When the first reports of a coronavirus outbreak hit the airwaves in early January, several dozen people had already caught the disease in or around the Chinese city of Wuhan. In the weeks since, the virus, nCoV, has spread quickly and the number of infections has grown by the day, even as Wuhan and other Chinese cities isolated large numbers of patients and quarantined some 50 million residents. At the latest count (as of January 31), there have been 213 deaths in China out of a total of 9,776 confirmed cases, and the virus has spread to more than 20 countries. On January 30, the World Health Organization (WHO) declared the disease a “Public Health Emergency of International Concern.”
The epidemic is still in its early days, and its defining characteristics will take time to understand. The scale of nCoV’s ultimate impact will depend on just how contagious it reveals itself to be and how lethal it is in those who fall ill—properties that cannot be precisely determined at this stage. The efforts underway to contain the disease in China and elsewhere could prove effective in the weeks ahead, and they should be fully supported. Yet there is a clear possibility that nCoV may not be contained in time to prevent a large global outbreak. Countries should start preparing for that prospect now.
KNOWNS AND UNKNOWNS
Assessing the risks of nCoV will require data and time. Among the most crucial indicators in any epidemic is the fatality rate: the share of the infected who die from the disease. The statistics on diagnosed nCoV cases available as of today would suggest a fatality rate of around two percent. (For comparison, SARS, or severe acute respiratory syndrome, had a fatality rate of ten percent when it broke out in 2002 and 2003, while seasonal flu has a fatality rate of about 0.01 percent.) But that fatality rate will change. At the start of a new outbreak, the most serious cases of illness and death are the easiest to spot and are thus recorded first. As more cases come to light, including many milder ones, the fatality rate is likely to go down, perhaps substantially. In an optimistic scenario, nCoV will have a lethality closer to seasonal flu than to SARS—but it is too early to know. As of now, older adults appear to be most at risk, with very few recognized cases in children.
Another critical factor is the rate at which the virus spreads. The rapid rise in cases in China suggests that nCoV is transmitted efficiently from human to human, although scientific details about the patterns of its spread among most of the infected are not yet fully available to the WHO or governments other than China. In past outbreaks of respiratory disease, the rate of spread has sometimes slowed over time, probably because people became more aware of the risks and took steps to protect themselves (washing their hands, covering their coughs, staying home if sick, canceling large gatherings, and so on). And as more people fall ill, recover, and become immune, fewer people will remain susceptible. But whether nCoV will follow that path or will instead continue to spread widely and quickly, scientists cannot now accurately judge. SARS was contained within about seven months, but each year’s seasonal flu circulates globally until the next year’s strain replaces it. So far, the control measures that China has taken have not seemed to slow nCoV down. And although the virus has not evolved substantially over the course of this outbreak, its genome could change over time, perhaps affecting its lethality or capacity to spread.
Some steps should help slow the disease’s international spread in the short term. A number of airlines, for instance, have reduced or canceled service to China, and new arrivals from the country are being screened for the disease at many airports around the world. Within China, steps to isolate patients and protect health-care workers from contagion will continue to be vital no matter what. But given nCoV’s rapid rise and spread so far, even these measures may not suffice to stop it. Planning for that outcome is an urgent necessity, even as containment efforts continue.
An nCoV pandemic would require a strong and sustained response by governments and the international community. Developing a vaccine is a top priority, and a number of countries, companies, and international organizations have already started this work. An effective nCoV vaccine could slow the spread and lessen the impact of the disease dramatically, but vaccine development normally takes a long time. Assuming that everything goes right, an nCoV vaccine could take around a year to develop, according to leading experts in the field. That timeline would already be record breaking in a new outbreak, but governments, international organizations, and philanthropies should make every available effort to accelerate it by coordinating and giving support to any and all serious vaccine candidates. Contenders might come from universities or biotech and pharmaceutical companies—nobody knows where an effective vaccine will appear first. Money should not be a limiting factor.
Once a vaccine is developed, it will need to be produced on a large scale at different sites around the world. To disperse the manufacturing in this way would be unusual, as a vaccine is normally made in one location. But the WHO, other international organizations, and private-sector logistics companies could more quickly distribute the vaccine if it is produced in multiple locations. Moreover, any one country producing the vaccine will face strong domestic pressure to vaccinate its own people before sharing any of it.
While work on a vaccine is underway, researchers should look for medicines that could help treat nCoV, including antivirals, a class of drugs that fight a virus’s ability to replicate. Existing antivirals—some experimental, others for known human viruses such as the flu and HIV—might have some value in combating nCoV. They should rapidly be tested for their utility. Therapies that rely on patient injection of antibodies have proved successful in treating SARS in humans and animals; researchers might have success in developing similar treatments for humans with nCoV. Conducting the necessary trials for new treatments during an active outbreak is a challenge—so much so that medical professionals long considered it too difficult—but the response to an Ebola virus outbreak in the Democratic Republic of the Congo in 2018 and 2019 showed that new therapies can be tested and proven even in the middle of an epidemic.
In order to find new cases and treat them, medical professionals will need to quickly identify people with nCoV, which requires a reliable diagnostic test. Fortunately, an accurate test already exists, but the number of labs capable of conducting it is limited, creating delays that will only get longer as the case count rises. Governments should fund a major global effort to manufacture rapid diagnostic kits and distribute them to countries around the world.
Once patients are identified, hospitals must stand ready to care for them, a task that requires immediate preparation. If an nCoV pandemic occurs, hospitals could receive high numbers of patients, many requiring intensive care. Past coronavirus epidemics have spread widely within hospitals and infected health-care workers. Hospitals should prepare for this risk by strengthening their infection control procedures, making sure their workers have the right training, and maintaining a reliable supply of masks, gowns, and gloves. Such preparation is harder than it sounds: only a small number of countries produce these essential materials and supply them to the world, so international planning to keep supply chains functioning will be paramount.
Governments and public health authorities, too, will shoulder significant burdens, not least in communicating with the public in moments of crisis. Authorities will need to say what they know, what they don’t know, and when they will know it. They should be accurate and not withhold information, whether the news is good or bad. Public trust is essential to controlling an epidemic, for a simple reason: trust will determine whether the public listens to what authorities advise, such as suspending social gatherings, getting diagnosed quickly, seeking care at certain locations, and agreeing to be isolated while contagious. To such ends, confidence in government action and advice will be crucial. Governments will also have to partner with traditional and social media to help distribute factual information and minimize hoaxes and conspiracies.
A GLOBAL ACTION PLAN
An nCoV pandemic would require a great many measures from governments, the World Health Organization, other international organizations, medical and public health professionals, industry, and the public. The priorities above are just some of those measures—and alarmism is not among them.
The virus may still be contained before it spreads widely around the world, and all useful efforts toward that goal should continue. And even if nCoV does spread widely, it may eventually prove to be so mild that it comes to resemble other common respiratory diseases, obviating the need for continued extraordinary steps.
Yet the world cannot afford to presume these best-case scenarios. This new virus could prove to be both uncontainable and to cause a serious or lethal disease for many across the globe. Governments need to come to grips with this risk and act accordingly. If that worst-case outcome fails to materialize, their work will still have been right and worthwhile, as an insurance against this crisis and as preparation for the next one. If these measures turn out to be necessary, however, then the earlier we start, the more valuable our efforts will be.
This article was originally published on ForeignAffairs.com.