Editor’s Note: Laurie Garrett is a Pulitzer Prize-winning writer and policy analyst, and the author of “The Coming Plague: Newly Emerging Diseases in a World Out of Balance.” The views expressed in this commentary belong to the author. View more opinions at CNN.
On this date 17 years ago, I was covering the severe acute respiratory syndrome (SARS) virus for several months as it spread across Asia, eventually reaching 37 countries, sickening 8,098 people and killing 774 of them.
So, as I read the first reports of a cluster of animal-market related illnesses, with the first patient exhibiting symptoms of pneumonia as early as December 12, 2019, I had a chilling sense of déjà vu. By New Year’s Eve, it was obvious something akin to SARS – as it turns out, the Wuhan coronavirus is in the same family of viruses as SARS and MERS (Middle East respiratory syndrome) – was unfolding in China.
The mysterious pneumonia virus that emerged from a live animal market in China’s central city of Wuhan last month has now infected far too many people, over far too vast a geographic area, to be easily controlled.
The Wuhan coronavirus – part of a family of viruses that are common among animals and can cause fever as well as respiratory symptoms when transmitted to humans – has been found in cities all over China, and travelers have since spread the virus to several countries, including Singapore, Japan, Vietnam, Taiwan and South Korea as well as Hong Kong and Macau.
The first American case – involving a man in his 30s who recently traveled to Wuhan – was confirmed outside Seattle on January 21, before the Centers for Disease Control and Prevention announced on Friday a second case in Chicago. As of Friday, at least 41 people have died from the illness.
I warned that China appeared to be taking more aggressive steps shutting down social media posts, arresting people accused of spreading “rumors” and capping the flow of information about the outbreak than it was halting the transmission of the virus. For more than a week, the reported number of cases barely changed after local authorities shut down the Huanan Wholesale Seafood Market, the putative source of the virus. And authorities insisted the cause was neither SARS, nor similar viruses like the flu, avian flu, or MERS.
They also repeatedly stated that there was no evidence of human-to-human spread of the disease (which turned out to be false), leading the World Health Organization and outside world to believe that closing the live animal market effectively brought the outbreak to a halt.
As recently as January 18, the Chinese Center for Disease Control and Prevention posted stern warnings against paying heed to “rumors” and insisted there were no cases of the disease in hospitals outside of Wuhan, adding that the outbreak was “preventable and controllable.”
But we now know that was far from true.
Officially, there are more than 1,000 cases of the Wuhan coronavirus. Unofficially, however, the toll is likely to be far higher, and more than 20 Chinese cities have reported cases of the coronavirus.
Separate studies from London’s Imperial College and Hong Kong University Medical School estimated that some 1,300 to 1,700 people were infected during the first week of January, when Chinese officials reported just a handful of cases and downplayed the epidemic’s severity. This week, the Imperial College team estimated that there were a total of 4,000 cases (with the possibility of up to 9,700 cases in the worst-case scenario) by January 18, when the official tally was still at 62 cases.
Using a different statistical method, scientists at Northeastern University in Boston reckon that 5,900 were infected by January 23.
Despite the wide disparity in the figures, this new epidemic seems poised to eclipse the scale of the 2003 SARS epidemic, and is already well outside of the reach of simple control measures.
Hong Kong University virologist Guan Yi, who was part of the team that discovered the SARS virus, tells the Washington Post that the epidemic is so out of control now that “a bigger outbreak is certain.” He said that even with a conservative estimate, the outbreak could be 10 times bigger than the SARS epidemic – with a reach of more than 80,000 cases.
Speaking on background, other SARS veterans tell me there may already be “many thousands” of infected individuals in China.
Because authorities initially downplayed the seriousness of the outbreak instead of implementing swift control measures, people have traveled to and from Wuhan – a major transportation hub with a population of 11 million people – and unwittingly carried the virus with them.
Chinese authorities have shut down flights, ferries, highways, and trains leaving Wuhan, as well as public transportation within the city. Twelve other cities in China have issued travel restrictions in an unprecedented move to contain the virus just days before the Lunar New Year on January 25, which usually ushers the largest human migration on earth, with hundreds of millions of people traveling to see relatives.
