Shared with permission from Fred Brown

1. Defeating COVID-19
Fred Brown
2020 04 05

2. Where I ve Been
▪ M life o k i defea ing illne and i al e idemic
▪ My epidemic intervention experience includes:
Developing and commercializing first test for HIV (Centocor)
Developing and commercializing polyvalent vaccines (GSK, Novartis, (many))
Managing Roche Diagnostic andTamiflu suppression of H5N1 Influenza
▪ I have also led 0r supported the discovery, development and/or launch of 27
pharmaceutical, 13 diagnostic and 6 vaccine products saving 5.6M lives per year and
achieving combined peak sales of over $35B
Global Head, Hoffmann LaRoche Product Lifecycle, Partnerships and Informatics.
Co-founder and executive leader of two innovative Life Science companies like Alkermes (NASDAQ:
ALKS).
▪ Board Member of Continuing Medical Education - Johns Hopkins Medical School/ES4P
2©2020 Fred Brown

3. Where I m Coming From
▪ I believe humans are responding too slowly and too narrowly to the
scale and speed of the pandemic threat
▪ These are solely my opinions based on my experience and the data
available on 4/5/20
These are early days and facts are scarce; beware of certainty (economists,
scientists, politicians, pundits, investment advisors, relatives)
Government and industry leaders are naturally biased on behalf of their
institutions; evaluate their statements accordingly
My only interest here is to save lives
▪ I ee m elf a an an igen ing o im la e he o ld imm ne
system to respond more robustly to the threat
3©2020 Fred Brown

4. Goals of This Presentation
▪ To help people think clearly about the huge issues raised by the
COVID-19 pandemic
You as leaders have the potential to make a real difference; I want you to know
the facts and use them: feel free to steal and use this material!
Other audiences: scientists, elected officials, journalists, general public
▪ To make it easier to parse the daily flood of information and opinion
on the topic
▪ To provide some easy frameworks with signals and indicators to help
people determine where we are in this war
4©2020 Fred Brown

5. What We re Up Against
▪ SARS CoV-2 is an exceptionally dangerous virus
We have no immunity: it will take a long time to reach herd effect
I highl con agio i co ld infec mo of he o ld a idl
I a kille le ing i n i co e o ld be ca a o hic
I in a famil of i e fo hich accine a e diffic l o de elo
I abili o m a e o e ade accine and an i i al i nkno n
▪ Our world is tailor-made to be vulnerable
Our economies depend on global supply chains, pervasive travel, face-to-face
service industries, and high population densities in concentrated urban areas
We e mo e mobile and mo e ocial han h man ha e e e been befo e
Our information environment is ubiquitous, engaging, and unreliable
Our politics are polarized
5©2020 Fred Brown

6. Where We Stand
▪ Since first identified in humans in China in late 2019, COVID-19 has
appeared in 184 countries, accounted for 100,000 confirmed deaths,
and overwhelmed healthcare systems in China, Italy, Spain, and the US
▪ Hence e e managing a a o la ion le el no an indi id al le el
▪ The only response thus far which has moderated the exponential
growth of infections has been strong social distancing, including
extreme reductions in travel
▪ Such social distancing brings economies to a near-standstill
▪ The virus itself is impairing our ability to respond because it disrupts
our fragile just-in-time systems and global supply chains.This impacts
healthcare, pharmaceuticals, medical supplies, and medical equipment
6©2020 Fred Brown

7. #ofInfected
1 5 30
15 R = 1.25
Influenza
Every Day Counts
Influenza has a typical
infection rate of 1.25.
In 30 days from the
fi ca e o ll ha e
ca e if o don
intervene.
Days 7©2020 Fred Brown

8. #ofInfected
Days 1 5 30
15 R = 1.25
Influenza
Every Day Counts
406
R = 2.5
COVID 19 COVID-19 has a typical
infection rate of 2.5. In
30 days from the first
ca e o ll ha e
ca e if o don
intervene.
Influenza has a typical
infection rate of 1.25.
In 30 days from the
fi ca e o ll ha e
ca e if o don
intervene.
8©2020 Fred Brown

9. #ofInfected
Days 1 5 30
15 R = 1.25
Influenza
406
China intervened on Day 12. Had
they intervened just SEVEN DAYS
EARLIER, they would have cut
their 30-day case count in half.
Had they waited SEVEN DAYS
LATER, they would have let their
case count increase nine-fold.
The virus attack is exponential.
Our responses are linear.
Every Day Counts
x/2 9x
R = 2.5
COVID 19
9©2020 Fred Brown

