Was 2020 a turning point year?

Why do I think 2020 may be a rare turning point year?
I still think there’s a decent chance that COVID will fade from memory and we will have learnt little (this would make it like Swine flu). But, I think that chance sits around 30% and moving lower. This is partly due to the length of time COVID will be affecting us and partly due to our response both innovation-wise and public health wise.

On the positive front we have had many science innovations not least on the vaccine and biomedical front:  mRNA technology looks set to prove long-term robust to make many kinds of vaccine. We have a malaria vaccine in late stage testing, Deepmind/AI has made advances in protein folding modelling, and new molecular entity drug approvals (excluding vaccines) was c. 51 this year in the US, which is in line with the last few years in terms of therapeutic innovations. With gene-editing technology and our increasing knowledge and comptuting power, biomedical advances for the next 10-20 years look promising to me.

Environment-wise: We’ve had China, Japan, South Korea commited to carbon net zero. Battery technology has continued to improve. Solar power is the cheapest form of energy in many places. Even Nuclear (mini) and fusion technology has continued to improve. Apple has joined the electric vehicle / driverless car race. 

Governance-wise: We had fiercely contested US elections that have essentially been peaceful and robustly managed given that over 161 million Americans voted. UK and EU managed to agree a Brexit trade deal. 

My guess is that certain people will be inspired by science and innovation as having some answers to our challenges that will make them place more bets here and invent more valuable things that will improve human welfare and the environment. That COVID has triggered an enhanced ability to work out of the office should help bring more productivity and people to work and develop and, hopefully, this should also bring about better welfare.

Many of these improvements are slow-moving - like our overall improvements in human life expectancy and welfare. Many of us both misjudge how far we have come, and perhaps if we understand our progress we misjudge the challenges which are still great.

But we will need both parts. To understand where we have made progress, where we still have challenges and to use the opportunities COVID has given us to do better while trying to defeat its catastrophic impact.

That's not to downplay the awfulness of COVID. That's with us. But how we react is still up to us.

I remain more worried about creative arts practitioners.While over the long-term creative industries have typically bounced back from hard times, I think 2021 will continue to be hard and I see many brilliant creatives having to leave the arts and related work. It’s hard to measure the value of arts and the financial rewards are low for the majority. There is little joy in a future generation of creative work when this generation is so hit.

COVID, why so many are mostly wrong, or only a little correct.

Summary: Vaccines are likely to give protection for at least c. 12 months and likely to reduce transmission rates, but vaccine hesitancy, mutation and maybe some amount of re-infection will mean that the virus stays with us permanently like influenza does. However like ‘flu we will find this disease manageable. We may also never know for sure why certain groups (eg men) suffer higher mortality. 

The medium to long term speculative thoughts is that this crisis will spur more innovation and creativity across several domains.

This is because many may conclude it is human innovation that has saved us and will save us. Similar thinking may be applied to climate challenges (I expect Bill Gates will double down on this in his next book). I also think - while with much pain- the creative arts will also react with more creativity, although extremely crimped near term, as people will have to find new ways of reaching audiences/consumers.


This is a long form read over why so many people are fairly wrong (or only a little correct) about COVID and why the information seems so confusing. I will attempt to touch on:

  • Predicting vaccines

  • Immunity and immune memory

  • Cross-protection

  • Different strains

  • Different genetics

  • Super-spreaders

  • Cultural differences

  • Data reporting differences

  • Complexity models

  • Re-infection

  • Narrow vs broad thinking (fox vs hedgehog)

  • Ideology

Back in August 2020, I made the point estimate judgement of an 80% chance of a vaccine by the end of 2020. Significantly above some observers estimates (although a good number of healthcare investors were making similar judgments).  I noted some of my thinking in my August blog.

What’s useful to note is why many expert observers were more pessimistic. I can summarise that those group were focused on past experiences, focused on the risks (which were clear) and anchored on previous examples. They were not willing to place faith in mRNA technology that had not produced commercial vaccine before even if much of the theory is well established.

Source: Google Finance

Source: Google Finance


Stock market prices embody future expectations that people with money (not reputation or press articles) buy and sell at. It’s very difficult typically to be ahead of this collective wisdom of the crowd. Still with in a stock price reveals a signal that can be interpreted.

