The World Health Organization formally declared on March 11 what many public health experts had been saying for several weeks now, and that is that the novel coronavirus, or COVID-19 has become a pandemic.
While there is no formal definition, in general a pandemic occurs when a local infectious disease outbreak spreads to at least three other regions of the world with sustained human-to-human transmission. Every continent except Antarctica reports COVID-19 cases. The six countries now facing major outbreaks with sustained community transmission are China, Japan, South Korea, Iran, Italy, and likely North Korea given its trading and proximity to China, although we don’t know if they are testing for the disease, and they are not publicizing infection rates.
This means that efforts at containing the spread of the virus across the globe have failed. We are now entering what is called the mitigation phase of a pandemic in which emergency measures are taken to reduce the speed at which the virus is spreading and to reduce the number of deaths.
What we know so far
What do we know about COVID-19? Scientists have begun to study the virus that causes the disease, but many questions remain unanswered. For example, there have been no reported deaths of children under nine years old, and those who do catch the disease show mild symptoms. For most infectious diseases, children are most seriously at risk because they have underdeveloped immune systems, and so they die at a much higher rate. That is not the case with COVID-19 so far, but scientists do not know why, and they are unsure if children transmit disease if they are asymptomatic.
Scientists believe the virus has existed for some time in bats, but only made the jump from bats to people as early as mid-November of last year in Wuhan, China. Over the past 40 years, 75 percent of all new infectious diseases in humans have been zoonotic, meaning they originated in animals, but have made the jump to people. These viruses become dangerous when there is efficient human-to-human transmission, which is what has happened with COVID-19.
The efficiency of transmission or contagiousness – called R naught – is measured by how many other people one person who gets the disease will infect. COVID-19 is highly infectious: One person on average will infect between two and three other people.
COVID-19 is worse than the flu
Some have suggested COVID-19 is no worse than getting the flu which kills between 300,000-650,000 people each year worldwide, but the comparison is inaccurate and misleading. Scientists believe that COVID-19 is twice as infectious as the flu. In addition, the assumed death rate for COVID-19 is much higher than the flu. About 0.10 percent of the people who get the flu each year die from it, while on average about 2.5 percent of those who get COVID-19 die. That means COVID-19 is 25 times more lethal than the flu. However it will take time before we know the true death rate, and it may decline in countries with advanced health care systems.
The good news is studies of the disease in China tell us that 81 percent of the people who get COVID-19 have mild symptoms, 15 percent have severe symptoms requiring hospitalization, while 4 percent may die from it. Most of those who die from COVID-19 are over 60 years old, and many have other health complications such as heart disease, lung issues, stroke, cancer, auto-immune diseases, or diabetes, among other health conditions.
Many people have partial or complete immunity from the flu because they have been vaccinated, but few people have immunity from COVID-19. It will be at least 18 months before a vaccine may be available. We also do not have medication to treat the virus, which will take at least six months for scientists and pharmaceutical companies to develop and mass produce.
COVID-19 presents two great communication risks. One is to underestimate how serious the disease is so that the warnings of health scientists are ignored or minimized, and mitigation measures are not taken. The other is creating a panic which makes people act in irrational ways. COVID-19 is not bringing the apocalypse upon us; it is a serious health crisis which needs to be addressed, but it is not the end of the world. Stock markets across the globe are now overreacting to the pandemic and that is causing economic chaos that could be as bad as the disease.
Lessons learned from 1918
The 20th century’s greatest catastrophe measured by the loss of life was not World War I or II, but the Great Influenza, or Spanish Flu epidemic of 1918, that killed, at the upper end of the estimates, between 50-90 million people in six months, or about 5 percent of the world’s population. This current pandemic is not another 1918. We did not know much about viruses in 1918, and medical research and health care were primitive.
But we can take valuable lessons from 1918. John Barry in his book the Great Influenza reports that public leadership particularly at the community level in a pandemic crisis can lower death rates, slow the spread of the disease, and reduce human suffering. This happens when government officials, the business community, religious leaders, and civil society join together in a common effort carefully coordinated to quarantine those who are infected, care for the ill, educate the public about proper sanitary measures to reduce infections, make sure the economy continues to function, public services are protected, and at-risk populations, such as older people, are monitored and protected from infection.
With this kind of leadership we can weather the pandemic, save lives, and reduce human suffering. The final impact of COVID-19 on public health and the economy is now up to us.
Andrew Natsios is executive professor at the George H.W. Bush School of Government and Public Service at Texas A&M University and Director of the Scowcroft Institute of International Affairs which has hosted a pandemic policy program for the past five years. He is the former Administrator of the United States Agency for International Development and former US Envoy to Sudan.
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