10. #ofInfected
Days 1 5 30
15 R = 1.25
Influenza
406
Every Day Counts
Take-Aways
1. It s better to over-respond to an epidemic
early and back off rather than to hope,
wait and see it will overwhelm you
• COVID-19 reproduces exponentially while
our responses are linear
• Our traditional processes will not work
to control COVID-19
2. Data, Data, Data
• Real time, not batch
• Granular, broad, and searchable, not
siloed
3. Range of uncertainty also increases
exponentially over time with no new data
R = 2.5
COVID 19
x/2 9x
10©2020 Fred Brown

11. How Should We Proceed?
▪ Sufficiently strong social distancing collapses infection rates but
devastates economies & societies.Three restoration strategies have
been suggested:
1. Get lucky. Perhaps one of the first vaccines to be tested will prove safe,
effective, and scalable.With a lot of luck, we could arrive at a post-COVID-19
era as soon as late 2021.
2. Get brutal. If allowed to run rampant, this virus might follow the path of the
1918 Influenza epidemic, which eventually died off after killing perhaps
hundreds of millions in three trips around the world. It left most of the
survivors with immunity, insuring its own demise.
3. Win a marathon. Learn to manage social behavior to minimize risk while
restoring some economic activity. Press ahead on antivirals and vaccines with
realistic expectations. Innovate to optimize economic benefit under duress.
This could last for years.
11©2020 Fred Brown

12. Getting Lucky: How Lucky Can We Get?
▪ Vaccines against viruses average 13 years to develop
▪ So far, no vaccines exist for any human Coronaviruses
▪ Today there are 78 COVID vaccine candidates under investigation
▪ There is no consensus yet about most likely candidates, an indication of early days
▪ Huge resources have been committed. There is initial coordination between some
efforts, but the vast majority remain independent. Regulatory agencies have
promised streamlined processes
▪ Odds of getting lucky? Less than 20%
▪ We need a Plan B
12©2020 Fred Brown
The costs of a decision could be orders of magnitude higher medically, economically, psychologically and socially if
unchecked. Social distance shut-downs have projectable economic and health costs. Unchecked pandemics do not.

13. Getting Brutal: Betting on Herd Immunity
Bet: Total humanitarian costs of shutting down the economy > Total costs of letting coronavirus run its course
We are early in this war to make an all-or-nothing decision. We know so little about COVID and are defenseless against it.
Leaders have always bought time until they know more about alternatives and true risks of deploying such a strategy.
1. Wild Bet right now we have no idea of the true, eventual downside risk
▪ COVID e fa ali e od c i e and m a ion a e
▪ The range of medical issues it can cause across diverse genetic populations and broader ranges of underlying conditions,
▪ The degree and duration of herd immunity after infection, and
▪ The costs of a decision could be orders of magnitude higher medically, economically, psychologically and socially if
unchecked. Social distance shut-downs have projectable economic and health costs. Unchecked pandemics do not.
▪ Until a detection and public health infrastructure is in place to guide deploying a brutal strategy, it could run tragically amok.
2. This bet is all in
▪ A deployment decision is non-reversible and on a hair-trigger. We have no weapons to fight COVID 19 today- unchecked, it
co ld infec mo of he o ld o la ion in a ea o o
▪ Healthcare services would be utterly overwhelmed
▪ Total COVID19-related mortality rates worldwide are uncertain, but global deaths on the order of 1 2% of total population
75 to 150 million people in 2021-22 would be a plausible first guess.
▪ Any large mobile population can trigger a brutal pathway that envelops the world. Once initiated, we have no infrastructure
to detect or halt the virus. It would run its course unchecked - No do-overs. Nowhere to hide.
▪ This choice is morally, psychologically, and politically devastating ©2020 Fred Brown
13

14. Welcome to the Marathon: COVID-19 War Games
Four Scenarios:
1. Spontaneous Combustion (<1% chance)
The virus mysteriously sputters out. It has happened before.
2. Magic Bullet (<20% chance)
We get lucky fast with an effective vaccine ~19 months (<20% chance)
3. Therapeutic Cocktails (60% chance)
Intermittent social distancing, testing and tracing; and a sequence of improving
cocktails and partial vaccines; then an effective vaccine in ~5 years (60% chance)
4. War of Attrition (20% chance)
Similar to #3, but on a more typical timeline for development of vaccines, antivirals,
and other treatments, leading to an effective vaccine in ~10 years (20% chance)
14©2020 Fred Brown