If you look at Moderna’s (one of the vaccine makers) stock price - which embody many factors including politics, interests rates, etc - there was much of a run up from March to early November before the positive pivotal data in November. There are still future unknown events to come eg launch and distribution, but looking back one can suggest that investors with money were not super surprised by early November as much had already been “priced in” over March to October.


Mostly investors do not bet directly on a question such as “will there be a COVID vaccine in 2020?” But indirectly on stocks or other assets and prices which lead to money win/loss outcomes. These investors were suggesting through the Moderna stock price signal that there was a decent expectation of some success here.


I won’t rehash all the many science and socio-political points that went into my August forecast but suffice to say there are a number of people who do make and essentially bet behind these predictions.

Cross-immunity, herd-immunity, re-infection, strains, genetics and why everyone is only a little bit right.


Mostly - with rare exceptions - media articles will take a single look at a narrow domain question and present evidence in favour of a certain answer. Sometimes coloured by an ideology. (Even studies tend to look at a narrow question).


For example, if by ideas, you strongly favour individual choices you may balk at the idea of government imposed lockdowns and so you are drawn to articles suggesting Sweden or a “herd immunity” process as a way of proceeding without lockdowns. The actual data from Sweden does not matter too much - especially when you can find media articles to support your inclination.

Another example is re-infection. There are cases of re-infection, but it seems from what we know re-infection is rare but it can and does make article headlines.

[A distant simplistic parallel that people might understand is that you can get chickenpox twice (or rather, shingles after chickenpox) but it is rare.]


Still depending if you have an idea already about what we should be doing then a case of re-infection or an article about it can be used to support that view.

So you can put all of these statements together which have a little bit of truth to them.

  • There are asymptomatic carriers of COVID.

  • You can gain (some amount of) cross-protection for some (unknown) amount of time by exposure to other coronaviruses including the common cold. 

  • This level of protection will vary with strain, genetics, immune responses and memory - which in turn vary with factors such as age.

  • Different strains can act with different people’s genetics to cause varying levels of severity of disease.

  • Different people’s immune system will “remember” the virus differently (age, strain etc. variant)


All of this becomes confusing because we would like a simple answer of do I get cross-protection or not? Not the complex answer of it dependant strain, time and genetics (and perhaps environment)  and will not be static.

And from some of these simple parameters that can change we can have events such as “super-spreaders” where one person or one event (eg a sports or a night club evening) seem to cause many infections. The interplay of all those infection factors can produce those results. Or not.

In that sense - a distant parallel is with weather forecasting.  We can put together large trends to fairly accurate assess total infection cases in regions over  a few weeks or days, but predictions at the single person or event level are much more uncertain.

Other factors which interplay are cultural differences and reporting data differences. Certainly, if you have ever travelled through Japan then the cultural differences in hygiene and also in the populations general adherence to rules from authority (also see China, Taiwan) are very different from England or the US.

As an aside, I do think the politics of mask wearing especially in the early days of the pandemic in Europe and the US were surprising to me - although not in hindsight. There was (and is) a strand of thought as to how so simple an intervention could have an impact. A walk through a poorer country or even a more mixed one like South Africa would not scorn “simple” interventions so heavily (access to proper toilets and hygiene make huge impacts). I do think - again with hindsight - it is surprising that more weight was not given to first principles - in that we knew the virus was carried in aerosol droplets (and like colds, flus) and so the physical methods of transmission could well be interrupted by barriers like masks.

Putting this all together what does this mean? In my view, vaccines are likely to give protection for at least c. 12 months and likely to reduce transmission rates, but vaccine hesitancy, mutation and maybe some amount of re-infection will mean that the virus stays with us permanently like influenza does. However like ‘flu we will find this disease manageable. We may also never know for sure why certain groups (eg men) suffer higher mortality. 

The medium to long term speculative thoughts is that this crisis will spur more innovation and creativity across several domains.

