The world is clearly in the grip of not one, but two pandemics, caused by a new coronavirus, the “novel Coronavirus 2019” or nCoV-2019 for short. The first pandemic is the actual infection caused by this virus. The second is the panic, hysteria, threat inflation, associated racism and xenophobia that are exploding in the shadow of the viral outbreak. The latter pandemic may claim more lives than the first.
Around the world, masks are selling out from local pharmacies and online retailers. Schools, colleges and other public places are abandoned at the first site of a Chinese-looking individual. And even Bitcoin is mounting a comeback.
Rumours abound: The Malaysian health ministry actually had to deny zombie-like behaviour on the part of those infected with the nCoV-2019. Several countries, acting against WHO guidance have banned foreigners arriving from China, despite good science showing that such steps are ineffective in preventing spread of a respiratory virus like nCoV-2019.
Ironically, this is all unfolding against a background of far greater transparency and access to real information about the infection than ever before. Newspapers have dedicated live blogs to provide minute-by-minute developments. There are constant updates about the number infected and dead. And reports continue about ever escalating steps taken by national governments. Do the facts justify the panic? Clearly no.
The facts of the viral infection are becoming clearer with every passing day. China, criticised widely for its opaque handling of the 2003 SARS crisis, has been far more forthcoming with information and data this time. It has also been draconian in measures intended to contain the spread of the virus. The picture that is emerging is of a concerning, but relatively benign virus. It remains too early to be definitive, but it now appears that the fatality rate associated with nCOV-2019 is settling in at 2-2.5%.
By comparison to other coronaviruses, like SARS in 2003 (10%) and the Middle East Respiratory Syndrome (MERS-CoV - 30%), this is a fairly low mortality rate. At the time of writing, the number of people reported infected with nCoV-2019 is just under 25,000 and just under 500 people have died as a result of the infection.
Both numbers are certain to grow with the final tally of people infected possibly rising into the range of 75,000-100,000. However, and to place the numbers in context, if the current mortality rate holds, the total number of people dying from nCoV-2019, while substantial and tragic for those affected, will be a fraction of the burden of mortality associated with more mundane viral infections like the seasonal influenza. The latter claims some 300,000-500,000 lives worldwide annually.
It is also important to note that the infection and mortality rates outside of China have been exceedingly low. As of the time of writing, there were fewer than 200 people infected around the world of whom 2 have died. That translates into <1% of cases being reported outside of China. In comparison, 14% of SARS cases were outside China and the mortality rate, even in developed health care systems was quite high. For example, Canada’s mortality rate was 17%. The current statistics – and acknowledging that this remains an evolving situation - speak to the effectiveness of efforts at containment but also to the relatively low infectiveness rate.
So, why is this virus generating so much panic? In the answer to this question may lie the future of global public health care. Doctors are used to providing information and believing that most people will rationally and calmly weigh the evidence. It is clear that, if this was ever true in the past, it no longer is.
Outbreaks of entirely preventable communicable disease in developed countries are testament to the post-expertise, post-science world in which we live. The 24 hour news cycle, the rise of mass social media and lay journalism all play a role. But the fault does not lie entirely at the feet of the public or the media. In the early days of reporting, the news emerging from Wuhan about the infection were extremely grim. In the first case series published in the prestigious medical journal, The Lancet, the mortality rate was reported as 11%, 5 times what it now appears to be.
That series focused on patients who required hospitalisation, and hence excluded the far greater number of patients who were asymptomatic or only mildly unwell. This is a lesson we should do well to heed. Early information about any public health crisis is always inaccurate, and almost certain to change as more data is acquired. In this case, the initial over-estimates of the virus’ lethality led to many countries around the world being over-prepared and that may have helped contain the spread outside China. But it comes at a cost.
And the news is not all positive. This virus, despite its apparent low infectivity and low lethality displays other extremely concerning features. The incubation period, the time from being infected to showing symptoms, is very long (up to 14 days) which allows people who are infected to travel widely. In addition, it appears people can transmit the virus even when asymptomatic and not only through droplets, but also through stool.
These two factors combined are extremely worrisome and may lead to difficulty in completely containing the infection. If a coronavirus with the level of lethality like MERS-CoV emerges with these characteristics, it will pose a significant global public health challenge. And at that point, if a true global pandemic takes form more people will die from fear, panic, misinformation, racism and xenophobia than from the infectious disease itself.
Wael Haddara is an academic physician and educator and the Chair of Critical Care Medicine at Western University in London, Canada.