15. Welcome to the Marathon: COVID-19 War Games
2020 2021 2022 2026 2027 2028 2029 2030202520242023
Economic &
Social Normalcy
95 100%
30-60%
60 75%
75-95%
LEGEND
Magic Bullet: revolutionary vaccine by Q2 2021,
perfect execution, no COVID-19 bounce-back
Spontaneous Combustion: COVID-19 quickly sputters out<1%
<20%
20%
60%
Convalescent Plasma
Repurposed Drugs
Therapeutics
Antivirals
PartialVaccine
Vaccine
Therapeutic Cocktails: behavior
management and drug treatments
reduce harm and buy time until an
effective vaccine takes over
War of Attrition: traditional
drug and vaccine timelines
and failures. COVID-19 may
fight back with mutationsConvalescent Plasma
Repurposed Drugs
Therapeutics Antivirals
PartialVaccine
Vaccine
Vaccine
15©2020 Fred Brown

16. Winning a Marathon (Full of Sprints)
Social Distancing
& Diagnostics
Drugs
Vaccines
Time
Effectiveness
Herd
Immunity
16©2020 Fred Brown

17. Phase Shifts
▪ Phase I Social Distancing & Diagnostics: non-pharmaceutical; requires
intermittent strict behavioral constraints: test & trace, social distancing,
and mo e AKA bo ing
▪ A third of the economy in any one geography will be turned off at any one time.
Unsynchronizable.Governed by adaptive triggering
▪ Phase II Drugs: useful anti-viral cocktail(s) become available to reduce
severity, frequency, and mortality of infections which reduces duration
and frequency of boxing episodes
▪ Phase III Vaccines: effective vaccine(s) become available at scale (if virus
cooperates); vaccines accelerate herd immunity, boxing ends
▪ Within phases, incremental improvements; at phase shifts, bigger jumps
17©2020 Fred Brown

18. NewConfirmedCases
Non OutbreakArea Shutdown 2 Months
OutbreakArea Shutdown (Wuhan) 2.5 Months
FY GDP
6.1+%
FY GDP
3.3-%
The First COVID-19 Attack (China): One & Done?
4000
3500
3000
2500
2000
1500
1000
500
0
18©2020 Fred Brown

19. Or Recurring Attacks
Sep
21
Nov
21
Jul
21
May
21
Mar
21
Jul
20
May
20
Jan
21
Nov
20
Sep
20
Mar
20
Trigger:
>2.5% of
Available
ICU Beds
Devoted to
COVID-19
Boxes =
Economy
off d e o
social
distancing
and other
restrictions
Wi ho he a e ic and accine o figh back h man m o imi e ocial di ancing i h ada i e igge ing
Herd Immunity? After wave 1, 95% of us remain susceptible. Herd immunity may
require 55-85% to have antibodies and may only last for one season.
Goal: Make the
boxes narrower
and farther apart,
to keep the
economy
switched on more
of the time.
19©2020 Fred Brown

20. D
Sense and Respond
4 weeks ago 3 weeks ago 2 weeks ago 1 weeks ago Today In 1 week In 2 weeks
Exposure Symptoms Resolution 1 Death
Infectious 14 days
- Number Infected
100
200
400
800
1600
3200
6400
2 Deaths 4
Deaths
Clinical Surrogate
(Death)TriggerDiagnostic TestTriggers
Case Fatality Rate 1%
Doubling Time 1Week
Shorten the Detection Window
VS.
• Humans - No counter attack technologies
COVID A mame
• Long infectious period
• Large asymptomatic population
• Moderate death rate
• Mutation rate stable so far
20©2020 Fred Brown

21. The Dance of Science and Economics
ManageThe Box to Increase Normalcy
1. Narrow the length of economy off by increasing the compliance to distancing measures
2. Reduce the frequency of economy off with improved drugs and diagnostics/tracing control
3. Raise the height of the trigger (adaptively) with improved health system capacity
Increase Compliance
• Infrastructure
• Diagnostics
• AI
. . . . . .
Step 2
Medicines
• Therapeutics
• Anti-virals
• PartialVaccines Economy Off
. . .
Step 1
Reduce
Shut-Down
Duration
Reduce
Shut-Down
Frequency
21
21©2020 Fred Brown

