Can the
Virus Be Stopped?
The Global
Effort to Contain Covid-19
Epidemiologists
and doctors around the world are doing all they can to slow the spread of the
new coronavirus. But new hotspots continue to pop up, indicating that it may
already be too late.
24.02.2020,
18:40 Uhr
By Matthias
Bartsch, Uwe Buse, Lukas Eberle, Georg Fahrion, Jan Friedmann, Johann Grolle,
Veronika Hackenbroch, Marc Hujer, Martin U. Müller, Fritz Schaap
It was a
knock at the door on day 10 of the quarantine that had Jerri and Mark Jorgensen
fearing that it may now be their turn to changes sides -- from the healthy
passengers of the Diamond Princess to those who were infected and sick. To
those who had been separated from their spouses and families and sent to
hospitals in and around Yokohama. To those left to hope that their experience
with the new coronavirus would not be severe.
The
knocking was not a good omen.
Three days
earlier, two Japanese, a man and a woman, had entered the married couple’s
cabin. They were wearing protective suits, face masks and gloves and they took
samples from the throats of the two Jorgensens before disappearing again. They
didn’t speak much: The visitors seemed to know about as much English as the
Jorgensens could speak Japanese.
The two
Americans from the U.S. state of Utah were naturally concerned about what their
test results would reveal. Jerri Jorgensen had been feeling unwell for a few
days, but she kept trying to tell herself that it was nothing. At least nothing
connected to the strange, new virus.
She was
more concerned about her husband. Mark Jorgensen was feeling fine, but he had
two transplanted kidneys and had been taking medication since the operation to
suppress his immune system so that his body wouldn’t reject the new organs.
Jerri and Mark were both fully aware that a coronavirus infection could prove deadly
for him.
The
Jorgensens opened the door, and again found themselves facing two people
covered head-to-toe in protective clothing. They were bearing bad news: Jerri’s
test had come back positive.
She would
like to have been given time to pack a small bag, but the two health workers
told her she could not. She was only permitted to take along a daypack with the
essentials. And a short time later, Jerri Jorgensen was on her way to the
quarantine, a hospital in Fukushima. Her husband stayed behind all alone in the
cabin.
Mark
Jorgensen found himself wondering: If the virus had spent three days
multiplying in his wife’s throat, how great was the danger that he was now
infected as well?
The ease
with which the novel coronavirus SARS-CoV-2 was able to spread throughout the
cruise ship Diamond Princess triggered global concern. One day, there were 99
new infections discovered on board, on another it was 88, and on still another,
79 new patients were identified. Ultimately, almost a third of the 3,700 passengers
and crew had tested positive for the virus during the 14-day quarantine.
Two of the
passengers have since died from the lung infection triggered by the virus. And
it is quite possible that additional infections have been discovered among the
passengers, who have now been allowed to return home, where they can expect
another two weeks of quarantine.
Many Open
Questions
But how was
it allowed to happen? Was it because important quarantine and hygiene rules
were disregarded aboard the ship, as the Japanese epidemiologist Kentaro Iwata,
from the Center of Infectious Diseases at Kobe University, suspects? Or was the
ship’s ventilation system to blame? Either way, the infected passengers and the
two who have died were victims of a quarantine that was imposed for their
protection but maintained to their detriment. There are a lot of open
questions.
What is
clear, however, is that wherever large numbers of people are in close quarters
– on cruise ships, in hospitals, in prisons, on buses and subways, in open-plan
office spaces and at festivals and trade shows – the virus is presented with
ideal conditions to spread. It looks as though SARS-CoV-2 has no trouble
jumping from person to person.
As a
result, it appears that a pandemic has become almost unavoidable. Increasing
numbers of experts are beginning to wonder whether the global spread of the
virus can still be stopped, and the sudden uptick of cases in Italy has
underlined that concern. "There are many scenarios imaginable for a
worldwide spread,” says Marc Lipsitch, an epidemiologist at Harvard University.
He is, however, prepared to make one prediction: "The assertions that by
April everything will be over, are not true.”