This is because many will conclude it is human innovation that has saved us and will save us. Similar thinking may be applied to climate challenges (I expect Bill Gates will double down on this in his next book). I also think - while with much pain- the creative arts will also react with more creativity, although extremely crimped near term, as people will have to find new ways of reaching audiences/consumers.

Here are a mix of random thoughts and questions that I considered when thinking about COVID:

Where did SARS-CoV-2 come from?

Some uncertainty, but seems very likely that it came from animals (zoonotic, maybe bats) and crossed into humans. Evidence that is was present in China in November 2019 (as early as 17 Nov) and maybe earlier. Open question. We don’t know if the virus mutated in animals and then crossed to humans. Or crossed to humans and then mutated and crossed human-to—human.

Definitely seems NOT lab made (IMO).

https://www.nature.com/articles/s41591-020-0820-9

https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back

Why have certain regions (Taiwan, South Korea, Singapore, Hong Kong) handled the pandemic better than others (Italy, Spain, all of Europe, US….)?

…Same for sectors and businesses ?

The high-performers had:

-Very prepared systems

-Responsive public health authorities

-Responsive general public

-Responsive private companies (at the request of the public health authorities)

But, they had very prepared systems + public because:

-They had dealt with the trauma and cost of SARS-classic

The actions were/included:

-Early responses (masks, restrictions)

-High testing (fast deployment + development of tests)

-Strict isolate, contact, trace protocols

-Travel bans and similar

-Tracking of quarantined people

There is a 124 point list of what Taiwan did:

https://www.vox.com/future-perfect/2020/3/10/21171722/taiwan-coronavirus-china-social-distancing-quarantine

https://jamanetwork.com/journals/jama/fullarticle/2762689

…Same for sectors and businesses ?

Some sectors/businesses:

-had more awareness on what exponential growth can look like (tech), and/or, 

-had more respect for the seriousness that China were taking (and put weight on that signal)

-more redundancy built into their supply chains (typically, as product considered critical, eg insulins, other must-have pharmaceuticals)

-more cash on balance sheets to deal with emergencies (typically these were maybe ear marked for litigation or other catastrophic events)

-ability to remote work

-business models that are resilient to COVID (eg. Video conference calls)

This has lead to:

(Parts of) Tech + Health + Utilities > most business

Big business > small business


Within countries / regions 

Some regions influenced by:

-understanding of exponential growth (Tech community in San Francisco)

-population density

-culture

-strains

-maybe weather?


Open Question: Why are death rates different across European regions, Asia etc ? Also, knows as heterogeneity.

We don’t know. 

We do know:

-Data is patchy

-Testing criteria are different

-Testing efficacy varies

-Older people, men, people with underlying diseases (eg heart problems) are more at risk

(But even here, there are regional differences with US rates of hospitalisation in the young much higher than in other regions).

-Different strains

-Different genetics

-Different cross protection

No one has a model that explains these intersecting factors.

One tentative suggestion is the difference in “viral load” or dosage of virus you get on first infection may explain part of this.

We do know viral load can have an impact with other viruses.

Open: Why are some people more susceptible than others?

This goes across many subgroups: Children, Men, but also differences in the young who do get impacted.

Open Question: Why are death rates so low in children? This pattern is consistent across regions even if rates vary. Explanations include:

  • Children’s immune system being more flexible and rapid

  • Adult immune system may over react due to priming with other coronaviruses

  • Adult immune system being slower

  • Other varieties of explanation…

See: Christakis https://twitter.com/NAChristakis/status/1243883141900763137

Open Question: Why are death rates higher in men? (also Co-morbidities)

We don’t know. Partial explanations that I have seen touted but with no evidence include:

-men being worse at hand washing/hygiene 

-men being more likely to smoke or use vapes.

But, essentially whatever your underlying risk the virus seems to magnify it (eg age, male, underlying diseases)…

Open Question: How long will immunity last? (Likely ranges, we have looking to be quite a few months, I’d would hone in on at least a year) 

Partly Open Question: How long does a person remain infectious? (We have some likely ranges)

Partly Open Question: How exactly is the virus spreading? (While we know it’s via viruses in droplets, we don’t really know if it’s surviving to infect people in open spaces as opposed to enclosed spaces. There’s tentative evidence that open spaces are safer (some outdoor mass events protests have not lead to super-spreading spikes but some internal ones have, also cf. different experiences in Italian cities, also Brazil) . Even if viruses can survive on cardboard in a lab how that works in the real world is unclear.)