22. Our Phase 1 Weapons
1. Diagnose
Surveillance
All Crowded Events/Venues
Minimum - 128 M tests per week
85% Predictive, Instant, <1c $2.00
PCR/Point-of-Care
Accurate ActiveVirus Detection -
Minimum capacity 75M tests per week
0.04% False neg. rate, 15 min, $20 -$50
Monitor
Antibody Detection
Minimum capacity 65M per week
0.01 % False pos. rate, 2 d, $15 - $50
COVID WAZE
COVID
Expert
Bot
Contact
Tracing
&Status
National
COVID-
Registry
Global
Vaccines
Registry
2.Track &Trace
• Artifical Intelligence
• Expert Systems
• Machine Learning
• Predictive Analytics
Apps
3. Auto-Mitigate
Large infrastructure upgrades are required immediately in three areas to support and
automate our social distance defenses
©2020 Fred Brown 22©2020 Fred Brown

23. Manhattan Project Identify, Isolate and Auto-Trace
Q2/2020 – Building the New Infrastructure Q3/2021 - Precision Monitoring
or
Self/Dr. Report
Surveillance
ContactTracking
TEST
No COVID
30% 70%
Hospital Field
Hospital
Home
(+/-
Smart)
Quarantine
/Isolation
COVID
Confirmed
Triage
ClinicVery
ill ill
Population
Sick
Asymptomatic
Immune
Well Low Risk
Well High Risk
Anti-body
Testing
For
Immunity
Vaccine
Registry
Tracking App
- Immune Cert
- Test Checks
- Location
- Result
- GPS
- O he
43%
Telehealth
COVID
Suspected
5/20 - Cost of Social Distancing U.S. ~ $85B/Day
PAT &Vaccines to Come
Diagnostics
9/21 ~$51B/day GDP $18.8T
Feel Sick
23©2020 Fred Brown

24. ImportancetotheWarEffort
Ease of Social Distancing
Low
High
Low High
e.g.,
Farming/Ag
New Residential Construction
e.g., Retail
Non-Essential Mfctg
Restaurants
Travel Industry
Big venue events
e.g., Research science vs Covid
Infrastructure vs covid
Strat call centers/consulting/exec
Remote Workers
IT professionals/Knowledge Workers
e.g.,
Delivery Svs
Police/Military
Essential Mfctr/Infrastructure Cons.
Infectious Disease Workers
Teachers
Virtualize
Automate
Robotics
Manhattan Prjts
Eliminate/Mothball
Transfer/ Restructure
(Immune market only)
Activity Selection Matrix
What to keep on and what to turn off
Accelerate/
ExpectCompetitioin
LimpAlong
Expect New Entrants
CAGR - 80%
CAGR +100% CAGR +30%
CAGR -20%
Where are you today and where do you need to be?
How do your personal behaviors change if you are at low vs high risk of contracting and dying from COVID?
Surviving COVIDWAR Phase 1: Prioritizing Our SocioeconomicActivities
Our only weapon vs COVID-19 today is social distancing How do we deploy it most effectively?
24©2020 Fred Brown

25. Cocktail Therapies Humans Counter-attack!
Social Distancing
& Diagnostics
Drugs
Vaccines
Time
Effectiveness
25©2020 Fred Brown

26. WHO
SelectedTheir Antiviral
Cocktail 3/20
CETI
SelectedTheirTop 3
Vaccine Cock ail
Treating Associated Illnesses140 Candidates in Development
PAD
BARDA
HHS
SelectedTheirTop 2
VaccineCock ail
Diagnostics Needed!
Reduces Fatalities, not COVID-19
1.Increases Risk of Failure
2.Reduces Scale
3.Threatens outcome
consistency and
comparability
Red Flags
Vaccine Manhattan
Project Required NOW
Attacking COVID-19 A new, difficult target
Stem Cell Therapy
69 DruggableTargets
Attacking theVirus
Vaccines
26©2020 Fred Brown