There is
some cause for some optimism though: The warmer seasons are slowly approaching,
and it could very well be that the virus will loosen its grip, similarly to how
most flu and cold pathogens behave. Furthermore, the number of new infections
reported each day by China is dropping. The problem, though, is that nobody
knows if those numbers can be trusted.
The news
from the sealed off province of Hubei, which is primarily disseminated via
social media channels, continues to be horrifying. Most of the 2,000 deaths
thus far caused by the virus have occurred in the provincial capital of Wuhan.
And it is particularly concerning how many health-care workers have become
infected. Some 3,000 of them have tested positive for the virus across China.
Sports
arenas, hotels and cultural centers have all been transformed into quarantine
stations where the infected are interned. The Chinese government has sent
several thousand soldiers to Wuhan in addition to an army of nurses. One widely
shared video shows some women having their long hair shaved off before being
pressed into service – symbolic of the fact that just like members of the
military, soldiers in the fight against the virus in Wuhan must sacrifice their
individuality.
The city,
with a population of 11 million, is involved in nothing less than a war against
the epidemic, a war declared by no less a personage than Chinese President Xi
Jinping. Those who have become infected may no longer be cared for by family
members at home. Everyone is required to report suspected cases. Functionaries
have been tasked with finding all those who have bought cough or fever medicine
in the last several weeks.
Myriad
provisions and decrees have been imposed across China as all levels of
bureaucracy seek to prove their assiduousness. They are all united by fear: In
late January, Xi threatened that all those who did not fulfill their obligation
in the battle against the disease would be punished. He also warned that the
economy cannot be made to suffer for an extended period.
According
to the official numbers, the mixture of fear, sacrifice, surveillance and
rigorous quarantining is having some effect. After weeks of paralysis, public
life in many parts of China is also returning to something approaching normal.
Social media users have begun posting their relief at once again seeing traffic
jams on city streets.
The Beijing
leadership is also displaying growing self-confidence in the fight against the
disease. Just over a week ago, the party periodical Quishi published a speech
by Xi in which he praised his own leadership in the fight against the
coronavirus. The word "I” appears 13 times in the speech, a sign that the
president is optimistic and is no longer concerned about having to take
personal responsibility for the spread of the disease.
Bad News
from the Front Lines
It is
precisely that optimism, however, that has triggered concern in the
international community of disease experts. It seems doubtful, after all,
whether a leader posing as the savior of his country would be willing to accept
bad news from the front lines.
Because the
data from China cannot be trusted, experts are left to wait and see where the
virus pops up next. Cities in East and Southeast Asia are particularly at risk,
believes Andrew Tatem from the University of Southampton in England. Using
international traffic patterns, he and his team assembled a ranking of cities
where the risk of a coronavirus outbreak is greatest. Bangkok, Hong Kong,
Taipei, Seoul, Tokyo and Singapore are at the very top. The first German city
on the list is Frankfurt, way down in 28th place.
Experts
have, in fact, been focusing most of their attentions on countries in the Far
East, apparently with good reason. Last Thursday, it was announced that more
than 100 new cases were found in a single church in the South Korean city of
Daegu, located three hours south of the capital Seoul. "We are involved in
an unprecedented crisis,” said the mayor of the city, which has a population of
2.5 million. The streets quickly emptied out and one 28-year-old resident told
the news agency Reuters: "It looks like someone dropped a bomb in the
middle of the city. It looks like a zombie apocalypse.” On Sunday, South Korea
announced that 556 cases had been identified.
"The
assertions that by April everything will be over, are not true.”
Marc
Lipsitch, epidemiologist at Harvard University
In Japan,
the health minister said the country was entering a "new phase” in the
spread of the virus. For the first time, the country has identified cases in
which officials were unable to determine where the infection had taken place.
But in
Italy, too, the situation seems to be getting out of hand. On Monday, Italy
reported that six people have now died of the disease and the number of
infected people has risen to more than 200, most of them in the northern
regions of Veneto and Lombardy. On Sunday, the government made the decision to
seal off several municipalities in northern Italy. None of those who initially
tested positive had been in China recently.
For
epidemiologists, such a transmission is considered a key moment -- if the path
of the virus can no longer be followed, then are hardly any effective measures
available to block its spread.
