, among the country’s most prominent ear, nose and throat specialists, had both noticed the same odd symptom in their coronavirus patients: a loss of the sense of smell. “Anosmia,” it is called, but I suppose they have to call it something.

The inability to smell was the first symptom many patients noticed; in some cases, it was the only symptom the patients noticed. “In the past it was once in a blue moon that we saw patients who had lost their sense of smell,” Kumar told me. “Now we are seeing it 10 times as often. It’s one of the things that happens with this virus.” The British doctors compared notes with doctors from other countries and gathered what data they could. They concluded that roughly 80% of the people who lost their sense of smell would test positive for the coronavirus, and that somewhere between 30% and 60% of those who had tested positive for the virus had also lost their sense of smell.

Those numbers might turn out to be a bit off — maybe even way off. They are a heroic guess, given how little testing has been done. But it’s precisely the scarcity of tests that makes the observation so intriguing, as it offers the possibility of a crude alternative to a test. Lose your sense of smell and you know to isolate yourself, even if you feel great.

It offers two other things as well: a way to glimpse the virus as it moves through various populations, and a tool for managing the risk. Oddly, hardly anyone who read the doctors’ letter had this thought — or, at any rate, hardly anyone who got in touch with the doctors. “We’ve had more than a thousand responses,” Kumar said. “But almost no one really seeing it as a risk management tool.” The exception was a former Wall Street guy, an Englishman named Peter Hancock.

Hancock had spent much of his career at JPMorgan, where, in the late 1990s, he had served as the bank’s chief risk officer. After the financial crisis he’d been tapped to run the giant risk management mess that was AIG. When he read the letter written by the British doctors, he thought, “Here might be a free way to get a signal, out of all the noise.”

Like everyone else, Hancock has been sitting at home, trying to make sense of what’s going on. To a person who had spent his career managing risk, it was especially troubling how little data there was about the virus. Everywhere he looked, people seemed to be treating the absence of people who tested positive as the absence of the disease. “The governor of West Virginia was on TV saying there are no cases in his state at the same time some poor West Virginia woman was driving her sick husband around, looking for someone to test him,” he pointed out. (The man tested positive.)

Hancock was troubled not just by the dearth of testing but also by its distribution: the only people getting tested were the people who turned up at hospitals with coughs and fevers, the people who very likely had the disease. Those weren’t the people who were going to wander around, infecting other people. To get a picture of the disease in the population — and to find the people who were going to wander around infecting other people — you wanted to test lots of people randomly. That didn’t seem like it was going to happen anytime soon.

Then he read the letter from the British doctors — and called them up. Yes, they agreed, wholeheartedly, it might make a lot of sense to use this odd symptom to track the disease as it moved around the world. If enough people who suddenly found themselves without a sense of smell self-reported their condition, you might well create an early warning signal that told you where the virus was heading, and how fast. “The missing piece is population-wide infection rates,” Hancock said.

His background in risk management was relevant here. He saw an analogy to pandemic risk in his early days at the Wall Street bank. “Those were the days when risk was being quantified in all sorts of new ways,” he said. The bank’s traders organized their risks into buckets — there was one bucket for credit risk, for example, and another bucket for market risk. But there were all sorts of risks that didn’t fit neatly into any particular bucket. Hancock watched a rival firm lose $300 million in a day on its equity derivatives portfolio after an obscure court ruling involving corporate dividend withholding tax. He asked: How would you ever uncover such a risk? His answer was to crowd-source the problem.

And so he created a program — which exists to this day — in which everyone in the bank was encouraged to alert the traders to risk. “There were two rules,” Hancock said. “Your note had to be two sentences or less. And your boss was not allowed to edit it.” The general idea was to make it simple and painless for everyone in the bank to share their thoughts. These thoughts often wound up improving the bank’s risk management. Even though the people who supplied them usually knew nothing about risk management.

So why not do a similar sort of thing with the virus? Encourage everyone in the world with access to the internet to report whether they can or cannot smell. Make it easy for them to do so. Find widely admired people with big social-media followings to make short videos on the subject — at the bottom of which there’d be a simple button that allows anyone watching to report their sense of smell. Go viral with the virus. Before long you’d have a pile of data that smart analysts could use to map it, and evaluate its risks. The results might not be perfect, but they were far better than what we have now in any rich country and far better than what they might ever have in countries with fewer resources.

I love this idea. Hancock is well on his way to building an organization to make it happen — the website is sniffoutcovid.org. He is in the market for both widely admired people and data scientists.  Here’s to hoping he finds them before my father calls me to say that he can no longer smell his Burgundy.

This column does not necessarily reflect the opinion of Bloomberg LP and its owners.

Michael Lewis is a Bloomberg Opinion columnist. His books include “Flash Boys: A Wall Street Revolt,” “Moneyball: The Art of Winning an Unfair Game,” “Liar’s Poker” and “The Fifth Risk.” He also has a podcast called “Against the Rules.”

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