We live in our world surrounded by hazards or dangers of varying types and magnitude from sunburn, food poisoning, drug abuse, and hepatitis to traffic accidents. The objective risk from such dangers is complex and variable. An in-depth understanding of any hazard (earthquake, drought, flooding, famine, and austerity) requires the application of interdisciplinary science, which in the case of an epidemic must be coordinated globally. The subjective perception of risk to a specific agent, by a shared audience is even more complex. One prevalent thought being I’m at lower risk than you. But when the agent comes home to roost? The agent of discord in our case in point is a novel new strain of the coronavirus emergent in China, which has captured the obsessive coverage of the media as it continues to spread.
The current devil, the novel corona virus (2019-nCoV) attacks cells in the respiratory system to precipitate coughing, nasal drip and high temperature in the afflicted persons leading to respiratory discomfit, pneumonia and probable death. As with its predecessor SARS (2002), it seems to leave children alone although some children have come down with pneumonia, without cough or fever. In perspective, the current flu season has led to about 9,000 deaths in the USA while seasonal flu globally left 650,000 deaths the previous year.
The new virus can still prove to be non-containable to China and the world cannot afford to presume a best-case scenario, consequently, governments need to come to grips with the risk and act accordingly, the earlier the start, the better. A pandemic requires a great many measures from governments, the World Health Organization, other international organizations, medical and public health professionals, industry, and the public.
Other devils to be dealt with include panic moderation and rumor control, which must be held in check by accurate information, conspiracy theories that require transparency, especially with secret bioweapons research and black market profiteering that always comes with disaster.
Keep in mind also that the world has always suffered devastating and periodic disasters such as the Indian Ocean combo, earthquake, tsunami, nuclear disaster (Fukushima, Japan) with long-term radioactive contamination. Today a decade later, the region struggles in poverty and neither the Japanese government nor the nuclear industry have resolved the socio-political challenges. Much more worrying; with special interests being placed ahead of humanitarian interests, public trust is depleted. Public trust determines whether the public listens willingly to what the authorities advise, such as suspending social gatherings, getting diagnosed quickly, seeking care at certain locations, and agreeing to be isolated while contagious all essential to the control of an epidemic.
They have included, pandemics such as the “Black Death” (1346-1353), which played an influential role in an unfolding new world order, epidemics that appeared and disappeared such as English Sweating Sickness (1485-1552) and Pichardy Sweats (France) in the 18th and 19th centuries as well as annually recurrent ones, such as influenza, with Spanish flu in 1918, the worst. In 1918, half the world’s population was infected and left 25 million people dead, while in 1956 and 1968 the “Asian” and “Hong Kong” flu together, killed 4.5 million. Although influenza sickens a significant percentage of the world’s population and causes the demise of millions its fatality rate is very low. And we have Bird Flu and Ebola (11,000 dead in Africa). The ongoing epidemic of 2019-nCoV is in its early days and must be kept in strict perspective, without ignoring its health damaging aspects and severity, or wrongly estimating its impact or naively comparing the risk of damage between individual populations, different societies or countries by the media and to some extent by governmental agencies.
Viral and non-virally produced infectious diseases are hazardous to health and when one breaks out the health of individuals, communities regions and the world is compromised. The effects are reported in the numbers of sick people, say 10,000, the number of deaths, say 1,000 from which the mortality rate (death rate, fatality rate) is extracted (10%) as an important indicator of severity. Contagiousness is another. Consequently, threat response by society must focus on removing the threat if possible (sanitation, good nutrition, vaccination, education, policy-legislation), modifying contagiousness, or significantly reducing the damage if one emerges and by effective and efficient health services and by management and mitigation measures (hand washing, masks, staying away from crowds, avoiding hospitals where the bacterial load is high, vaccines). Containment is essential to prevent a global expansion by keeping it in its place of origin.
With an aim to do so, China is undertaking the single largest quarantine program ever, by locking down 50 million people in several well sprayed-disinfected cities. Vaccine development, essential to slow epidemic spread and reduction of health damage and antiviral medicines should be a priority. Chinese science has already cracked the genetics of the new virus and shared the information with other scientists. Swift containment and control of the virus will reduce commercial loss. Alternatively, slower economic growth can jeopardise weaker economies in the region with world knock-on effects.
Rural China presents a perfect environment of poor and filthy living conditions like for example as those seen during Britain’s industrial revolution. Another example circa 1930 was a pandemic of dengue fever at a time of inadequate hygiene and poor domestic water supply to a background of endemic malaria. Its fatality rate of 6% left 3,000 dead and 80% of the population sick. Such conditions precipitated public health revolutions in Britain (public health legislation. 1848) and in Greece with a unique School of Public Health and whose prime minister said wrongly that he would never succumb to the fever. China with help of the international community can further develop public health and do what Germany and Britain did in the 19th century and America, at the beginning of the 20th.
Almost two decades ago SARS spread rapidly along international air routes to more than 30 countries on five continents demonstrating the global risk from new and unexpected epidemics. It cost an unfortunate death toll of 900 with a mortality rate of 10%. SARS is an example of how health troubles in one part of the world provokes health and health system problems elsewhere and how disease spread can be facilitated by social and political arrangements of various kinds and at several levels. It is an example of the complexity and multiple dimensions of disease, either in a direct sense, relating to unhealthy, unhygienic living conditions, or indirectly, as in global economies. It emerged against an alarming background of rising infectious disease in poor rural China, a backdrop of interregional and global polarization of population well-being and vulnerability and was referred to as the "Chinese Chernobyl. It’s international “health disturbance" was quite limited compared to the death and morbidity from influenza and could have been further reduced by increased transparency. Its cost to interrupted world commerce was horrendous and even now it is not accurately known. SARS – and this new strain emerged when an animal virus crossed over into the human population where human to human transmission occurs. Surprisingly, it did not spread to some less developed countries with extremely limited health resources, e.g., Burma, Laos, and Cambodia, where containment would prove even more difficult. After China came clean, its response was as good, if not better than Canada’s and SARS became a shining example of the success of interdisciplinary science. At the same time, it pointed to major failures in the implementation of appropriate public health policy and emphasized the need for modernization of surveillance systems and improved control capacities. One outcome was the inauguration of a European CDC. Sometime later, Ebola showed up the cracks in American health defence.