Once that
stage is reached, experts fear, it doesn’t take long before the pathogen will
find its way into countries where the health-care system is not prepared to
handle an epidemic. The concern was therefore significant when Iran reported
last Wednesday that two people had died from Covid-19 in the city of Qom. None
of the two had recently traveled abroad and contact to Chinese tourists could
also not be found. According to news reports, the situation has only worsened
since then, with the number of officially reported deaths in the country having
risen to 12.
Such a
rapid climb in the number of cases is exactly the kind of scenario that Michel
Yao is afraid of. In the World Health Organization regional headquarters in
Brazzaville, the capital of the Republic of Congo, he is responsible for
emergency coordination in a region that is widely considered to be the Achilles
heel when it comes to the global response to epidemics. The region encompasses
47 African countries and it's his job to develop strategies the prevent or slow
the spread of epidemics there.
Developing
Criteria for Hospitals
"Coronavirus
could become a huge challenge here,” Yao says. Health-care systems are weak in
the region, he says, and they could easily be overwhelmed. Just 100 sudden
cases, he says, would be enough.
The day
before we spoke to Yao last week, the alarm had been sounded in Sierra Leone,
with 29 travelers from China stuck in the airport. Two of them were suffering
from a fever. There were other suspicious cases in Burkina Faso, Kenya and
Equatorial Guinea. "We are expecting the first confirmed case at any
time,” Yao said.
Many
experts believe that the virus has long since found its way into central and
southern Africa, and Yao says he can’t rule it out. "It is a new virus and
we don’t know how it behaves here.”
And then,
he has to go. He has more on his plate than just coronavirus, after all. He
must also address outbreaks of Lassa fever, measles and Ebola.
About 6,000
kilometers to the north, Christian Drosten is sitting at his giant,
note-covered desk drinking tea on a recent Friday. A tall man with dark, curly
hair, Drosten is director of the Institute of Virology at Berlin’s Charité and
had cancelled all appointments that day to finally write the scientific paper
that many experts around the world had been waiting for. The focus was on how
long Covid-19 patients remain infectious and when they can be released from
hospital without posing a danger to others.
Virus
measurements in discharge and stool samples provided Drosten with the
definitive clues. On the basis of those measurements, he says, he was able to
develop clear criteria for hospitals, which is vital for the clinical treatment
of any disease outbreak. "If the virus spreads around the world, we will
have to free up beds as fast as possible,” Drosten says.
Virologist
Christian Drosten: "I was immediately thinking: SARS.”
Virologist
Christian Drosten: "I was immediately thinking: SARS.” PAUL LOVIS WAGNER /
DER SPIEGEL
Drosten
grew up on a farm near the border with the Netherlands and became interested in
medicine during his mandatory civil service. He realized before long that he
wasn’t cut out for working in the intensive care unit and ultimately decided to
work in the lab as a virologist.
He became
famous overnight in 2003 when he was able to identify the SARS virus more
quickly than the U.S. authorities. He is now seen as a leading coronavirus
expert and a specialist when it comes to analyzing samples.
The two
monitors on his desk display patient data on which his arguments rest.
"Unfortunately,” he says, "I am constantly distracted by emails.” He
is receiving around 300 of them a day at the moment, "and about 100 of
them need to be answered that same day.”
Positive or
Negative
Ever since
it became known in January that the new lung infection from Wuhan was caused by
a coronavirus, Drosten has been working long hours, with barely enough time in
the morning to take his son to daycare. His goal is that of learning as much as
possible about the virus, which can only be seen with an electron microscope -
and he hopes to do so before the pathogen has spread around the world. Only if
doctors know their opponent, after all, can they prescribe the correct treatment.
One of the
next projects that Drosten intends to embark on is the development of a test
for the virus which can, similar to a pregnancy test, identify the illness
immediately, positive or negative. One of the problems facing medical
professionals at the moment is that many of those infected show only very mild
symptoms or none at all. Without a quick test to identify the pathogen’s
presence, controlling and monitoring its spread is virtually impossible.
"Such a test could, for example, be used in rural areas of Africa,”
Drosten says. "But also in totally normal family practices and emergency
rooms.”
Every virus
has its own modus operandi, says Drosten, and that of the Covid-19 pathogen was
initially misidentified by him and by many other scientists around the world.
