As I face weeks of lockdown with my kids thanks to COVID-19, I am trying not to be too daunted. COVID-19 is undoubtedly a black cloud. It is a killer disease, and the mishandled political response has caused panic and will cause great social and economic upheaval. And yet… there is potentially a silver lining.
This is a very difficult thing to write, and I fear I will be shot down for appearing to welcome death and destruction. I do not. I do think the world will get through this, and COVID-19 has a good chance of leaving the world a better place (and not just because of reduced carbon emissions).
It is important to emphasise that I’m not an expert, a scientist or a doctor, just a former reporter.
I worked for the past eight years as a journalist covering the United Nations and the World Health Organization in Geneva. And I’ve written frequently about disease outbreaks, including the big ones you will have heard about (such as Ebola and Zika) and the ones that may have passed you by (such as MERS, meningitis, diphtheria, cholera, dengue and yellow fever).
In that time I’ve had it drummed into me that the world is due a pandemic, and the WHO has long been worried about a pandemic disease outbreak — quite possibly a kind of flu, or something worse. Beyond Geneva, the message about a pandemic has fallen somewhat on deaf ears, as political leaders did not want to invest in preparedness for something that appeared only a vague threat. Donald Trump’s budget, released last month, proposed to halve U.S. funding for the WHO and slash funding for the WHO’s America’s arm by three-quarters.
Now we have COVID-19, and the world is getting a real-time lesson in how to deal with a pandemic. It is creating a huge shock in Europe and America, while several of the Asian states with experience of SARS appear to have reacted more capably and confidently.
The terrible thing is: a pandemic could be far, far worse than this. COVID-19 has hit hard. But in some ways, this is still just a dry run for the big one.
Consider this: the current case fatality rates are probably skewed upwards by a massive under-reporting of COVID-19 cases. If the worst is to be believed, the fatality rate is in the low single digits, say 1%-4%. But the real rate is almost certainly much lower, because of the great number of untracked cases. By contrast, the case fatality rate for Ebola averages around 50%.
A pandemic would not need to have the lethality of Ebola to devastate the world — a case fatality rate of 10–20% would be easily enough. Such a pandemic could still come — there’s no reason to think that its appearance is less likely just because of COVID-19. However, the world’s response, next time round, will be utterly different.
More and more people now appreciate the lessons of basic health. Top of everybody’s list: Wash Your Hands. Public health experts have been saying this for years, but it’s an unsexy message. It’s much more exciting to be involved with big “moonshot” projects like eradicating diseases such as polio or AIDS or malaria. Those campaigns cost many billions of dollars, and while their goals are worthy, they have taken away attention from the much more fundamental need to make sure everyone observes basic hygiene and has access to basic healthcare.
The WHO has been restructured under its current chief Dr Tedros, who was elected on a mantra of “universal health coverage” — emphasizing the importance of ensuring basic standards globally, rather than having good healthcare in rich countries and woeful hygiene in Africa. This is crucial, and it is happening. It is happening not just because of Tedros’s leadership but also because of frequent reminders that we all breathe the same air: an Ebola sufferer can fly from Liberia to the United States and suddenly a regional health situation blows up into a global emergency and the U.S. media is awakened. It seems that Washington sleeps until someone utters the crucial words: “threat to U.S. national security”. That is what it took with Ebola. COVID-19 is not entirely different.
If you want to protect Joe in Kentucky and Madison in San Diego, you need to recognise that they are not simply at risk from friends and neighbours, but they are potentially under threat from viruses that could arise in Sierra Leone or Wuhan or anywhere. So if the United States wants to be safe, it has to help the world keep safe, and it has to help pay for it. If political leaders try to hide behind nationalist rhetoric and denial of science, they should, and hopefully will, be held to account.
Right now, apart from Wash Your Hands, if there is one lesson that the world is learning from COVID-19, it is surely this: take it seriously. Act with lightning speed. Find the people with the virus. Do not wait. Test and test and test. If you neglect the start of a disease outbreak it will probably explode on you. The WHO learned this lesson the hard way — they were asleep at the wheel when Ebola hit in West Africa in 2013. Now they are wide awake, but some national leaders were clearly caught napping and are struggling to catch up.
It seems amazing that the WHO’s Emergency Committee said this on Jan. 23, almost two months ago:
“It is expected that further international exportation of cases may appear in any country. Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO.”
If only the leaders of countries where the virus is now exploding had taken this to heart. Instead, we are now locking down entire countries, and it is not at all clear that that is going to be a net positive. As I recall, in every previous disease outbreak the WHO always advised against imposing any travel or trade restrictions, because they do more harm than good. The same advice is in place for COVID-19.
“WHO continues to advise against the application of travel or trade restrictions to countries experiencing COVID-19 outbreaks,” it says.
No doubt the WHO is still too timid to criticize failed leadership openly.
The school closures are not only damaging for education and expensive — there are of questionable use against COVID-19. It would make sense in a flu pandemic because kids spread flu, but apparently not so much in COVID-19. Are we sure this is really a useful step?
In any case, the economic and societal cost of COVID-19 is going to be huge. Not entirely because of the virus, but because of the way politicians are reacting to it, too late, perhaps in something of a panic. The way Ebola and other disease outbreaks are tackled is to throw huge resources at tracking and tracing every suspected case, and at every person who had contact with those suspected cases. It seems like a bad joke to recommend that now for COVID-19, with much of Europe effectively quarantined. But perhaps it could have been done.
And it’s not too late for some. As Dr Tedros said on March 11:
“If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.”
When the worst is over, there will be a review of the response to the virus, and there will be much to learn.
With any luck, the world will emerge from COVID-19 with a better awareness of the threat of pandemics, a better knowledge about how to react, a better respect for science and better funding for global public health. And everybody will know to wash their hands.
