Via The New York Times, an op-ed by Dr. Michael T. Osterholm and Mark Olshaker: Is the Coronavirus Outbreak a Pandemic Yet? Excerpt and then a comment:
On Tuesday, Feb. 18, no coronavirus cases had been reported in Iran. On Sunday, the government announced 43 cases and eight deaths. Some 152 cases (and at least three deaths) were confirmed in Italy on Sunday, up from three cases on Thursday. The number of infected people in South Korea jumped to 763 (and six deaths) in just days.
As of Monday, Covid-19 was detected in at least 29 countries. In nations with few or no reported cases so far, particularly in South America and Africa, the absence of evidence shouldn’t be interpreted as evidence of absence. More likely, it reflects lack of testing.
Is the Covid-19 outbreak now a pandemic, whether or not the World Health Organization calls it that yet? If so, what’s next?
First, let’s get the facts straight about what can and cannot be done.
It’s now clear that the epidemic was never going to be contained. At most, its spread was slowed by the lockdown imposed in China and other countries’ efforts to identify infected people and anyone they might have been in contact with.
Covid-19 seems to spread like influenza, through the air, person to person. Unlike Ebola, SARS and MERS, individuals can transmit this coronavirus before the onset of symptoms or even if they don’t become ill. An infected person appears to spread the disease to an average of 2.6 people. After 10 generations of transmission, with each taking about five or six days, that one initial case has spawned more than 3,500, most with no or mild symptoms, yet probably infectious. The fact that mild cases are difficult to differentiate from colds or the flu only complicates the diagnosis.
In light of the disease’s features, the quarantine of the passengers and crew members on the Diamond Princess cruise ship in Yokohama Bay in Japan looks like a cruel experiment: While confined, these people were forced to breathe recycled air for two weeks. The measure achieved little except to prove just how effective the virus is at spreading. Trying to stop influenza-like transmission is a bit like trying to stop the wind.
Vaccines are many months away, at the earliest. And based on previous experiences with SARS, MERS and pandemic influenza, there is no reason to believe — as President Trump claimed — that Covid-19 will go away this spring as warmer weather arrives in the Northern Hemisphere. Transmission around the world could continue for months.
The lockdown imposed by the Chinese government in Hubei, the province worst hit by the disease, substantially reduced the number of new cases for a time. But even that has limited benefits. As China tries to return to work, public transportation resumes and citizens start moving about, there will likely be a major rebound in cases. Unless an entire population shelters in place for many months, infectious agents like influenza or this coronavirus will find people to infect.
In other words, a lockdown is mostly a delaying tactic. By distributing cases over time, it can help manage an outbreak — but only if it takes place against the backdrop of a robust health care system. Yet even the best system is too fragile, and a moderate increase in infectious cases, whether from a seasonal flu or Covid-19, can quickly overwhelm resources, in China or the United States.
As chilling as it is to imagine this scenario, what happened in Wuhan, the Chinese city at the epicenter of the outbreak, will likely play out elsewhere, too. Hospitals might have to turn away all but the people most seriously ill; their ability to handle their usual load of patients with heart attacks, critical injuries or cancers may be severely compromised.
In a world ill-prepared for a potentially life-threatening, easily transmitted disease like Covid-19, the most effective way to mitigate the pandemic’s impact is to focus on supporting health care systems that already are overburdened.
Osterholm knows his stuff, and perhaps for that reason his colleagues call him "Bad News Mike." In 2017, he and Olshaker published Deadliest Enemy: Our War Against Killer Germs, which I reviewed for The Tyee. It's worth reading for the excellent background it offers on how we've set ourselves up for outbreaks like this one.
