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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.”
