I’m feeling ill. Not from the new coronavirus, thankfully, but because the mysterious disease’s alarming spread closely resembles the 2003 outbreak of SARS, which killed more than 770 people worldwide within a year. When SARS erupted, I was reading galleys of The New Killer Diseases, a book I had co-written with Boston University microbiologist Elinor Levy, and we had to scramble to add a new opening chapter on the emerging lessons of the outbreak. Big mistakes by Chinese health officials and politicians allowed SARS to spread. And based on published reports about the new coronavirus through January 28, 2020, I feel sick to say that China, and perhaps even the World Health Organization (WHO), may be repeating some of those mistakes. Here are five takeaways, followed by my reasoning further below.
1. Admitting there is a problem: Although China acknowledged the coronavirus much sooner than it did SARS, it still waited too long, allowing infected people to spread the pathogen widely. As of today, 106 people have died in China, and nearly 60 cases have been confirmed in at least 14 other countries.
2. Sharing genetic information: Chinese health officials did promptly release the genetic sequences of virus collected from patients, allowing faster diagnoses globally.
3. Declaring a global health emergency: The WHO has not done so, but it should, because superspreaders—lone individuals who are highly contagious and could infect large numbers of people—are just coming to light. They made SARS a global calamity. Reluctance might also arise because the novel coronavirus does not seem to spread readily from person to person. That was the case for SARS—until the virus mutated and infected people.
4. Eliminating the source: China has to finally shut down live animal markets, where the new coronavirus and SARS—as well as bird flu—have jumped from animals to people.
5. Naming this villain: “Coronavirus” is a family of viruses that includes SARS and forms of the common cold. Putting a distinct label on this particular strain will sharply focus people’s attention, from doctors on Main Street to leaders at the highest levels of government.
Admitting There Is a Problem
The first SARS cases were identified in southern China in November 2002, but the world knew almost nothing until a retired Chinese army doctor blew the whistle in early 2003. The virus was already coursing worldwide by then. Other nations slammed China for covering up information, which it later admitted it had done, supposedly to keep people calm. Ultimately, the national government apologized, and politicians and officials at various levels were fired or resigned.
This time around, officials in the Chinese city of Wuhan, where the new coronavirus was first detected, downplayed the risks. They did not institute screening measures until a month after the first case was found, according to CNN. During that time, citizens were reportedly arrested for spreading “rumors” about the start of a new disease like SARS, and journalists who were trying to report on the outbreak later said they were detained or threatened. Finally, President Xi Jinping ordered that the virus be “resolutely contained.” Although health authorities had already shut down the animal market, and the genome sequences had already been shared, much greater preventive actions suddenly began.
One widely recognized problem in China is that local leaders, who can have great autonomy, do not want to displease national officials. Officials in Wuhan had done the muzzling so their regions did not seem unstable. Instability rankles authoritarian governments; civil unrest is their greatest enemy.
The problem with secrecy, of course, is that the rest of the world doesn’t know it is being infected. Steps to contain a pathogen’s spread come too late, medical care and potential vaccines are delayed, and people die.
Sharing Genetic Information
All that said, Chinese scientists and doctors quickly sequenced the new coronavirus and gave the genetic information to the WHO on December 31, 2019. The WHO shared details 10 days later on the National Institutes of Health’s GenBank, a widely used international database. This action, in turn, allowed experts to determine that the new virus was akin to SARS and had likely leaped to humans from animals.
Gene sequencing is much more efficient than it was in 2003, but the greater lesson is that researchers need fast and unfettered access. The world did not learn of the SARS virus’s details until a doctor named Carlo Urbani, who worked at a regional WHO office, examined patients and alerted his colleague at the WHO’s headquarters in Geneva. Sadly, Urbani contracted the virus and died a month later.
Declaring a Global Health Emergency
As I write, the WHO has not declared the new coronavirus an international health emergency. This is an official proclamation it makes rarely, reserved for the worst threats. The health reason is that thus far, the vast majority of patients are inside China, so the threat is not yet “global.” And the philosophical reason is that a boy who cries wolf too often is ignored.
I certainly do not claim to have greater insight than experts at the WHO, but two factors seem important: SARS traveled like wildfire in part because of superspreaders. One young woman who checked into a Singapore hospital after returning from Hong Kong infected 20 nurses and patients. A similar scenario happened in Toronto. Reports about superspreaders of the new coronavirus are unclear thus far, although an article published in Nature on January 21 said Zhong Nanshan, who directs the State Key Laboratory of Respiratory Disease in Guangzhou, China, confirmed that 14 medical workers had been infected by one virus carrier.
Another part of the WHO’s reluctance may be that the virus does not seem highly transmissible from person to person. But it took the SARS virus a little while to figure out how to do this. Viruses can mutate as they spread, and virulence can change quickly. Zhong, who is the lead investigator of the novel coronavirus—and who helped reveal the SARS epidemic—confirmed on Chinese state-run TV that at least two cases had been spread human-to-human, according to an article published by CNN. On January 26 China’s health minister Ma Xiaowei warned that the virus seemed to be becoming more transmissible, according to STAT, the online medical news publication. On January 28 CNN reported that Germany and Japan had confirmed there were patients who tested positive for the virus who had not visited Wuhan.
Eliminating the Source
China has to shut down the live animal markets. This outcry came after SARS and bird flu, yet the markets continue.
The markets are a traditional part of China’s culture and of local economies, so the step cannot be taken lightly. And it may seem draconian. Then again, China has, at times, ordered the mass slaughter of thousands or even millions of birds when they are found to carry a pathogen that threatens humans. Influenza viruses that often start in China and travel the world over—a major factor in which flu strains are included in the annual vaccine—can spread in these markets as well.
Markets have also been implicated in Middle East respiratory syndrome (MERS), another deadly coronavirus. It jumped from camels to humans in 2012, but one recently published paper suggests that this transmission occurred more frequently when camels lingered next to animal markets in Saudi Arabia. By the way, researchers ultimately determined that SARS jumped to humans from civet cats, which were routinely sold in China’s live animal markets.
Naming the Villain
This new pathogen needs a name. Technically, it is called 2019-nCOV, short for “2019 novel coronavirus.” This odd acronym means nothing to the average person, and “new coronavirus” is too generic. A clear name helps people focus. The International Committee on Taxonomy of Viruses usually decides on one, although right now, it seems the WHO may take the lead.
Health officials who work at such organizations are rightfully cautious, because they don’t want to incorrectly characterize a pathogen; once a name goes out, it sticks. When an unnamed pathogen broke out in New York City, officials were close to calling it another case of Saint Louis encephalitis, but a closer examination determined it was something new, which they finally termed West Nile virus. Ironically, the taxonomy committee and the WHO do not like to name pathogens after places or people, because doing so can disparage a family or region. So the name Wuhan virus, or Wu flu, which is going around social media, will not likely win out. That’s the problem, though: if officials don’t act soon, and some other moniker does catch on, confusion could be worse instead of better.
There is certainly middle ground for quick action with sufficient specificity. SARS stands for “severe acute respiratory syndrome”—an acronym that is unique yet still scientifically safe.