The coronavirus conundrum: To contain or carry on?

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The coronavirus conundrum: To contain or carry on?

Coronavirus looks unstoppable. But it’s deadly for only a small percentage of patients.

By SARAH WHEATON 2/28/20, 3:08 PM CET Updated 2/29/20, 7:39 AM CET

Coronavirus is likely coming to a respiratory tract near you. This could turn out to be a catastrophe — or an inconvenience.

The coronavirus outbreak reached a turning point this week after two straight days in which reported new cases outside China exceeded those originating from the epicenter. “Our greatest concern,” said World Health Organization boss Tedros Adhanom Ghebreyesus on Thursday, is “what’s happening in the rest of the world.”

The world’s top public health authorities insist the virus can still be contained with diligent bouts of expert whack-a-mole. But political leaders are increasingly talking about an inevitable pandemic.

The growing realization that the highly contagious virus comes with few symptoms for most is creating an uncomfortable question: Do we pull out all stops to contain it — saving lives but crippling the economy — or accept this as Flu 2.0, a winter cold that irritates many but kills only a few, mainly the old and the weak?

In a speech meant to reassure the American public, U.S. President Donald Trump repeatedly expressed awe at the U.S. death toll from the regular old flu: 25,000 to 69,000 a year.

“Now it's beginning to become clear that maybe up to 80 or 85 percent of infections are very mild, like the common cold” — David Heymann, epidemiologist

“It was shocking to me,” Trump said.

Flu kills up to 650,000 people each year worldwide. Yet this annual scourge prompts none of the disruption of coronavirus. Along with more than 2,800 COVID-19 deaths as of Friday morning, fears about coronavirus have frozen a Chinese province of nearly 60 million; caused a historic stock market slide; and canceled carnival festivities from Brazil to Greece — and the hajj could be next.

“This virus is not influenza,” Tedros told reporters Thursday. “With the right measures, it can be contained.”

But there are increasing signs those measures are failing. German Health Minister Jens Spahn warned of an epidemic on Wednesday when he acknowledged that his country has lost track of how people got infected — making it impossible to curtail the spread with quarantines. A woman in the U.S. state of California who had no close contact with people who’d traveled abroad was diagnosed on Wednesday. In Italy, which is coping with one of the world's largest outbreaks outside China along with Iran and South Korea, officials still haven’t traced the “patient 0.”

“The risk of a global pandemic is very much upon us,” said Australian Prime Minister Scott Morrison on Thursday. French President Emmanuel Macron warned a “crisis” is coming.

Trump, by contrast, insisted the virus’ spread is “not inevitable.” But he was contradicting an official from the U.S. Centers for Disease Control and Prevention, who said a day earlier that it’s not a question of if but when — and of how many people will have severe symptoms.

And despite Tedros’ reassurance that the virus can be contained, his top aides are also more skeptical.

Over the next two to six months, it could “settle down [to] an endemic pattern of transmission, into a seasonal pattern of transmission or could accelerate into a full-blown global pandemic,” the WHO’s emergencies chief, Mike Ryan, said Monday. “At this point it is not possible to say which of those realities is going to happen.”

Evolving understanding

While COVID-19 isn’t the flu, authorities have been relieved to discover that it’s also not the 2003 infection known as SARS, which killed about one in 10 people who caught it.

The initial perceptions of the new coronavirus’s lethality were “skewed, because initially all that was reported were serious infections,” said David Heymann, an epidemiologist who headed the global response to SARS in 2003, now at U.K.’s Chatham House think tank.

“Now it's beginning to become clear that maybe up to 80 or 85 percent of infections are very mild, like the common cold,” he added.

While those who end up in hospital can have serious complications, including needing a ventilator to help breathing, most people recover. Current estimates peg the mortality rate at 1 or 2 percent, predominantly among people aged over 80 and those with other medical conditions.

The fact that people may have minimal, if any, symptoms from coronavirus is what’s making it so hard to track.

“In the early stages we try containment. We see how much we can do to tamp it down,” said Tom Frieden, a former U.S. CDC head who oversaw the 2014 Ebola response, in an interview with POLITICO.

