Is coronavirus a global emergency? What we don’t know can be dangerous
Public health knows no borders, no boundaries, nor should it. In fact, the more we consider health concerns occurring elsewhere in the world to be our problems too, the better off we will be.
Diseases like the deadly Ebola, the highly contagious measles, the immunocompromising HIV or the cancer-causing HPV remain problems in underdeveloped countries in Africa, Asia and the Middle East — and they’re our problems, too. We need science rather than hysteria in order to contain them.
This is why it is beyond absurd that the World Health Organization has yet to declare the emerging coronavirus from Wuhan, China, an international public health emergency, despite there already being close to 3,000 reported cases — the vast majority in China— and at least 80 deaths.
Thirty Chinese cities and provinces have activated their highest emergency response level. China is halting all outbound tourist groups, locking down 60 million people at the epicenter of the outbreak; the city of Wuhan is building its second emergency coronavirus hospital in a month. President Xi Jinping has ordered control and prevention of the coronavirus to be his country’s primary task, and he has acknowledged that the disease’s spread is accelerating.
What isn’t yet known is how contagious this virus is. This depends in part on whether the cases now being revealed are all new and indicative of rapid spread, or whether China has been slow for months to reveal a cauldron of contamination in order to save face, as critics suggest.
In public health circles, this analysis is determined by a numerator and a denominator, with the numerator being the numbers of cases and deaths and the denominator being the overall number of people at risk of acquiring the disease. This risk depends on the rate of sustained spread — in other words, how contagious it is, which remains unknown. The numerator appears to be vastly understated, because of the hundreds of cases that either haven’t been reported or haven’t been directly linked to this coronavirus.
What we do know is that this strain of coronavirus originated from a market containing exotic animals in Wuhan, a city of 11 million people. We don’t know which animal, although coronaviruses tend to be harbored in mammals and birds, making a study just published in the Journal of Medical Virology (one based on an examination of the virus’s genetic structure, and pointing to snakes) appear to be incorrect.
Coronaviruses are very unstable, frequently mutate, and jump from one species to another. There is evidence that the last two coronaviruses to cause a serious outbreak among humans —Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) — began in bats before jumping species, to civets in the case of SARS and to camels in the case of MERS, and then on to humans.
The problem with the current strain, as well as the previous ones, is the close exposure in these cultures between people and animals, including the practice of eating raw meat. This causes humans to come in close contact with ever-changing coronaviruses.
The World Health Organization (WHO) has declared five international emergencies in the past decade, helping to extend resources and attention — as well as fear, even though none of these outbreaks led to a worldwide pandemic on the magnitude of what was anticipated or what we may face now. These emergencies were the H1 swine flu virus in 2009, the Ebola outbreak in West Africa in 2013, polio in 2014, Zika in 2016, and Ebola again in the Democratic Republic of Congo in 2019
WHO has a poor track record when it comes to predicting both the numerator and the denominator, however. Ebola, for example, is a deadly virus but is fairly stable and difficult to contract, so it is a limited worldwide threat in its current form. H1N1 flu and the mosquito-carried Zika did spread to different regions but were nowhere near as deadly as anticipated.
WHO issued a global alert for SARS in 2002, which was warranted for a novel contagious killer — and WHO should do so now for this similar virus. Waiting to identify a large number of cases in countries beyond China is an extraordinary mistake. China, with 1.5 billion people, cannot be fully isolated, no matter what measures are taken.
WHO’s assistant director-general for communicable diseases, Dr. Ren Minghui, is a former public health official in China’s Ministry of Health. Critics claim that WHO is under economic and political pressure from China not to declare this outbreak an international emergency.
Here in the U.S., our Centers for Disease Control and Prevention (CDC) has evolved when it comes to identifying a disease and isolating its victims (the numerator) and those with whom they have been in contact (the denominator).
It was unfortunate that a nurse who cared for an Ebola patient in Texas in 2014, despite wearing protective gear, still managed to acquire the dreaded disease by violating protocol and then getting on a plane.
Since then, the CDC has played an aggressive role in disease containment, by battling Ebola in Africa or working with U.S. state and local health authorities to identify and contain this past year’s measles outbreaks.
The CDC already is helping with the new coronavirus, tracking and isolating potential cases. States and local health departments, hospitals and doctors need to pitch in to try to keep this virus from taking hold here.
When it comes to the evolving coronavirus situation, we will need all hands on deck to battle this emerging strain. First, we need WHO to identify it properly as the international public health emergency it is. And, second, we need to figure out both the public-health numerator and the denominator — how many cases, how many deaths, how contagious, and how many truly are at risk. I believe restricting travel to and from China is a prudent start.
Marc Siegel, M.D., is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent. Follow him on Twitter: @drmarcsiegel.