NEW YORK (Reuters Breakingviews) - It’s not time to panic, but it is time to face reality. The coronavirus is spreading around the world. China’s unprecedented efforts slowed the spread of the new disease officially known as Covid-19, but that’s merely won some time. Infected people have now been detected on every continent except Antarctica. Competent and open government is the best defense against hospitals and society being overwhelmed. But nations will probably have to deal with recurring outbreaks.
No. China helped reduce transmission by shutting down public gatherings, factories, and schools. Mass testing is also key to figure out who has the disease, and track who may have been exposed. China now claims the number of new cases is falling. While the country’s official statistics are notoriously unreliable, it makes sense such methods would slow the spread of the disease which has afflicted more than 78,000 people in the People’s Republic and killed around 2,700.
While the World Health Organization has declined to call it a pandemic – a deadly disease which is spreading worldwide – the cat is out of the bag. Cases have been found in 50 countries, and the list is rapidly growing. On Wednesday the number of new cases reported outside China exceeded those inside the country for the first time since the disease was identified in early December.
What’s especially alarming is that one of the first indications of a mass outbreak in Iran came from a traveler being diagnosed in Canada. If countries that appear uninfected are spreading the disease, many other outbreaks are presumably underway. Nearly every country neighboring Iran has now been affected.
For a disease to be truly worrisome, it needs to be both highly contagious and dangerous. Ebola has caused a lot of suffering in central Africa, but the disease often kills its victims before they can infect many others. The odds of it spreading widely are therefore low.
By comparison the 2009 flu – the last pandemic – spread all over the earth but was surprisingly mild. America’s Centers for Disease Control estimates over 60 million Americans were stricken. It swamped medical offices, workplaces were short-staffed, and schools emptied. But it only killed about one out of every 5,000 people who were infected.
The new coronavirus appears to spread easily. The experience of the Diamond Princess cruise ship suggests it can be explosive. Out of 3,700 passengers and crew, there have been about 700 confirmed cases and that number continues to rise. More broadly, cases outside China are more than doubling every week. It’s also dangerous. The estimated death rate for Covid-19 is about 2%, making it about 20 times deadlier than typical influenza.
Healthcare systems aren’t designed to deal with pandemics, because they are so unusual. The United States has about 900,000 hospital beds, about two-thirds of which are occupied on average according to the CDC. The World Health Organization estimates about 80% of coronavirus cases are mild, with others serious or critical. So if just 1% of America’s population of 330 million contracted the virus at the same time, there wouldn’t be enough hospital beds. An uneven outbreak could lead to more overcrowding in some cities and critical-care units.
Hospitals would probably run short of protective gear. The U.S. Department of Health and Human Services has said the government has stockpiled 30 million masks, but it needs 300 million to protect front-line healthcare workers alone. Doctors would be overloaded, because many would become sick, and because people who have not been infected would still seek help.
Stretched medical systems will kill more patients. This dynamic helps explain why the death rate in the city of Wuhan, the center of the outbreak, has been higher than in other parts of China. Countries with poor medical care will be hit harder. They lack the ability to find clusters of disease and dampen the outbreak, while patients won’t be treated.
Closed factories and housebound consumers have already depressed Chinese economic activity. Companies ranging from Apple to Yum China have warned of supply chain issues and decreased demand. These will cascade as more countries embrace drastic measures. Japan on Thursday closed all its schools early ahead of an upcoming spring break.
It’s notable that three of the four flu pandemics in the past century were followed shortly by U.S. recessions. The exception was the 2009 outbreak, which occurred when the world economy was already in the dumps. Closed factories and offices reduce output, restaurants and cinemas suffer revenue shortfalls, corporate debt weighs heavier, while small businesses may fail if the owner falls sick or dies.
The World Bank estimated in 2014 that a pandemic of similar size and effect to the 1918 flu would knock 5% off global gross domestic product. That disease was both widespread and probably more virulent – it killed over 50 million people – so that’s a worst-case scenario.
Allowing information to flow freely is the best way to identify clusters early. When local officials cover up, or doctors are afraid to disclose cases, outbreaks fester. The epidemics in China and Iran probably would have been caught and acted upon earlier in less authoritarian countries.
Measures such as shutting down society or closing borders can slow transmission, but can’t be sustained for months on end. Democratic societies may not allow the kind of intensive surveillance China has practiced. Workers and businesses can only go so long before the financial crunch becomes unbearable. China is now revving back up, and that will almost certainly result in more infections.
Mass testing of the exposed and isolating the sick can be sustained and might keep clusters manageable. But this requires a functioning system with competent leadership. South Korea said on Wednesday that over 20,000 people were being tested. The United States has not started surveillance and has only been testing about a dozen people a day. That means undetected outbreaks are probably underway.
Past pandemics have spread in waves. The virus may propagate more effectively when the weather is cold and dry. Behavior changes too; people wash their hands more often when evidence of sickness is around them. As the proportion of the population with immunity rises, the disease spreads more slowly. However, immunity may wane over time. The most likely outcome is that the disease becomes endemic with smaller outbreaks following the initial flare.
Several anti-viral medicines and vaccines are already being tested. Showing efficacy, safety and scaling up production will take time, though. A drug to treat the coronavirus probably won’t be widely available for at least a year; developing a vaccine will take longer. In the meantime, the world can only prepare for the worst, while hoping for the best.
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