Coronavirus: no need to panic… at least not yet
As China grapples with the outbreak of a mysterious pneumonia-like illness, Mark Honigsbaum says earlier pandemics offer clues as to how it will play out
Put on your face mask and batten down the hatches. A new virus is on the loose and, to judge by the smoke signals emanating from World Health Organisation headquarters in Geneva, it might be time to cancel those winter holiday plans.
Certainly, with 41 deaths reported in China, several cities under quarantine and more than 1,400 confirmed cases, including in Hong Kong, Thailand and Malaysia, this is no time to be boarding a plane to south-east Asia. Right now, around a thousand American citizens based in Wuhan, a city of 11 million about 500 miles west of Shanghai, are preparing to be evacuated on a US government-chartered flight.
But is this so-called “Wuhan flu” really the oft-predicted “Big One” – the start of a pandemic like the 1918-19 Spanish flu? Is that horseman on the horizon an outrider for the coming Apocalypse, or merely a reminder of pandemics past?
The fact is, no one knows whether the new coronavirus, which was first detected six weeks ago in Wuhan will prove as contagious as the Spanish flu, much less Sars, a related coronavirus which, in 2002 and 2003, sparked a major scare and the meltdown of Asian stock markets.
The good news, at present, is that the Wuhan virus doesn’t appear to be as catchy as Sars. And while it could become as virulent as Middle East respiratory syndrome (Mers), another type of coronavirus, so far that doesn’t appear to have happened. Indeed, reports from China suggest that the virus is relatively stable.
On the other hand, the Wuhan virus – which causes a pneumonialike illness, with symptoms such as fever, dry cough and shortness of breath – has already spread to 11 other countries, including Australia, France and the United States. With millions of Chinese commuters boarding planes, trains and buses for this weekend’s Lunar New Year celebration, the concern is that all that toing and froing could greatly boost transmission.
Although the Chinese have been quick to own up to the outbreak, the fear is that the authorities are downplaying the true extent of infections. One British disease modeller estimates there could be as many as 4,000 cases in China.
As we saw in 2002-03, when Sars spread to 30 countries worldwide, killing 916 people, coronaviruses – which take their name from the menacing, crown-like protein spikes on their surface – are no laughing matter.
This is because, like influenza viruses, coronaviruses are made up of single strands of RNA (one of the three major macromolecules which, along with DNA and proteins, are essential for all known lifeforms) that are highly prone to copying errors. The fear is, the more people who are infected, the more copying errors and the greater risk of mutation.
The challenge for the WHO is anticipating whether those mutations will make the virus more or less transmissible, and more or less deadly. (At present, the illnesses appear to be less severe than those seen during the Sars and Mers outbreaks.) In the absence of a vaccine or a treatment, those unknowns make the Wuhan virus a scary prospect, and one we ought to take seriously.
Looming over the discussions in Geneva is the spectre of 1918. Last week, one disease modeller pointed out that this coronavirus had a similar mortality rate to the Spanish flu, prompting hysterical headlines in the tabloids. In an 11-month period between the summer of 1918 and spring 1919, the Spanish flu encircled the globe, infecting a third of the world’s population and killing in excess of 50 million people, the majority of them young adults in the prime of life. Adjusting for population growth, that’s equivalent to around 210 million today.
But the comparison with the Wuhan virus may be misleading, not least because the modeller’s comparison was based only on confirmed cases of coronavirus infection – patients admitted to hospitals. There could be many thousands more asymptomatic patients who have not come to the attention of the Chinese medical authorities. Also, the majority of deaths involved elderly patients with preexisting medical conditions – another key difference with the Spanish flu.
These judgments are finely balanced. Get the call right and you are hailed as a hero. Get it wrong and you are branded a villain and accused of inciting panic. It’s not if there will be a new pandemic, we are constantly told, but when.
The problem is that while we have got much better at detecting new pathogens, we are still very poor at predicting which of them might pose wider epidemic and pandemic threats and determining where best to direct our resources.
Remember the false alarm, in 2009, over the “Mexican” swine flu? That was initially classified as a pandemic by the WHO, triggering a billion-dollar windfall for vaccine manufacturers, only for it to prove to be no more severe than a regular seasonal flu.
Then there was the missed alarm of the 2014 Ebola outbreak in Guinea. Initially dismissed as a “localised event” by the WHO, within months Ebola had spread to Liberia and Sierra Leone, sparking an international medical and humanitarian emergency. By 2016, nearly 12,000 West Africans were dead.
