The trouble with pandemics is they are unpredictable. We don’t know if they’re going to happen, we don’t know how bad they will be, and we don’t know who will be affected.
In the deep, dark corners of public health, we don’t even say the name. Instead, we talk about the “p-word,” as if using the term will invoke a deadly plague on the world.
There are mutterings on twitter, in the corridors of power, and in queues at the local coffee shop. “Are we in a pandemic?”
First, let’s talk about what we know and what we don’t know.
Coronavirus: What We Know
We know that there has been a large coronavirus outbreak in China. The outbreak continues to rapidly grow though there are some signs that the growth is slowing. The numbers of deaths continue to rise, and this would be expected with the increase in cases.
Early figures on case fatality rates in Wuhan suggest that 2 percent of cases are dying, while about 20 percent of cases are severe. The severity figures for the rest of China are lower, likely implying that the more severe cases in Wuhan were the ones that were tested and that less severe cases elsewhere are now also being tested. This suggests that the disease may be less severe than we first thought.
We know that the virus seems quite transmissible – in households, in buses, in workplaces, and on cruise ships.
We know that other countries are reporting cases. While most confirmed cases acquired the disease in Wuhan, more and more instances of local transmission, where the cases are infected by someone else in the country, are now being reported.
We know that at the moment, we can only control the spread of the virus by good hygiene measures and border controls: washing hands, wearing masks (worn and removed correctly), and avoiding people who show signs of respiratory illness such as coughing and sneezing.
We know that travel restrictions and quarantine measures have been put in place – both in China and many other countries – and, while contentious, these do seem to be working to contain and limit the spread of the virus.
We know that we don’t have vaccine, and it’s unlikely that we will have one for many months. We know that treatment is currently only supportive. There is no pill you can take to make you less sick.
Coronavirus: What We Don’t Know
We don’t really know how the disease is spread. We are assuming that it is like most other respiratory viruses and transmitted mostly through droplets in the air and on surfaces. This means that we aren’t sure of the best way to stop transmission.
We don’t really know how bad it is. It is difficult to get a true idea of the numbers of cases. We don’t know who is being tested. We don’t know whether those who are hospitalized are there because they are ill enough to require hospitalization or if they’re not very sick but are being held in hospital until they test negative for the virus.
We don’t know whether the interventions, mostly travel restrictions, will continue to limit the spread of the coronavirus.
Are We in a Pandemic?
A pandemic occurs when a new virus emerges and spreads globally, while most people don’t have immunity.
Rather than using the term “pandemic,” the World Health Organization (WHO) uses “Public Health Emergency of International Concern (PHEIC).” In other words, a health event that we should be worried about on global scale. On January 30, the WHO declared the coronavirus outbreak a PHEIC.
Most public health professionals would say that we are not yet in a pandemic. Although there are confirmed coronavirus cases outside China, there are only minimal signs of community-based transmission where there is no known connection with another confirmed case. We are still able to detect contacts of those cases. Through quarantine and monitoring, we can stop further spread.
Will a Pandemic Happen?
The answer to whether a pandemic will happen, unfortunately, is probably “yes.”
It’s encouraging that the growth of the coronavirus outbreak seems to be slowing in China, but is it enough to stop a pandemic? I don’t think so.
We will probably see a drop off in cases in China. The world may very well relax, as interest in coronavirus wanes. But in the background, outside China, cases that we don’t yet know about are quietly transmitting the disease to their friends, neighbors, and colleagues.
In the Northern Hemisphere, it is the respiratory season. Everyone has the sniffles, and coronavirus cases are likely hiding in plain sight.
Before too long, there will be respiratory outbreaks in nursing homes, more absenteeism in the workplace, and clusters of respiratory illness in families until there is widespread community-based transmission of the coronavirus and sentinel testing (the regular testing of a certain number of cases with influenza-like-illness) starts to detect cases. Emergency rooms will become crowded, intensive care units will be overwhelmed, and the worried will demand that they are tested.
The Northern Hemisphere may get lucky, and not too many cases will appear before winter finishes and the respiratory season is over. The Southern Hemisphere is unlikely to be as fortunate, and large outbreaks will probably occur in Australia, South America, and Africa as they move into their winter season. India, Asia, and countries situated near the equator will also be in trouble. By next winter, the Northern Hemisphere will be seeing large-scale outbreaks.
Trouble With Pandemics
The trouble with a pandemic is that most people are susceptible. The trouble is the scale of the event, with cases potentially numbering in the thousands, hundreds of thousands, or even millions.
The trouble with a pandemic is that, on a global scale, if even a small proportion of those infected get really sick, then that is a huge number of people.
We can now only wait and see if a pandemic happens.
Avoid people who have respiratory symptoms. Get your influenza vaccination; you don’t want to have another respiratory virus during a pandemic. Be prepared.