Armin Taheri, Class of 2022
On January 2, 2003, Chinese health officials dispatched a team of experts to Zhongshan, a city in the Guangdong province, where mysterious cases of atypical pneumonia had begun to emerge two months earlier. The team’s report was classified “top secret,” concealed from the media and the public for over a month while the number of cases continued to climb. By February, rumors of a deadly “flu” were circulating in Guangdong. Fearing mass panic, Chinese officials relented, holding a press conference to address the outbreak. By that time, Guangdong had already witnessed 305 confirmed cases of the illness that would come to be known as Severe Acute Respiratory Syndrome, or SARS (Huang, 2004). The culprit: a family of viruses first discovered in the 1960s, but never before known to cause serious illness in humans. They were collectively named coronaviruses since, under an electron microscope, their abnormally large surface glycoproteins resemble a crown encircling the viral capsid. The particular one responsible for the crisis unfolding in Guangdong would be named the SARS coronavirus, commonly abbreviated to SARS-CoV (Lim, 2016).
For once, the truth was more devastating than the rumors. This was not influenza, against which we were armed with vaccines, antivirals, acquired immunity, and a century of epidemiological data from three major pandemics and innumerable seasonal outbreaks. There was no medication to treat a coronavirus infection, simply because there had never been a need for one. Further, the lack of historical precedence for a coronavirus outbreak meant epidemiologists were in uncharted territory. At that belated press conference, Chinese authorities maintained that the virus was contained (Huang, 2004). By the time it was actually contained at the end of July, 8096 cases had been reported in 29 different countries and territories across the globe and 774 people had died (“Summary of probable SARS cases”, 2002).
Even today, however, the most striking aspect of the SARS outbreak is not the catastrophically incompetent initial response, but how quickly the blunder was rectified. The world launched an aggressive containment campaign, identifying and isolating the infected, meticulously tracing their contacts, and screening travelers from affected areas for symptoms. Through unprecedented cooperation and transparency, a network of 11 infectious disease laboratories across 9 countries succeeded in identifying the virus, mapping its genome, and developing diagnostic tests for its detection (Knobler, et al, 2004). The results were nothing short of miraculous, and the pandemic concluded with fewer than one thousand deaths. Brian Robertson, who served as a regional director of the World Health Organization during the outbreak, would later write in reflection, “It would be tragic if we did not learn from the experience of 2003 and make the most of it” (Chew, 2007).
It did appear as if we had learned. When coronaviruses made the cross-species jump once again in 2012, the resulting outbreak of Middle East Respiratory Syndrome (MERS) was effectively contained within the Arabian peninsula (Milne-Price, 2014). It was time, it seemed, for coronaviruses to be thrown atop history’s heap of forgotten ailments, once-ferocious monsters tamed and declawed by modern medicine.
Perhaps this string of past successes contributed to the complacency of authorities when yet another novel coronavirus materialized in late 2019, this time in Wuhan, China’s industrial and technological hub. In a befuddling replay of 2003, Chinese authorities censored initial reports of the disease. Government records uncovered by the South China Morning Post trace the earliest known case of COVID-19 to November 17, despite Wuhan officials reporting no cases to the World Health Organization before December 8. More disturbingly, China continued to claim there were only 41 confirmed cases as late as January 11. The new records indicate that there were 381 by January 1 (Ma, 2020). When the international community learned of the impending danger, world leaders brushed it aside in a chorus of false reassurances, wishful thinking, and outright denial. On February 26, as the fifteenth U.S. case was confirmed, President Trump donned his proverbial blindfold and proclaimed the risk posed to the American public to be “very low” (Romo, 2020). British Prime Minister Boris Johnson was similarly unperturbed. On Friday, February 28, he described the outbreak as “the government’s top priority,” before inexplicably waiting until after the weekend to hold an emergency meeting (Gallagher, 2020). In 2003, China’s reckless handling of the SARS outbreak was counterbalanced by impeccably coordinated global containment efforts. In 2020, an ineffectual initial response in Wuhan was followed by an even more inept international response. Between the chauvinistic optimism and indecisive hand wringing of Western leaders, and the misreporting of early cases by China, the virus was granted months of unmitigated spread before serious social distancing measures were implemented. Trump himself best captured the West’s bizarre attitude of congratulatory self-deception during his January 30 speech in Michigan. As the world teetered on the brink of the pandemic, the President declared triumphantly: “We have it very well under control. We have very little problem in this country at this moment — five. And those people are all recuperating successfully” (Leonhardt, 2020). It is difficult not to hear in his words echoes of that fateful press conference seventeen years ago, where Chinese authorities insisted SARS-CoV was contained.