27. COVID-19 Therapy Progression Likely Scenario
Effectiveness
Cure (R=0)
Time2021 2022 2023 2024
Symptomologic &Co-Morbid
DiseaseTreatments
No Impact on COVID-19 R
Significanty reduces mortality
PassiveAnti-bodyTherapy
(Convalescent Plasma)
Small impact on C-19 R
Boost for those at risk
ExistingAnti-Virals,Anti-Bacterials
+ Anti-Inflamatories
Small impact on C19 R
Cocktail Component
COVID 19 Specific Drugs
Antiviral and Other
Cocktail Components
Stem Cells, other vaccine
Insurance Policy
Vaccines Partial Immunity
Vaccine
(2025)
Today there are NO approved therapeutics to treat COVID 19
27©2020 Fred Brown

28. Cocktail Therapy: A Partial, Fragile Solution
Treatments
Therapeutics
• Reduce disease
progression and mortality
• SymptomologicTreatment
Antivirals
• Pre-Exposure Prophylaxis
• Post Exposure Prophylaxis
• EarlyTreatment
• LateTreatment
Scenario A
Outbreaks trigger conflicts
over who receives treatment
Unlimited population,
usually sufficient supply
Controlling COVID- before there s a complete vaccine available
Defined populations,
predictable demand
Scenario B Scenario C
Healthcare Workers
Social distancing error
(Day after pill)
At Risk Populations Partial vaccines like Flu
Tamiflu
Cough suppressant, pain
reliever
Combinable cocktails:
diagnostic/prognostic
separators required
Specific to co-morbid diseases, generally after onset
IncreasingPersonalized/PrecisionMedicine
Increasing Demand and Susceptibility to Outbreak Breakdowns
Diagnostic/Prognostic
Separators Required
Diagnostic rqd
28©2020 Fred Brown

29. Cocktail Therapy: A Partial, Fragile Solution
Treatments
Therapeutics
• Reduce disease
progression and mortality
• SymptomologicTreatment
Antivirals
• Pre-Exposure Prophylaxis
• Post Exposure Prophylaxis
• EarlyTreatment
• LateTreatment
Scenario A
Outbreaks trigger conflicts
over who receives treatment
Unlimited population,
usually sufficient supply
Outbreaks can quickly destabilize the system.
Defined populations,
predictable demand
Scenario B Scenario C
Healthcare Workers
Social distancing error
(Day after pill)
At Risk Populations Partial vaccines like Flu
Tamiflu
Cough suppressant, pain
reliever
Combinable cocktails:
diagnostic/prognostic
separators required
Specific to co-morbid diseases, generally after onset
IncreasingPersonalized/PrecisionMedicine
Increasing Demand and Susceptibility to Outbreak Breakdowns
RATIONING
ISSUES
Outbreaks
Unpredictable
Outbreak
Demand
Overwhelms
Supply
29©2020 Fred Brown

30. Global Partnering & Synchronizing
Issues
• SupplyChains money, people and goods
• Bridging Populations, Politics andTravel
• Seasons
• Compounding Natural Disasters
• Policy Ripple Effects and Unintended Consequences
• Frequency - COVID
Global SupplyChain
Manufacturing/Dist
Real-Time Re-routing
LongTerm/Risk Sharing Contracts
More Flexible Plants, Eq.& x-training
Global Multi-Sourcing
Regulatory Flexibility
Ne P od c De ign e g PPE S ab Reagen
Demand Mgt
Capacity Mgt
MRP/ERP/QC
Inventory Mgt
Dist. Mgt
Pedigree Mgt
Health System
D Forecast Models
Usage Levels
Inventory Levels
Procurement/Blockchain
RCM
Distributor/Suppliers
Labs Hosp Dr. Rx
Predict/Sense/Respond
Intelligence
©2020 Fred Brown 30

31. Rationing Societ s Winners and Losers in the War
Free MarketTriage vs Central Planning
• Who wins with one outbreak? With many?
• Who wins early in life of the drug vs late?
Rationing
CocktailTherapy Effectiveness
Low
High
Selective High
ProcessControls
e.g., StepTherapy
Diagnostics
Triage
Free Market
P i i i e b De i ed O c me B
• What outcomes are most desirable?
• Who decides?
• How do they decide?
• When do we start or stop rationing?
• What rationing processes should be used?
Country vs Country
Sick vsWell
Young vs Old
Poor vs Rich
T ibe T ibe
Unequal Levels of Illness and Death
Distrust among and between partners
31©2020 Fred Brown