Vaccine hesitancy, UK (79%) would take vaccine

Source: https://www.weforum.org/agenda/2020/11/fewer-people-say-they-would-take-a-covid-19-vaccine-now-than-3-months-ago

Source: https://www.weforum.org/agenda/2020/11/fewer-people-say-they-would-take-a-covid-19-vaccine-now-than-3-months-ago

Vaccine hesitancy, the ‘reluctance or refusal to vaccinate despite the availability of vaccines’, was listed among the World Health Organisation’s top ten threats to health in 2019.

In an August 2020 poll around one in four (26%) adults globally disagreed that they would take a vaccine for COVID-19 if it were available, with worry about side effects, followed by perception of effectiveness being mentioned most frequently as reasonsfor not getting a vaccine. This slipped further down in October. The November report from Ispos here. And WEF link here.

COVID vaccines, timeline update

Short update on COVID vaccine timelines. US/EU timelines have slipped by 1 -3 months, but China has held up since my August estimates. Treat all estimates with caution etc.

I thought I would update on my speculative COVID vaccine thoughts given the moving timelines here. There are >100 vaccine projects and COVID treatments in motion, and although recent vaccine timelines have slipped, it looks ;like we will have a vaccine at some point. When? is a key debate. Given the challenges around public health interventions, (lockdowns etc.) in EU/NA - one way we can cut the knot is to go fast on the vaccine. This is one reason why (althoguh not without some downsides) I support the UK challenge trials starting in early 2021. That said we have some decent chances of vaccines by very late this year / Jan 2021. Below is a moderatel positive scenario of how the US could be vaccinated in 2021.

Oct 2020, estimates. Treat with caution.

Oct 2020, estimates. Treat with caution.

I think China will have a vaccine starting to distribute to the public by Dec 2020. Chinese officials have indicated data is positive and they are willing to approve.

The UK has an 80% chance (IMO) of a vaccine in Dec/Jan for at risk populations (AZ/Oxford, timelines, newspaper leaks) under emergency approval. The early data is promising and despite the delays, if there were serious safety issues I would have expected to have had more negative news here.

The US has a chance for an emergency vaccine approval late Dec (slipping) or Jan, there are two shots on goal here (Moderna and Pfizer), and I rate the chances around the 70% level (although 40% and dropping for before year end as both have slipped, but still at 70% or so in Q1 2021 time frame). (This is down slightly from earlier due to challenges in the trials). Again early data is promising and no catastrophic safety events seen. Full approvals are more debatable than emergency (as hurdles different, but mixed messages from FDA makes this uncertain). The AZ trial stalled for longer in the US, so is more likely a Q1 2021 event as US don’t seem to want to recognize the UK/EU regulators view here.

Antibody treatments (Regeneron/Roche, Lilly) have a 90% chance of emergency approval before year end, but are only available in limited doses of around 5m to 10m doses pa. Data has been positive especially in the mild-moderate pateients.

12 Oct, 2020 Source: Gallup for Sep survey.

12 Oct, 2020 Source: Gallup for Sep survey.

There are a lot of variations on scenarios here, and supply and distribution as well as anti-vax movements are all other factors to consider. Some polls but vaccine willingness only at or so 50% in the US. Debates  arise are on (1) Willingness to vaccinate (2) Regulatory caution around durability as well as efficacy (3) social-political pressures.

It is of note that China is more advanced here seemingly than NA/EU and generally the countries outside of EU/NA are potentially faring better.

15 Leading vaccine projects, Source: Milken, press releases

15 Leading vaccine projects, Source: Milken, press releases

Life changing love of a world changing physicist

This was fascinating on Paul Dirac (by Richard Gunderman for the Conversation based on Graham Farmelo’s biography, The Strangest Man: The Hidden Life of Paul Dirac, Mystic of the Atom)…

…Born in Bristol, England, in 1902, Dirac became, after Einstein, the second most important theoretical physicist of the 20th century. He studied at Cambridge, where he wrote the first-ever dissertation on quantum mechanics. Shortly thereafter he produced one of physics’ most famous theories, the Dirac equation, which correctly predicted the existence of antimatter. Dirac did more than any other scientist to reconcile Einstein’s general theory of relativity to quantum mechanics. In 1933 he received the Nobel Prize in Physics, the youngest theoretical physicist ever to do so.