Merely a month after Trump’s speech, the ironically named SARS-CoV-2 has enrobed the planet in death and chaos. As of March 30, there have been over 784,000 confirmed cases of COVID-19 worldwide, resulting in more than 37,000 deaths (“Coronavirus COVID-19 Global Cases", 2020). A team of experts developed a computer model to simulate the course of the outbreak in China, where the outbreak appears to have run its course, and can serve as a tentative microcosm of what we may see globally. Their findings suggest approximately 86% of all cases may never have been detected (Li, 2020). Assuming the outbreak is behaving similarly outside China, the model places the true number of cases well over one million.
This emphatically does not excuse resignation to defeat, nor the belief that the worst has already come to pass. Yes, the current situation is bleak, but forecasts for the coming months verge on apocalyptic. The March 17 report from the COVID-19 response team at Imperial College London projected another 18 or more months of pandemic before a vaccine becomes widely available. It predicted an 81% infection rate in the US assuming no control measures were taken, resulting in 2.2 million deaths (Atchinson, et al., 2020). The paper was widely cited by the media, and is believed to have been responsible for jolting the United States and Great Britain out of their stupor (Landler and Castle, 2020). The same analysis calculated that, if the most stringent intervention strategies possible were adopted immediately, and kept in place until a vaccine became available in 18 months, deaths could be reduced by up to 99 percent. This is not so much a best-case scenario as it is purely speculative fantasy. Even so, the outcome would entail over 200,000 deaths only in the United States. This alone should stifle any remaining grumblings of overreaction from the public and the media. If anything, the world may have underreacted, and underreacted far too late. The staggering rate with which new cases are being confirmed in Italy, despite the two-week-long nationwide lockdown, could indicate that the virus may have already spread far beyond the confirmed numbers, with infections that occurred before the lockdown being diagnosed only now. It may also indicate that the virus is spreading despite the lockdown, which is even more concerning. Should the same trend be observed in other nations under lockdown over the following weeks, harrowingly high death tolls may already be inevitable. The world would do well to err on the side of caution, not only maintaining but escalating intervention. If authorities, driven by economic or popular pressure, gamble by relaxing restrictions, the virus may rebound, transmitting beyond our capacity to diagnose or treat, if it has not already done so.
Even now, however, as we grapple with the greatest threat to public health in over a century, we must look to the future. Not the next few weeks, but the next few decades. The coronavirus has exposed deep inadequacies not only in healthcare systems across the world, but also in governmental planning, foresight, and common sense. We may never see SARS-CoV-3, but when the next outbreak inevitably looms over the horizon the number of lives it claims will be determined by whether we have learned from this one, built trust and transparency among governments, increased capacities of healthcare systems across the world, and mended the counterproductive disjunction between science and political policy. There is no question that the world will look different after COVID-19. Whether it will look better or worse is entirely up to us.
References:
Atchinson, C., Bowman, L., Eaton, J., Imai, N., Redd, R., Pristera, P., Vrinten, C. and Warn, H.,
2020. Report 9: Impact Of Non-Pharmaceutical Interventions (Npis) To Reduce
COVID-19 Mortality And Healthcare Demand. COVID-19 reports. [online] London:
COVID-19 Response Team, Imperial College London. Available at:
<https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-corona
virus/> [Accessed 22 March 2020].
Chew, Suok Kai. “SARS: how a global epidemic was stopped.” Bulletin of the World Health
Organization vol. 85,4 (2007): 324. doi:10.2471/BLT.07.032763
"Coronavirus COVID-19 Global Cases". Johns Hopkins Coronavirus Resource Center, 2020,
https://coronavirus.jhu.edu/map.html. Accessed 30 Mar 2020.
Eckert, Alissa and Higgins, Dan . Severe Acute Respiratory Syndrome Coronavirus 2
(SARS-Cov-2). 2020, https://phil.cdc.gov/Details.aspx?pid=23311. Accessed 31 Mar 2020.
