Coronavirus disease versus the fluAccording to the Johns Hopkins Medicine web site, as of February 6, 2020, the Coronavirus disease has caused 2, 810 deaths worldwide. In comparison, the flu kills between 291,000 and 646,00 people every year. Why has the Coronavirus gotten so much attention? According to Dr. Bonnie Henry, a BC Health Inspector, the objective is to contain the virus. In theory, once it has nowhere to spread, it will be restricted to the animal population from which it first emerged.
"The Truth about PHEICs" (Public Health Emergency of International Concern)Containment is a nice idea, but it has become obvious that containment and quarantine haven't been working and generally don't work. In an opinion piece on the Ebola crisis, entitled "The Truth about PHEICs," Professor Emeritus Johan Giesecke, writing on behalf of the WHO [World Health Organization] Strategic and Technical Advisory Group for Infectious Hazards, observes that the "declaration of a PHEIC for the current Ebola outbreak would add no clear benefit [. . . .]." Giesecke points out that "The public health community must recognize the close link between disease and trade [. . .]." Although "WHO director-general Margaret Chan advised against imposing travel restrictions on Western Africa, saying they would worsen the crisis by keeping medical experts out of impacted areas," the Ebola crisis eventually became one of the five instances in which the WHO issued a PHEIC.
Why did the WHO issue a PHEIC for the Coronavirus?Part of the reason Coronovirus has received so much attention is that the WHO has issued a PHEIC. Given the predictable (predicted?) economic impact and the relative inefficacy of PHEICs, why did the WHO issue it? According to WHO regulations, a PHEIC is
“an extraordinary event which is determined, as provided in these Regulations:Diseases, in particular viruses, rarely respect national borders and the seriousness of Coronavirus relative to the flu and other viruses is in question. What remains as an explanation for the issue of a PHEIC and perhaps the global panic which has ensued is that the disease is "unusual or unexpected."
to constitute a public health risk to other States through the international spread of disease; and to potentially require a coordinated international response”. This definition implies a situation that: is serious, unusual or unexpected; carries implications for public health beyond the affected State’s national border; and may require immediate international action.
The "Perfect storm"For the news media, bad news is always good news. A disease that is "unusual or unexpected" is motivation both for the WHO and the media. Additionally, the virus offered another opportunity for China-bashing in Western media. Sometimes conspiracy theories are just irresistible: Anyone with advanced knowledge of the WHO's intention to declare a PHEIC would have made a fortune by shorting the stock market.
Comparing SARS-CoV-2 and HIV-1M-AIDSLike HIV ( Human Immunodeficiency Virus), the Coronavirus has numerous strains. Of the eight strains of HIV, HIV-1M is responsible for the AIDS (Acquired Immune Deficiency Syndrome) pandemic. Of the five strains of Coronavirus, most create symptoms of a common cold. CoV-2 causes the SARS (severe acute respiratory syndrome) now threatening the world. (Why the WHO decided to call the disease COVID-19 remains a bit of a mystery.) Like HIV which was transmitted from animals (monkeys, therefore, SIV; that is, Simian Immunodeficiency Virus), the Coronavirus virus responsible for "Covid-19" is believed to have begun in a fish market in China. For some time, HIV-AIDs was thought to have started in 1980 with a flight attendant from Quebec but, as Jacques Pepin establishes in The Origin of Aids, the fatal virus first entered the human population in Africa in the early 1920s. CoV-2 is currently assumed to have begun in China in December 2019, but we may eventually establish a new origin and chronology.
This Year 40 to 70% of the world will be infected with Coronavirus-2Harvard epidemiology professor Marc Lipsitch predicts that "within the coming year, some 40 to 70 percent of people around the world will be infected with the virus that causes COVID-19." No, the end of the world is not upon us. As this Atlantic article outlines, the reason quarantine and containment have not worked with this virus as they did in other cases, like H5N1 ("avian flu"), is that the fatality rate for COVID-19 is relatively low--less than 2%. Not only are there more live carriers of Coronavirus-2, but people infected with the virus may experience only minor symptoms or no symptoms at all, making it all the more likely that they will be walking around and spreading the disease.
How many viruses do you have now?
Ultimately the COVID-19-causing virus will join the 380 trillion viruses that already occupy the human body. The virus will prove fatal for some people with chronic illnesses and the elderly (people like me, I guess). The virus is highly infectious and will cause a pandemic. Stop and consider the definition of a "pandemic":
A disease or condition is not a pandemic merely because it is widespread or kills many people; it must also be infectious. For instance, cancer is responsible for many deaths but is not considered a pandemic because the disease is not infectious or contagious. In a virtual press conference in May 2009 on the influenza pandemic, Dr Keiji Fukuda, Assistant Director-General ad interim for Health Security and Environment, WHO said "An easy way to think about pandemic … is to say: a pandemic is a global outbreak. Then you might ask yourself: 'What is a global outbreak'? Global outbreak means that we see both spread of the agent … and then we see disease activities in addition to the spread of the virus."
The Snowball effect
When talking about the loss of human life, no one likes to compare numbers. Every life is sacred, right? However, at some point in the midst of global panic, we need to remind ourselves that every time we get into a car or board a plane or go to a hockey game or church or synagogue or mosque or have sex or visit a hospital or simply step outside, statistically, we are taking a risk that might cost us our lives. Ultimately, the reason Coronavirus has been getting so much attention is that the Coronavirus has been getting so much attention.
Here is a strong counter-argument to the theme of this post. (Thanks Dr. B.) This article argues that the real issue is that global health services aren't nearly prepared enough to face the degree of contagion of COVID-19. The article also crunches the numbers on the number of fatalities resulting at least in part from the under-preparedness of hospitals. The article concludes by saying something I perhaps should have written: "taking steps to protect yourself and your loved ones is the responsible thing to do."
A necessary point of view to bring to the discussion.ReplyDelete
The media has a systemic bias to focus on the new new thing. We, the media and even the experts cannot separate the signal from the noise.
Just as the financial markets often price in worst case scenarios with black swan events, humans are designed to do the same from an evolutionary point of view.
Commenting on the specifics, China bashing is clearly on the rise, and makes it hard to discern whether the Chinese have done a good job or not.
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