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Thursday, January 30, 2020
The Coronavirus - 1918 all over again?
We are no better prepared than we were for the great influenza pandemic of 1918
By Jane Orient
Doctors for Disaster Preparedness
of a dozen or so deaths may get nonstop “if-it-bleeds-it-leads” press
coverage. But the lack of preparedness for the really, really big
threats may be met with virtual radio silence – until panic breaks out.
The worst, possibly existential, threat is the stealthy, invisible one
that multiplies exponentially – in the accurate sense of the term: 400
cases today, 800 tomorrow, then 1,600, 3,200, 6,400, 128,000, 256,000,
512,000, and 1.024 million after only eight doubling times. Biological
threats proliferate – until they run out of susceptible victims.
1918, the great influenza pandemic killed as many people in 11 months
as the medieval Black Death did in four years. Ultimately, at least 50
million may have perished. Young healthy people, especially young
American soldiers headed off to the front in the First World War,
succumbed quickly. To avoid interfering with the war effort, the U.S.
government denied and covered up the threat, preventing the
implementation of public health measures.
Since then, the world has gotten smaller. A virus that jumps the species barrier
from animals to humans in a meat market in China can cross the Pacific
in hours. And despite the expenditure of US$80 billion on a National
Biologic Defense, the U.S. is arguably no better prepared than it was in
1918, state Steven Hatfill, M.D., and coauthors in their new book Three Seconds until Midnight.
in 1918, we lack a vaccine or wonder drugs, but must rely on
non-pharmaceutical interventions (NPI), and on public health authorities
to track and try to contain the spread of infection.
information is critical. Can we trust governmental authorities to tell
the truth? Travel restrictions, quarantine, closing businesses, and
cancelling public events have a huge economic and potential political
There can also be incentives to exaggerate the threat, in order to sell poorly tested vaccines or drugs. The 1976 swine flu epidemic was almost a non-event; more people were probably injured or even died from adverse effects of the heavily promoted vaccine.
World Health Organization (WHO) has so far declined to declare the
coronavirus outbreak a global emergency, although cases have been
reported in more than a dozen or so countries. China reported only
hundreds of “confirmed” cases – while countless additional cases were
not tested because of lack of diagnostic test kits.
The New England Journal of Medicine writes,
“Another Decade, Another Coronavirus.” This 2019-nCoV virus is the
third zoonotic (animal) coronavirus to infect humans in two decades. The
SARS (severe acute respiratory syndrome) and MERS (Middle East
respiratory syndrome) were contained. Other coronaviruses cause mild
virus has occasioned the quarantine of entire cities, for the first
time since medieval times. This could not be done other than in
authoritarian China, states virologist Steven Hatfill, but even that is unlikely to be effective – especially if five million people had left before the order was implemented.
A report of 41 hospitalized patients in Wuhan, published in The Lancet,
showed that patients were relatively young (median age 49) and fewer
than half had an underlying illness. Only 66 per cent had been exposed
to the Huanan seafood market, the apparent source of the infection. One
patient (two per cent) had no fever; all had pneumonia; 29 per cent had
severe respiratory distress syndrome; and 12 per cent had acute cardiac
injury. Most cases may be very mild, facilitating more rapid spread.
coronavirus is transmitted by droplets coming into contact with mucous
membranes, including the eye. It can persist on surfaces for days.
People without fever or symptoms can transmit the illness during the
incubation period, which might be as long as two weeks. At present,
definitive diagnostic testing is available only from the U.S. Centers for Disease Control and Prevention (CDC).
a severe outbreak, people whose job is not critical may need to stay
home. Those who do not have a supply of food, essential medications, or
other needed supplies would likely end up in a frantic crowd. Personal
protective gear, for people who need to be in contact with the public or
care for a sick family member, is already out of stock in medical
supply houses. This includes gloves, wrap-around eye protection, and
N-95 protective masks: regular surgical masks are probably of little
is never helpful; staying calm is always good advice. But failure to
heed previous warnings of the need for robust disaster planning, and
complacency about medical technology and governmental resources, has set
the stage for potential unprecedented disaster.
need to recognize that they themselves, and not 911 or the emergency
room or government emergency authorities, may hold the key to their
family’s and their community’s survival. Local authorities need to know
that they may be on their own.
now, stock up on supplies; cover those coughs and sneezes; wash hands
frequently for at least 20 seconds; avoid crowds; and stay aware, as the
situation could change rapidly.