Gallagher, James. "Coronavirus Patient First To Be Infected In UK". BBC News, 2020,
https://www.bbc.com/news/uk-51683428.
Huang, Yanzhong. THE SARS EPIDEMIC AND ITS AFTERMATH IN CHINA: A
POLITICAL PERSPECTIVE. In: Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al., editors. Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington (DC): National Academies Press (US); 2004. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92479/
Knobler S, Mahmoud A, Lemon S, et al., editors. Institute of Medicine (US) Forum on Microbial
Threats; Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington (DC): National Academies Press (US); 2004. THE PUBLIC HEALTH RESPONSE TO SARS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92460/
Landler, M. and Castle, S., 2020. Behind The Virus Report That Jarred The U.S. And The U.K.
To Action. [online] nytimes.com. Available at: <https://www.nytimes.com/2020/03/17/world/europe/coronavirus-imperial-college-johnson.html> [Accessed 22 March 2020].
Leonhardt, David. "A Complete List Of Trump’S Attempts To Play Down Coronavirus".
nytimes.com, 2020, \https://www.nytimes.com/2020/03/15/opinion/trump-coronavirus.html.
Li, Ruiyun et al. "Substantial Undocumented Infection Facilitates The Rapid Dissemination Of
Novel Coronavirus (SARS-Cov2)". Science, 2020, p. eabb3221. American Association For The Advancement Of Science (AAAS), doi:10.1126/science.abb3221. Accessed 18 Mar 2020.
Lim, Yvonne Xinyi et al. “Human Coronaviruses: A Review of Virus-Host Interactions.”
Diseases (Basel, Switzerland) vol. 4,3 26. 25 Jul. 2016, doi:10.3390/diseases4030026
Ma, Josephine. "Coronavirus: China’S First Confirmed Covid-19 Case Traced Back To November 17". South China Morning Post, 2020, https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back. Accessed 18 Mar 2020.
Milne-Price, Shauna et al. “The emergence of the Middle East respiratory syndrome
coronavirus.” Pathogens and disease vol. 71,2 (2014): 121-36.
doi:10.1111/2049-632X.12166
Romo, Vanessa. "NPR Choice Page". Npr.Org, 2020, https://www.npr.org/sections/health-shots/2020/02/26/809578063/trump-to-address-response-to-coronavirus.
"SARS (Severe Acute Respiratory Syndrome)". Nhs.Uk, 2019, https://www.nhs.uk/conditions/sars/.
"Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003". World Health Organization. 21 April 2004, https://www.who.int/csr/sars/country/table2004_04_21/en/.
For once, the truth was more devastating than the rumors. This was not influenza, against which we were armed with vaccines, antivirals, acquired immunity, and a century of epidemiological data from three major pandemics and innumerable seasonal outbreaks. There was no medication to treat a coronavirus infection, simply because there had never been a need for one. Further, the lack of historical precedence for a coronavirus outbreak meant epidemiologists were in uncharted territory. At that belated press conference, Chinese authorities maintained that the virus was contained (Huang, 2004). By the time it was actually contained at the end of July, 8096 cases had been reported in 29 different countries and territories across the globe and 774 people had died (“Summary of probable SARS cases”, 2002).
Even today, however, the most striking aspect of the SARS outbreak is not the catastrophically incompetent initial response, but how quickly the blunder was rectified. The world launched an aggressive containment campaign, identifying and isolating the infected, meticulously tracing their contacts, and screening travelers from affected areas for symptoms. Through unprecedented cooperation and transparency, a network of 11 infectious disease laboratories across 9 countries succeeded in identifying the virus, mapping its genome, and developing diagnostic tests for its detection (Knobler, et al, 2004). The results were nothing short of miraculous, and the pandemic concluded with fewer than one thousand deaths. Brian Robertson, who served as a regional director of the World Health Organization during the outbreak, would later write in reflection, “It would be tragic if we did not learn from the experience of 2003 and make the most of it” (Chew, 2007).
It did appear as if we had learned. When coronaviruses made the cross-species jump once again in 2012, the resulting outbreak of Middle East Respiratory Syndrome (MERS) was effectively contained within the Arabian peninsula (Milne-Price, 2014). It was time, it seemed, for coronaviruses to be thrown atop history’s heap of forgotten ailments, once-ferocious monsters tamed and declawed by modern medicine.