When it starts spreading too widely to contain, “then you make a decision based on risks and benefits — how deadly is it, how does it spread?” he added. “Then you have to make a call, which will be different for different places.”

Indeed, countries are making wildly different calls.

For example, Israel’s government, in a bid to stave off an outbreak beyond two likely cases, called on people to avoid travel abroad and to skip international conferences — even those held in Israel. Saudi Arabia is barring travel to Islamic holy sites, just months ahead of the annual hajj pilgrimage.

Iran, with a reported 388 cases, is closing schools, and at least seven government officials are sick — including a vice president. Japanese Prime Minister Shinzō Abe announced schools across the country are out until April as cases topped 200 on Thursday.

By contrast, EU countries’ health chiefs, even those from countries bordering Italy, have rejected closing the bloc’s open borders, saying that would be “disproportionate and ineffective” — a point underscored by the fact that Italy was one of two EU countries to bar flights to and from China.

For his part, Italian Foreign Minister Luigi Di Maio made a pitch to fearful visitors: “If our children go to school, it’s safe for international tourists to come visit Italy.”

While a few towns in northern Italy are on lockdown, that region holds just 0.01 percent of the population, Di Maio noted, speaking to foreign reporters Thursday.

Global economy on the brink

China’s outbreak has peaked and is now in decline, according to the WHO. But the result was achieved with methods critics call repressive, locking down nearly 60 million people in Hubei province with potential damage to their physical and mental health.

Beyond the human rights violations, shutdowns in China — and travel restrictions imposed elsewhere — are hitting the global economy hard. The U.S. stock market is wrapping up its worst week since the 2008 financial crisis. Tech producers like Microsoft and Apple are warning about supply chain problems — and so are producers of inexpensive, essential drugs with ingredients made predominantly by China.

“I’m not a health [policy expert], but I’m wondering if there’s a proportion between a health risk and the certainty of destroying Lombardy’s and Veneto’s economies”  — Gianfranco Zoppas, entrepreneur

And an all-out health system response to one epidemic can pose problems for others. During the Ebola outbreak, Heymann noted, deaths from measles and malaria surpassed those from the hemorrhagic fever because health workers couldn’t give vaccinations, and access to other health services was curtailed. In China, expectant mothers in the epicenter are afraid to go to the hospital, the South China Morning Post reports, and residents are struggling to get other medicines.

“Maintaining [open health services] has to be weighed with the cost of quarantining and doing other activities,” Heymann said.

Bristling under pressure

Financially and politically, governments are feeling both the heat of the outbreak and the efforts to contain it.

Trump’s aides worry the coronavirus could be a sort of “black swan” fluke that ruins his reelection chances in November. On Wednesday, he claimed that the most recent debate among potential Democratic challengers — not the growing contagion — prompted the stock market crash after it hit epic highs just weeks earlier.

In Italy, businesses are already starting to lose patience with the warnings and quarantines.

“I’m not a health [policy expert], but I’m wondering if there’s a proportion between a health risk and the certainty of destroying Lombardy’s and Veneto’s economies,” said Gianfranco Zoppas, a prominent local entrepreneur who employs over 10,000 people. In an interview with La Stampa, he called for an end to “draconian” measures.

Rather than treating coronavirus like the flu — and conceding the deaths of thousands of mostly elderly people each year — it should be the other way around, said Margaret P. Battin, author of “The Patient as Victim and Vector: Ethics and Infectious Disease.”

“We should worry about the regular flu and other circulating pandemic conditions more,” said Battin, a University of Utah philosophy and medical ethics professor. “The fact that we can get so exercised about this should suggest to us that we should get more exercised about that," such as intensifying the search for a universal flu vaccine, she added.

China, however, looks to be inching back toward normal operations. There’s not much chance of the threat really going away until there’s a vaccine — likely more than a year away, according to Bruce Aylward, the Canadian epidemiologist who recently wrapped up the WHO’s observation of the Chinese response. But the country is slowly starting to turn the lights back on in schools and factories, a “phased restart.”

“It is a risk,” Aylward told reporters, “but people have got to work.”