Ebola was followed, in turn, by the 2015 outbreak of Zika, a neglected tropical virus considered uninteresting by most medical researchers. Few thought the outbreak in north-eastern Brazil warranted international attention, until women in favelas starting giving birth to children with microcephaly and other neurological disorders, spooking athletes en route to the Rio Olympics.
In each case, what was “known” before the outbreak – Ebola is a disease of remote forests in central Africa, and Zika isn’t a threat to newborns – was shown to be wrong, and the experts were left looking foolish.
So how worried should we be about the Wuhan outbreak? And what measures should we take to stop the coronavirus spreading more widely?
The first thing to say is that quarantines, like the one imposed on Wuhan last week – the authorities have closed the airport and train stations, and blocked roads out of the city – are almost always counterproductive.
In August 2014, in an attempt to contain the spread of Ebola, Liberian officials ordered barricades to be erected around West Point, a sprawling slum area of Monrovia – and sparked rioting and violent clashes with police. By fuelling suspicion of the government, it also undermined confidence in health workers and did little to persuade Liberians in urgent need of medical care to report to Ebola treatment units.
Such measures make even less sense in the case of a fast-moving respiratory virus, especially one that has already spread throughout mainland China, as well as to Thailand, South Korea, Japan and Hong Kong. Closing Wuhan airport, which has direct flights to London, Paris, New York and San Francisco, makes more sense.
One of the tragedies of the Sars epidemic is that by the time Hong Kong realised it was harbouring the virus, tourists infected at a budget hotel in Kowloon had boarded planes to Vietnam, Thailand and Canada, where they went on to spark major outbreaks. In Toronto, 44 people died and economic activity ground to a halt.
Perhaps the most urgent question is how exactly the coronavirus got into humans? Seventy per cent of emerging infectious diseases originate in the animal kingdom. The first Wuhan patients are thought to have contracted the virus at a local seafood market. Despite the name, the market sold a huge range of wild animals, including wolf cubs, crocodiles, and snakes. This could be a vital clue: genetic analysis suggests the virus is most closely related to coronaviruses that have been isolated from snakes and bats.
Sars was traced to civet cats, a game animal prized by the Chinese for its yang, or “heat-giving energy”. But while sales of civet cats are supposed to be banned in China, last week CNN reported finding them on sale at a market in the south.
One of the lessons of the recent run of epidemics is they can often be traced to “spillover” events.
For instance, researchers believe the 2014 Ebola epidemic began when children in south-eastern Guinea ate a species of bat, lolibelo, that liked to roost in a rotten tree stump in their village. Other Ebola outbreaks in Africa have been blamed on the consumption of chimpanzees.
Another lesson is that epidemics are frequently amplified by social and cultural factors: prostitution and unprotected sex in the case of HIV; traditional burial practices in the case of Ebola.
Hospitals and medical technologies can also present unforeseen risks: for instance, most deaths from Sars occurred on open wards and were sparked by “superspreaders”, individuals who were able to transmit the disease to a disproportionately large number of people.
Last week, scientists suggested that transmission of the new coronavirus could be accelerated by a small number of highly contagious individuals coming into contact with a large number of people. China’s National Health Commission said that one patient is believed to have already infected 14 healthcare workers with the disease.
However, the good news this time round is that doctors and nurses have been equipped with hazmat suits and such patients are being rapidly isolated. The authorities started building a new, 1,000-bed hospital to treat the worst cases – a project they hope to complete in a matter of days – then promply began work on a second.
Another encouraging development is the speed with which the Chinese published the genetic sequence of the virus, something that didn’t happen in 2003, when it took microbiologists weeks to identify the cause of Sars. That sequence is now being used to develop a prototype vaccine for the virus with a view to fast-tracking a clinical trial.
One of the tragedies of Sars is that, because of the absence at the time of platforms for sharing scientific information, the opportunity to test a vaccine was missed. Scientists are determined not to make the same mistake again.
But while this weekend some will secretly be hoping the outbreak lasts long enough to enable them to complete their studies, the rest of us will be happy for the doom-mongers to be proven wrong.
Mark Honigsbaum is author of The Pandemic Century: One Hundred Years of
Panic, Hysteria and Hubris (Hurst, £20). Buy now for £16.99 at books.telegraph. co.uk, or call 0844 871 1514
Scientists believe the Wuhan virus is being accelerated by a few ‘super-spreaders’
Quarantine measures make even less sense for a fast-moving respiratory virus