At the time Dirac received the Nobel Prize, he was leading a remarkably drab and, to most eyes, unappealing existence….

….Dirac was socially awkward and showed no interest in the opposite sex. Some of his colleagues suspected that he might be utterly devoid of such feelings. Once, Farmelo recounts, Dirac found himself on a two-week cruise from California to Japan with the eminent physicist Werner Heisenberg. The gregarious Heisenberg made the most of the trip’s opportunities for fraternization with the opposite sex, dancing with the flapper girls. Dirac found Heisenberg’s conduct perplexing, asking him, “Why do you dance?” Heisenberg replied, “When there are nice girls, it is always a pleasure to dance.” Dirac pondered this for some minutes before responding, “But Heisenberg, how do you know beforehand that the girls are nice?”

Love finds the professor

Then one day, something remarkable entered Dirac’s life. Her name was Margit Wigner, the sister of a Hungarian physicist and recently divorced mother of two. She was visiting her brother at the Institute for Advanced Study in Princeton, New Jersey, where Dirac had just arrived.

Known to friends and family as “Manci,” one day she was dining with her brother when she observed a frail, lost-looking young man walk into the restaurant. “Who is that?” she asked. “Why that is Paul Dirac, one of last year’s Nobel laureates,” replied her brother. To which she replied, “Why don’t you ask him to join us?”

Thus began an acquaintance that eventually transformed Dirac’s life. Writes Farmelo:

His personality could scarcely have contrasted more with hers: to the same extent that he was reticent, measured, objective, and cold, she was talkative, impulsive, subjective, and passionate.“

A self-described "scientific zero,” Manci embodied many things that were missing in Dirac’s life. After their first meeting, the two dined together occasionally, but Dirac, whose office was two doors down from Einstein, remained largely focused on his work.

After Manci returned to Europe, they maintained a lopsided correspondence. Manci wrote letters that ran to multiple pages every few days, to which Dirac responded with a few sentences every few weeks. But Manci was far more attuned than Dirac to a “universally acknowledged truth” best expressed by Jane Austen: “A single man in possession of a good fortune must be in want of a wife.”

She persisted despite stern warnings from Dirac:

I am afraid I cannot write such nice letters to you – perhaps because my feelings are so weak and my life is mainly concerned with facts and not feelings.

When she complained that many of her queries about his daily life and feelings were going unanswered, Dirac drew up a table, placing her questions in the left column, paired with his responses on the right. To her question, “Whom else should I love?” Dirac responded, “You should not expect me to answer this question. You would say I was cruel if I tried.” To her question, “Are there any feelings for me?” Dirac answered only, “Yes, some.”

Realizing that Dirac lacked the insight to see that many of her questions were rhetorical, she informed him that “most of them were not meant to be answered.” Eventually, exasperated by Dirac’s lack of feeling, Manci wrote to him that he should “get a second Nobel Prize in cruelty.” Dirac wrote back:

You should know that I am not in love with you. It would be wrong for me to pretend that I am, as I have never been in love I cannot understand fine feelings.

Yet with time, Dirac’s outlook began to change. After returning from a visit with her in Budapest, Dirac wrote, “I felt very sad leaving you and still feel that I miss you very much. I do not understand why this should be, as I do not usually miss people when I leave them.” The man whose mathematical brilliance had unlocked new truths about the fundamental nature of the universe was, through his relationship with Manci, discovering truths about human life that he had never before recognized.

Soon thereafter, when she returned for a visit, he asked her to marry him, and she accepted immediately. The couple went on two honeymoons little more than month apart. Later he wrote to her:

Manci, my darling, you are very dear to me. You have made a wonderful alteration in my life. You have made me human… I feel that life for me is worth living if I just make you happy and do nothing else.

Full essay here.