Following my January 8 claim that the Chinese government was covering up a significant epidemic, pressure mounted from United Nations agencies, Ministries of Health worldwide and the scientific community. Finally, Wuhan provincial communist party chief Jiang Chaoliang, and his counterparts in neighboring districts, came under veiled criticism from President Xi Jinping who ordered Party leaders to “put people’s safety and health as the top priority and take effective measures to curb the spread of the virus.”
On January 20, China’s National Health Commission designated the new disease a Class B infection, although it was treating the virus as a Class A infection – meaning mandatory quarantines and community lockdowns may be used to stop its spread.
And the following day, the Central Political and Legal Affairs Commission posted on social media that, “Anyone who puts the face of politicians before the interests of the people will be the sinner of a millennium to the party and the people.” The commentary also warned that “anyone who deliberately delays and hides the reporting of cases out of his or her own self-interest will be nailed on the pillar of shame for eternity” and stressed that transparency was the best defense against rumors and widespread fear.
Not surprisingly, reported numbers of cases from all over China jumped dramatically after Xi’s speech and subsequent pressure from Beijing. This has confused matters considerably, making it impossible to tell how much of the soaring epidemic toll is due to a surge in actual new infections, versus release of case numbers that local authorities had been covering up.
Worse, despite calls for openness, SARS hero Dr. Zhong Nanshan, who was celebrated for his 2003 efforts, gave a televised interview on January 20 in which he warned that 14 healthcare workers were infected in Wuhan, the risk to medical personnel is acute, and severity of threat will rise if the virus mutates. Zhong, who had initially made several appearances on Chinese television, has not been featured on broadcasts in recent days, with some speculating that the government is now silencing him.
But Zhong’s warning represented sound science. As the leading Chinese virology team wrote, after comparing the genetics and proteins of the new virus and SARS, “the Wuhan nCoV poses a significant public health risk for human transmission,” because it – like SARS – has the ability to bind to a protein found on the surface of most human lung cells. “People also need to be reminded that risk and dynamic of cross-species or human-to-human transmission of coronaviruses are also affected by many other factors,” like the host’s immune response, the speed with which the viruses can multiply inside human lungs, and the potential mutations that might make the virus more virulent or transmissible.
Regardless of how transparent Beijing may now become, what I witnessed tracking SARS across Hong Kong and China, and subsequent investigations of sites hit by the disease in Hanoi, Bangkok, Singapore, Toronto and Hong Kong augurs poorly for this new viral epidemic and China’s ability to bring it to a rapid resolution.
While 17 years has brought significant improvements in virology, diagnostics development, international health regulations and the WHO, and we know more today about the nCoV2019 virus (as the Wuhan coronavirus is awkwardly dubbed) than we did one month into the SARS epidemic, there is no magic wand that can wave this highly dispersed, airborne-spread, human-to-human transmitting microbe away.
After the initial coverup, Beijing is now executing the playbook that ultimately stopped SARS. The city of Wuhan is now on lockdown and fever checkpoints are operating in most major transit hubs across the country while Lunar New Year celebrations have been canceled. Instant contagious quarantine 1,000-bed facilities are under construction, with one due to open next week outside Wuhan. One key step – closing all live animal markets nationwide – has not yet been implemented.
I discovered in 2003 that wildlife dealers and animal breeders sell their living creatures all over the country, so that an infected animal in one city’s market may well have a counterpart from the same dealer, on sale in another market hundreds of miles away. It is not yet known what beast was the source of nCoV2019, though one study suggests, based on genetic analysis of the virus, that it came from a snake. The SARS virus was transmitted to restaurant workers who bought and slaughtered live civets – raccoon-like animals in a Guangzhou live animal market, which I investigated before authorities shut it down.
Like the Guangzhou market, Wuhan’s Huanan Wholesale Seafood Market sells a vast range of animals, including civets as well as other exotic wild animals. All live animal markets throughout China and neighboring Asian countries should be shut down immediately, and not reopen until the source of the nCoV2019 epidemic is identified. Until then, it should be assumed that any live animals sold in markets from Hanoi, Vietnam, to Ulan Bator, Mongolia, might be dangerous to hold, slaughter or consume.
To stop the SARS epidemic in 2003, governments, hospitals and public health authorities resorted to measures that mirrored infection control in the early 20th century, focusing on taking temperatures to find individuals with fevers, and then placing those people – regardless of the causes of their febrile states – in mandatory quarantine. Eventually, with the feverish souls separated from the rest of humanity, the virus stopped spreading. By June 2003 the Chinese government was able to declare victory over SARS, eight months after the virus first emerged.