Perhaps this string of past successes contributed to the complacency of authorities when yet another novel coronavirus materialized in late 2019, this time in Wuhan, China’s industrial and technological hub. In a befuddling replay of 2003, Chinese authorities censored initial reports of the disease. Government records uncovered by the South China Morning Post trace the earliest known case of COVID-19 to November 17, despite Wuhan officials reporting no cases to the World Health Organization before December 8. More disturbingly, China continued to claim there were only 41 confirmed cases as late as January 11. The new records indicate that there were 381 by January 1 (Ma, 2020). When the international community learned of the impending danger, world leaders brushed it aside in a chorus of false reassurances, wishful thinking, and outright denial. On February 26, as the fifteenth U.S. case was confirmed, President Trump donned his proverbial blindfold and proclaimed the risk posed to the American public to be “very low” (Romo, 2020). British Prime Minister Boris Johnson was similarly unperturbed. On Friday, February 28, he described the outbreak as “the government’s top priority,” before inexplicably waiting until after the weekend to hold an emergency meeting (Gallagher, 2020). In 2003, China’s reckless handling of the SARS outbreak was counterbalanced by impeccably coordinated global containment efforts. In 2020, an ineffectual initial response in Wuhan was followed by an even more inept international response. Between the chauvinistic optimism and indecisive hand wringing of Western leaders, and the misreporting of early cases by China, the virus was granted months of unmitigated spread before serious social distancing measures were implemented. Trump himself best captured the West’s bizarre attitude of congratulatory self-deception during his January 30 speech in Michigan. As the world teetered on the brink of the pandemic, the President declared triumphantly: “We have it very well under control. We have very little problem in this country at this moment — five. And those people are all recuperating successfully” (Leonhardt, 2020). It is difficult not to hear in his words echoes of that fateful press conference seventeen years ago, where Chinese authorities insisted SARS-CoV was contained.
Merely a month after Trump’s speech, the ironically named SARS-CoV-2 has enrobed the planet in death and chaos. As of March 30, there have been over 784,000 confirmed cases of COVID-19 worldwide, resulting in more than 37,000 deaths (“Coronavirus COVID-19 Global Cases", 2020). A team of experts developed a computer model to simulate the course of the outbreak in China, where the outbreak appears to have run its course, and can serve as a tentative microcosm of what we may see globally. Their findings suggest approximately 86% of all cases may never have been detected (Li, 2020). Assuming the outbreak is behaving similarly outside China, the model places the true number of cases well over one million.
This emphatically does not excuse resignation to defeat, nor the belief that the worst has already come to pass. Yes, the current situation is bleak, but forecasts for the coming months verge on apocalyptic. The March 17 report from the COVID-19 response team at Imperial College London projected another 18 or more months of pandemic before a vaccine becomes widely available. It predicted an 81% infection rate in the US assuming no control measures were taken, resulting in 2.2 million deaths (Atchinson, et al., 2020). The paper was widely cited by the media, and is believed to have been responsible for jolting the United States and Great Britain out of their stupor (Landler and Castle, 2020). The same analysis calculated that, if the most stringent intervention strategies possible were adopted immediately, and kept in place until a vaccine became available in 18 months, deaths could be reduced by up to 99 percent. This is not so much a best-case scenario as it is purely speculative fantasy. Even so, the outcome would entail over 200,000 deaths only in the United States. This alone should stifle any remaining grumblings of overreaction from the public and the media. If anything, the world may have underreacted, and underreacted far too late. The staggering rate with which new cases are being confirmed in Italy, despite the two-week-long nationwide lockdown, could indicate that the virus may have already spread far beyond the confirmed numbers, with infections that occurred before the lockdown being diagnosed only now. It may also indicate that the virus is spreading despite the lockdown, which is even more concerning. Should the same trend be observed in other nations under lockdown over the following weeks, harrowingly high death tolls may already be inevitable. The world would do well to err on the side of caution, not only maintaining but escalating intervention. If authorities, driven by economic or popular pressure, gamble by relaxing restrictions, the virus may rebound, transmitting beyond our capacity to diagnose or treat, if it has not already done so.