"I was immediately thinking: SARS.” The new virus and the SARS pathogen,
after all, belong to the same family of viruses.
"If
the virus spreads around the world, we will have to free up beds as fast as
possible"
Christian
Drosten, director of the Institute of Virology at the Charité Hospital in
Berlin
But then,
Drosten and his team made a discovery that completely changed the prevailing
view of the virus. In contrast to the SARS virus, the Covid-19 pathogen can be
isolated in the throats of patients, and not just in their lungs. That could
explain why it is much more contagious than SARS, but also much less dangerous.
Drosten and
his colleagues are focused on comparing the two pathogens on a molecular level.
Both of them are currently in storage at minus 80 degrees Celsius in the
so-called S3 Laboratory of the Institute of Virology in Berlin. The security
precautions are tight, exceeded only by those surrounding super-dangerous
pathogens such as the Ebola virus.
Marcel
Müller, who heads up the laboratory, briefly has a look at a display that
monitors the negative air pressure inside the laboratory, a measure to ensure
that air can go in, but never out. He then opens a heavy door with a large,
circular window leading to the lab’s airlock entry before donning his
protective clothing: two pairs of blue gloves, yellow rubber boots, a green
micro-fiber protective suit, waterproof arm coverings and, at the very end, a
gray mask with a visor that covers his entire head.
Müller’s
task for the day is contaminating a cell culture with Drosten’s old SARS virus
so the pathogen can multiply and provide sufficient viral material for
experiments to be conducted later. It is astounding, says Müller, how
unreliable it is to draw conclusions about a virus’s behavior on the basis of
its genome. That is why it is important to not just compare the genome of the
novel coronavirus with that of the SARS virus, but to compare the two pathogens
to themselves as well.
The journal
Science just published a paper about the most important surface protein of the
pathogen that causes Covid-19. According to the team behind the paper, the
protein binds much more strongly to human cells than the comparable protein
from the SARS pathogen. That could be an additional explanation for why the
novel coronavirus is so much more contagious than SARS.
No Panic
Müller and
Drosten now want to find out why SARS-CoV-2, as the new coronavirus pathogen is
called, is able to multiply in the throats of patients, in contrast to the old
SARS pathogen. On that search, Müller uses a pipette to introduce virus samples
into a bottle inside of which a cell culture is growing in a reddish nutrient
solution. He then places the culture in an incubator. Within a few days, the
virus will have multiplied significantly and triggered many cells to burst,
with holes visible in the cell layer when looked at under a microscope.
Such cell
cultures, says Müller, will also be used to test drugs targeting the new virus.
Many of the drugs already proved a certain amount of effectiveness in the
battle against the SARS virus. Now, they could become an important weapon
should the new coronavirus develop into a pandemic.
It likely
won’t be long until the global alarm over Covid-19 reaches Germany as well, and
health officials in all German states are currently making preparations.
Strangely, though, it seems almost as though the mood has grown increasingly
placid the closer the virus comes.
Frankfurt
is considered to be particularly exposed, with the international airport seen
as a potential viral gateway. Local health authorities estimate that several
thousand passengers land in Frankfurt everyday who could theoretically have
come into contact with people infected with Covid-19. It seems unavoidable that
one of them will eventually bring the virus into Germany.
In
response, all passengers arriving from at-risk regions have had to fill out a
questionnaire, in a precaution introduced last week. Those who say they had
contact with someone infected are isolated in the plane and then examined by a
doctor upon arrival in Frankfurt. If the doctor believes the suspicion of
infection is credible, the passenger is then tested at the university clinic. Nobody,
though, believes that the procedure offers much in the way of reliable
protection. Not a single Lufthansa passenger has yet responded "yes” to
the relevant question. Other airlines report that some passengers have, in
fact, answered in the affirmative, but it later turned out that they only did
so because they had misunderstood the question.
The
airport’s ability to respond to the disease was put on full display in
mid-January, when almost 130 Germans flew in after being evacuated from Wuhan.
A medical center was quickly set up so that people could be examined – and two
of them were even found to be carrying the disease. But in both cases, the
disease proved unharmful, and one of them didn’t end up having any symptoms at
all.