The emergence of SARS family viruses should be perceived as a disturbing alarm that underscores the need to strengthen public health and facilitate construction or improvement of any existing human security "umbrella" or sanitary shield in the event of any future disaster, which seems certain to be the case as climate change goes unchecked. Inadequacies in existing structures to deal with hazard and risk have been uncovered, and the need for “fear and panic” control and truthfulness in reporting emphasized. This is highly important at this time of the fake. We have to build trust and collaborate on all environmental challenges.
2019nCoV should be perceived as a reverberating early alarm, analogous to the bell of the wandering leper, which adds its own dissonant note to global health disturbance. It should be heard as a call for further interdisciplinary public health development as an instrument for universal public good. Dealing with large unpleasant surprises and protecting the health of the population should become a more integrated component of organized society’s umbrella for human security. The world however, is preoccupied with “business as usual” (commercial food processing, extraction of fossil fuels) and less with ensuring the health and safety of the public, even though at the moment it is on high alert and demonstrates fear and anxiety.
As the new SARS emerged, doctors were reprimanded for their lies in a new coverup. The Soviet Union attempted a Chernobyl coverup and China concealed SARS to endanger their citizens and the world. Chernobyl was eventually normalized a result of massive resources and great human sacrifice and SARS 2002 ran its course. Recently, the highest court in China said the doctors should not have been punished. In retrospect, had they have been believed the world might have been better off today1. The Coronavirus Outbreak can add a nightmare element to Xi Jinping’s Dreams of a Chinese Century and a discordant note to Donald Trump’s make America great again.
No one knows the future course of health damage from 2019nCoV so we have to make guesstimates using information from previous outbreaks from SARS and MERS as well as unfolding knowledge of its yet unknown properties. We can only provide a qualitative flowchart as we follow it from its origin in China to the accumulation of global damage. As in SARS, we can think of two future scenarios covering the worse-case or pessimistic for containment and spread and unlikely as it currently appears. In the event of the worst-case scenario it is doubtful whether any health service in Europe could cope. The best case outcome or optimistic scenario can prevail when preparation of society is optimal and where population vulnerability is minimized by public health policy, measures and practice. At the moment it seems that the ongoing epidemic will somewhat outdo SARS.
Unfolding information from clinical observations demonstrates early onset of human-to-human transmission characteristics while its genetics reveal similarities and differences to SARS. Ongoing mathematical modeling indicates that 2019-nCoV has a higher effective reproduction number than SARS with a lower but comparable fatality rate or the same order of magnitude, which is supportive of the WHO Declaration that it is a public health threat of international concern. Its most likely outcome will register health damage at about the same level of SARS2.
The world is still not out of the woods and as thinking beings we have to wonder which system will collapse next: another part of the environment as a result of climate change; health from a global pandemic; a button pressed initiating nuclear conflagration; the collapse of an economic or banking network, a time when artificial intelligence might take over or some other unexpected disaster for which we are ill prepared. Is China’s lead in new technologies, the Internet, social media, AI, a means of supercharging authoritarian rule survival tactics? At 90 symbolic seconds to midnight, if a button is pressed, followed by others in less than 60 minutes there will be no further need for the olive branch as millions of years of evolution unravel and human consciousness disintegrates. At its closure there will be no one around to ponder good or bad futures, best or worst outcomes.
Climate change will be bad for human health as storms, hurricanes, flooding, forest fires, and heat waves arrive more frequently with water shortage, desertification and food scarcity. How bad, is unknown, but I ask you to imagine a new generation of infectious agents emerging in the middle age of climate change as planetary temperature rises. As our auto-immune system responses are compromised by heat permitting increased susceptibility, the agent’s survivability will grow. One scenario is that the worst case outcome will outdo the devastation of anything that went before equal or greater to the combined disasters of the Dark Ages towards the end of the Bronze Age and a time of the great migrations, the Black Death in the Middle Ages that decimated Europe and the more recent Spanish Flu which wiped out 25 million, globally.
At the moment, containment of the new strain of SARS (2019-2021) seems probable while the risk of transmission to Europe is low, as with SARS (2002-3). Even so, we cannot rule out its visitation to Greece or death in Venice. We have to put our faith in science, hope that with 2019nCoV, a pessimistic or worst case scenario does not unfold this time around and prepare here and now for the future.
Just as a forest fire can suddenly take a new direction as winds change or fire fighters reduce the fury of one front, the ongoing epidemic can shift course.
Note from a friend and of China: inside news suggests that some nasty issues are emerging about the Coronavirus that the West knows not. I would add that many nasty things are happening in the West that should not. In spite of viral damage and disruption, 2019-nCoV presents a great learning opportunity. My friend and I ask, will they learn?
Zhidong Cao et al. Estimating the effective reproduction number of the 2019-nCoV in China, 2020.
Jeffrey Levett. Severe Acute Respiratory Syndrome (SARS): Loud Clang of the Leper’s Bell, 2003.
1 Doctors in Turkey received jail sentences for calling war a man-made public health problem.
2 A computer model (Paris Mavrokefalos) predicts about 100,000 cases by 19-2-2020, just afterpublication of this article.