32. We are Fighting a World War
Unprecedented speed and scale will be required to win.
Allied Global Command
Regional Surgeon Generals
Country Deployment
Operational
Excellence
COVID Battle
Infrastructure
Innovation
Strategy
Health/Social System
Responsiveness
Battle Infrastructure
Supply & Demand Mgt
Diagnostic, Drug, Device, AI
Strategy,Apps, Data Deployment
Social Con ac ing Reg la o F ame o k Enfo cemen
Citizen Perspective Financial Perspective
Best Practices Aggregation and Monitoring
Financial
Management
Social Economic Health Markets Money
Local Commanders
Cross-Border Management
Fed & Fiscal
Manage
the SCIENCE
Manage the
EMOTION
Our
Forces
vs
. Implement a global hierarchy with a plan, balanced scorecard and metrics now.
Marshall Plan Manhattan Project
Medical/Social Policy & Best Practices
32©2020 Fred Brown

33. X
Vaccines: The Silver Bullet – How Soon?
Stable/Low MutationVirus
Mutating/Multi-StrainVirus
e.g., Influenza
Constantly Mutating
e.g., Malaria
Single Dose
+ Booster
High
Low
Seasonal
Partial
Trouble
Effectiveness
Mutagensis
Silver Bullet Scenario
Cocktail Scenario*
War of Attrition Scenario
Development Speed
Slow Fast
Scalability
ProvenUnproven
* Cocktail Scenario -The fastest route to some control may be
PAT (Convalescent Plasma) Monoclonal antibody cocktails
DNA
19mos13.4yrs 5 yrs
If Safe and Efficacious, then…
RNA
Non-Replicating
ViralVector
Replicating
ViralVector
Live Attenuated
Inactivated
Protein
Subunit No Scaled
FastVaccines
X Multiple Dose X Single Dose
33©2020 Fred Brown

34. Chloroquine
(Malaria)
Victory Paths - The Bets We Are Making
Effectiveness
Cure (R=0)
Time
2021 2022 2023 2024
Co-Morbid/Symptom
DiseaseTreatments
COVID 19 Specific Drugs
Antiviral and Other
Cocktail Components
Stem Cells, other vaccine
Insurance Policy
Vaccines
Partial Immunity
Vaccine
(2025)
2020
2020- Magnified
DATA
Yes
No
Gilead
Remdesivir
(Ebola)
Kaletra (HIV)
Kaletra (HIV)
+ Interferon B
BCG
Convalescent
Therapy
Regeneron
Monoclonal
Cocktail
Components
Moderna
CanSino
Inovio
CurVac
Generex
Shenzen
(Repurposed
PartialVaccine)
Alnylam
RNAi
Jena
Abcellera
Takeda
Harbour
Vir
BDB
Emergent
Sanofi
Kevzara
Roche
Actemra
Antibody
Therapies
Anti
Virals
Vaccines
PassiveAnti-bodyTherapy
(Convalescent Plasma)
ExistingAnti-Virals,Anti-Bacterials
+ Anti-Inflamatories
Start Ph 3ClinicalVaccine
Trial? Moderna 25%
Multiple attacks?
Epidemiology?
Economy, Societal?
NovaVax
270 ClinicalTrials
140 DrugTreatment
78Vaccine
Jan` April 5 SepJuly
©2020 Fred Brown
34
34©2020 Fred Brown

35. Innovation Challenges
▪ Reducing Infection
Social & Behavioral Innovations
Testing &Tracing/Immunity Management
Repurposing Drugs
▪ Reducing Mortality
More robust healthcare system
Antivirals & vaccines
Immune system response management & other therapeutic advances
▪ Creating Resilient Economy and Society
Federal monetary and fiscal activity
Efficient on/off switching
Safe workplace protocols, increased use of virtualization,AI/ML, robotics, automation
35©2020 Fred Brown

36. Framework
• Our time horizon must expand beyond what our imaginations are currently allowing us to imagine.
• We are running a marathon, not a sprint
• This enemy breaks all of our decision rules and comforts zones. Developing a predictive capability
using current, unvarnished data and scenario pathways is required to win.
The cold hard truth
• This is far worse than the market crash of 2008, or 9/11.Those were events: this is an era.
• Until we can vaccinate about 85% of the population, intermittent social distancing will be an
economically and psychologically burdensome reality.
• Business categories and populations will come back unevenly
o Businesses who do not find a way to incorporate intermittent social distancing may never fully
return
o For the poor and disadvantaged populations, full economic recovery could easily take a decade or
more.
How we will win
• Prepare for multiple scenarios and over-react when a response requirement is detected
• Develop unprecedented and unpalatable management of individual behaviors that influence infection
rate and deal with associated risks.
• A great wave of innovation offers our chance of winning this war and returning to normalcy
Conclusions
36©2020 Fred Brown