Indeed, the
new virus is fortunately not at all like the aggressive SARS pathogen, says
infectious disease specialist Antoni Walczok from the Frankfurt Health Office.
When it comes to how the illness is likely to progress, he says he is reminded
more of the swine flu pandemic in 2009.
A Certain
Amount of Optimism
Many of the
emergency plans developed back then have been pulled back out of the drawer,
including options for the cancellation of public events, school closures and
the reduction of public transportation. Still, Walczok says, it took months
before sporadic isolated cases ultimately became a larger outbreak.
Walczok,
though, still doesn’t think that such measures will become necessary this time.
Schools and kindergartens, for example, could likely remain open even should
the illness spread through Germany: Thus far, it appears that children only
rarely come down with Covid-19.
Nobody in
Germany has accumulated as much experience with the new virus thus far as the
Bavarians. In late January, 14 people connected to the auto supplies company
Webasto in Stockdorf, just southeast of Munich, became infected with
SARS-CoV-2. And here, too, the experience with the virus has led to a certain
amount of optimism.
"The
disease was quite mild,” says Clemens Wendtner, who was chief physician at the
Munich clinic that treated nine of the patients. Wendtner and his team
monitored the patients’ flu-like symptoms and dry coughs. Some of the patients
reported difficulties smelling and tasting their food.
The
strategy of admitting infected patients while home-quarantining those with whom
they had been in close contact worked, says Wendtner. "Hardly any
infections were imported,” he says. And hardly anyone else was infected by the
patients. He says he didn’t even need to make use of his clinic’s quarantine
station. "I currently believe that we won’t experience a large corona wave
in the country,” Wendtner says.
"I
currently believe that we won’t experience a large corona wave in the
country."
Clemens
Wendtner, chief physician at a clinic in Munich
Such
experiences could be a reason why precautionary measures in North
Rhine-Westphalia, Germany’s most populous state, have been anything but
draconian. As of late last week, four people had been classified as
"Category I Contact Persons” and were being monitored. The four of them
were among the 57 Germans who had sailed with the cruise ship Westerdam.
Passengers of the ship had been allowed to disembark in Cambodia, after the
shipping company had said the ship was not infected with Covid-19. Only after
many had already left was it made public that an 83-year-old American woman had
tested positive for the disease.
Four of the
ship’s passengers have now returned to their homes in North Rhine-Westphalia,
but they were not subjected to strict quarantines as were those who had
returned from Wuhan. Health officials felt that just keeping them in their
homes would be sufficient. They have been asked, however, to take their
temperatures twice a day and to keep a journal about how they feel and with
whom they have contact. Food is being brought to them by a delivery service.
A week ago
on Saturday, American officials with the Centers for Disease Control then
announced that there actually was no infection: The test of the 83-year-old
woman had actually produced a negative result, a spokesperson said.
The world
is essentially in a holding pattern. The SARS-CoV-2 virus is in the process of
circling the globe, and yet many questions remain unanswered. Perhaps too many.
Indeed, the
lack of knowledge about the pathogen remains the most serious of the
challenges. For as long as medical experts, health officials and political
representatives don’t know all they need to know about the virus, they will
continue to make disastrous mistakes.
Such as
those made aboard the Diamond Princess.
Two days
after Jerri Jorgensen was led out of the cabin she shared with her husband and
brought to the hospital in Fukushima, her husband and all other U.S. citizens
from Diamond Princess were evacuated. Buses brought them to the Haneda airport
and Mark Jorgensen was flown to California seated in the hastily repurposed
cabin of a cargo plane.
He is now
in a second quarantine - a three-room apartment at Travis Air Force Base just
outside of San Francisco. He is doing his best to keep his sense of humor,
referring to his new lodgings as his "bachelor pad.” Thus far, he has
shown no symptoms. But he won’t know for sure whether he is carrying the
disease inside until the 14-day incubation period has passed.
His wife in
Fukushima, meanwhile, is no longer showing any symptoms. She merely complains
of the food and that she has no internet. The two Jorgensens are forced to
remain in touch over the phone, and they talk daily. And they are forced to
wait. Just like the rest of us.
Sem comentários:
Enviar um comentário