Even now, however, as we grapple with the greatest threat to public health in over a century, we must look to the future. Not the next few weeks, but the next few decades. The coronavirus has exposed deep inadequacies not only in healthcare systems across the world, but also in governmental planning, foresight, and common sense. We may never see SARS-CoV-3, but when the next outbreak inevitably looms over the horizon the number of lives it claims will be determined by whether we have learned from this one, built trust and transparency among governments, increased capacities of healthcare systems across the world, and mended the counterproductive disjunction between science and political policy. There is no question that the world will look different after COVID-19. Whether it will look better or worse is entirely up to us.
References:
Atchinson, C., Bowman, L., Eaton, J., Imai, N., Redd, R., Pristera, P., Vrinten, C. and Warn, H.,
2020. Report 9: Impact Of Non-Pharmaceutical Interventions (Npis) To Reduce
COVID-19 Mortality And Healthcare Demand. COVID-19 reports. [online] London:
COVID-19 Response Team, Imperial College London. Available at:
<https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news--wuhan-corona
virus/> [Accessed 22 March 2020].
Chew, Suok Kai. “SARS: how a global epidemic was stopped.” Bulletin of the World Health
Organization vol. 85,4 (2007): 324. doi:10.2471/BLT.07.032763
"Coronavirus COVID-19 Global Cases". Johns Hopkins Coronavirus Resource Center, 2020,
https://coronavirus.jhu.edu/map.html. Accessed 30 Mar 2020.
Eckert, Alissa and Higgins, Dan . Severe Acute Respiratory Syndrome Coronavirus 2
(SARS-Cov-2). 2020, https://phil.cdc.gov/Details.aspx?pid=23311. Accessed 31 Mar 2020.
Gallagher, James. "Coronavirus Patient First To Be Infected In UK". BBC News, 2020,
https://www.bbc.com/news/uk-51683428.
Huang, Yanzhong. THE SARS EPIDEMIC AND ITS AFTERMATH IN CHINA: A
POLITICAL PERSPECTIVE. In: Institute of Medicine (US) Forum on Microbial Threats; Knobler S, Mahmoud A, Lemon S, et al., editors. Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington (DC): National Academies Press (US); 2004. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92479/
Knobler S, Mahmoud A, Lemon S, et al., editors. Institute of Medicine (US) Forum on Microbial
Threats; Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary. Washington (DC): National Academies Press (US); 2004. THE PUBLIC HEALTH RESPONSE TO SARS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK92460/
Landler, M. and Castle, S., 2020. Behind The Virus Report That Jarred The U.S. And The U.K.
To Action. [online] nytimes.com. Available at: <https://www.nytimes.com/2020/03/17/world/europe/coronavirus-imperial-college-johnson.html> [Accessed 22 March 2020].
Leonhardt, David. "A Complete List Of Trump’S Attempts To Play Down Coronavirus".
nytimes.com, 2020, \https://www.nytimes.com/2020/03/15/opinion/trump-coronavirus.html.
Li, Ruiyun et al. "Substantial Undocumented Infection Facilitates The Rapid Dissemination Of
Novel Coronavirus (SARS-Cov2)". Science, 2020, p. eabb3221. American Association For The Advancement Of Science (AAAS), doi:10.1126/science.abb3221. Accessed 18 Mar 2020.
Lim, Yvonne Xinyi et al. “Human Coronaviruses: A Review of Virus-Host Interactions.”
Diseases (Basel, Switzerland) vol. 4,3 26. 25 Jul. 2016, doi:10.3390/diseases4030026
Ma, Josephine. "Coronavirus: China’S First Confirmed Covid-19 Case Traced Back To November 17". South China Morning Post, 2020, https://www.scmp.com/news/china/society/article/3074991/coronavirus-chinas-first-confirmed-covid-19-case-traced-back. Accessed 18 Mar 2020.
Milne-Price, Shauna et al. “The emergence of the Middle East respiratory syndrome
coronavirus.” Pathogens and disease vol. 71,2 (2014): 121-36.
doi:10.1111/2049-632X.12166
Romo, Vanessa. "NPR Choice Page". Npr.Org, 2020, https://www.npr.org/sections/health-shots/2020/02/26/809578063/trump-to-address-response-to-coronavirus.
"SARS (Severe Acute Respiratory Syndrome)". Nhs.Uk, 2019, https://www.nhs.uk/conditions/sars/.
"Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003". World Health Organization. 21 April 2004, https://www.who.int/csr/sars/country/table2004_04_21/en/.
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