37. Implications: The New Normal
▪ It is still early days. Data is fragmentary, and coming in fast. New data can have an
immediate and unpredictable impact on these recommendations stay tuned in.
▪ Human mobility, integration and globalization has brought many benefits and
improvements to our lives. It also makes us more susceptible to pandemics
▪ This is our first, not our last pandemic
▪ We have to get good at pandemic response
▪ O effo no on be a a e of ime and ea e
▪ To win, we must build a global diagnostic testing, medicines development and
economic response infrastructures, even under a silver bullet scenario
▪ This great wave of innovation will pay off for decades to come.
▪ Viral transmission and exponential growth are network effects. If you have heard any
useful ideas in this presentation, be a super spreader tell all of your friends to tell
their friends!
37©2020 Fred Brown

38. Appendix
38©2020 Fred Brown

39. Poor
Good
Poor Good
DiseaseManagement
Economic Policy Management
Ger
China
Jpn
US
Emer
Mkts
It
Fr
UK
Kor
Twn
Ir
Sng
Sp
EU Region
ASEAN
Circle Size = GDP
Short Term – Economy is Driven by COVID
Management Capabilities and Outcomes
39©2020 Fred Brown

40. Economic Implications
• Countries that do not act quickly with unprecedented neutralizing stimulus to counteract the social distancing economic
impact will suffer permanent economic damage.
• Economic forecasts and policy models that are not directly driven by COVID 19 Epidemiologic models will be off by an
order of magnitude (Exponential Growth vs Linear Response)
Regional
• The US will be under tremendous pressure to restore economic order. It will be unable to until COVID-19 is under better
control. ( My model runs 3/24/20 projects August 1 unemployment 27%, Real Unemp 42%, 2020 4,5,6/20 GDP -62%)
• Compared to other OECD countries, the US must do more just to stand still to prevent demand disruption. Immediate
stimulus package throughAugust should be ~2.5x what is planned now. Speed is critical.
• EU will suffer high mortality due to elderly populations.
• China will delay stimulus for cosmetic reasons until Fall. It is better positioned to establish a new regional order.
• Emerging and second world countries will lose the most at least ten years of development and millions of deaths.
Global
• Significant investment is needed to create an infrastructure to control pandemics. This will slow economic stimulus.
• Country and regional supply chain strengthening will be required to diversify global risk and manage outbreaks.
• A policy framework like BrettonWoods must be established upon the subsidence of the virus to recover the global
demand function and restore confidence. Without it, a permanent deflation of asset values is likely globally.
40©2020 Fred Brown

41. Innovation Challenges
▪ Reducing Infection
Social & behavioral innovations
Testing &Tracing
Antivirals &Vaccines
▪ Reducing Mortality
More robust healthcare system
Antivirals
Immune system response management & other therapeutic advances
▪ Creating Resilient Economy and Society
Federal monetary and fiscal activity
Efficient on/off switching
Safe workplace protocols, increased use of virtualization,AI/ML, robotics, etc.
41©2020 Fred Brown

42. Welcome to The Marathon
▪ I believe this is our best option. It works like this:
1. Use strong social distancing to greatly lower infection rate
2. Establish program of comprehensive individual monitoring for infection, risk
factors for infection, and immunity
3. Selectively ease restrictions to allow economic activity to resume
4. Use individual data to constrain individual activity
5. Monitor gating indicators: for example, ICU bed use
6. When the indicators reveal that infection rates are beginning to rise, restore
strong social distancing quickly to keep the infection spike as small and brief as
possible
7. Adapt to changing circumstances: increased healthcare system capacity and
efficacy in preventing death, availability of antiviral cocktails, better data on
efficacy of behavioral constraints, rising immunity level in general population,
availability of vaccine, competence at switching economy off and on
42©2020 Fred Brown

43. For questions and comments
fred.brown.covid@gmail.com
April 5, 2020
43©2020 Fred Brown