Here is what it will take, then, to stop the Wuhan virus.
First, the flow of people who are infected has to stop and transportation across the entirety of China must be monitored or restricted. The Wuhan animal market from which nCoV2019 arose is located less than 0.5 miles from one of the city’s train stations, where several high-speed rails stop. It must be assumed that people, and their live animals, walked that short distance earlier this month to take the trains – possibly carrying the virus with them to cities across China.
A post from Wuhan Railway that has since been deleted said 300,000 people traveled out of Wuhan by train on Wednesday. It is imperative that the tough lockdown measures unfolding this week presage nationwide travel restrictions.
During the SARS epidemic, a brave military physician leaked medical documents to Time magazine, providing proof that SARS patients were secretly being treated in People’s Liberation Army facilities in Beijing. Once word was out, I watched as tens of thousands of Beijing residents climbed onto trains, fleeing the city – and taking SARS to every corner of the country.
After the exodus from Beijing in 2003, authorities erected fever check stations in every air, bus and train terminal in China, and placed policed health stations along the nation’s highways. Fever-check stations were so abundant that I was typically tested 10 to 12 times a day in Beijing, and every 10 to 20 miles while driving on major highways.
The Chinese government has started erecting a network of fever stations in transit hubs, and I expect this will ramp up considerably over the coming week. Social media posts already show several photos and videos of officials erecting roadblocks, barricades, and traffic diversions to police-manned fever stations and similar measures reminiscent of what I witnessed in 2003.
Currently, family members of known nCoV2019 patients are tested for infection and placed under surveillance. Chinese authorities are already tracking hundreds of close contacts of known patients, and this will escalate radically over coming days. Apartment complexes and hotels that are known to have housed a nCoV2019-infected person will also be scoured.
There must also be a safe place to quarantine people who are running temperatures. In 2003 I watched in frank astonishment as teams of Chinese workers erected entire hospitals – complete with air filters, special sewage systems and electricity – in just days, province-by-province. A similar effort is now underway in Wuhan.
By far the most important measures to stop the Wuhan coronavirus will be those related to hospitals and how well medical teams can contain the virus. Both MERS and SARS spread like wildfire through unprepared medical facilities, regardless of the comparative wealth and sophistication of the hospitals. Most of the SARS cases in Hong Kong went to two hospitals: one had just a single healthcare worker infected, while the other suffered terrible losses in both health workers and patients who were being treated for other medical ailments.
The key difference? The teams in the better hospital had years of infection control training, which taught staff to work in teams and make sure that any contaminated protective gear was safely removed without contact with the skin, face, eyes or hands.
Over the last few days, many Chinese social media users have posted dramatic videos and photos of over-crowded hospital emergency room facilities, in which frantic patients and family members are crammed together and healthcare workers are hard-pressed to control the influx, as the infectious spread of the virus is surely occurring. In the SARS epidemic, hospitals eventually realized the need to set up fever check stations outside the facilities, screening would-be patients, and ushering febrile individuals into an entry separate from other hospital admissions.
In Toronto and Singapore, which have remarkably good healthcare systems and state-of-the-art facilities, hospital workers struggled mightily to stop spread of SARS, and healthcare workers who were infected died. In some of my discussions with physicians and nurses that went through the SARS nightmares, I have learned that the wealthier facilities were, perhaps, at greater risk because they had more equipment and procedures to apply to patients, including intubation and lavage, which was used to remove fluids from the lungs that built up in response to infection.
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When SARS hit Hanoi, patients were originally taken to the prestigious French Hospital, where modern interventions were used, but the virus readily spread, taking the lives of doctors and nurses. When patients were moved to the far less sophisticated Bach Mai Hospital, which lacked some of the more advanced equipment, windows were open due to a lack of air conditioning.
According to some of the doctors, this slowed the spread of the virus by preventing it from adhering to surfaces and people in the hospital.
China is likely to take a serious economic hit as a result of the nCoV2019 virus. The SARS epidemic cost the global economy $54 billion, according to a World Bank estimate, and the Wuhan coronavirus is likely to affect Chinese tourism and trade. Seventeen years after SARS, China – now the second largest economy in the world – is likely to experience a higher scale of costs and burdens to execute nationwide containment strategy. But Beijing has no choice. The virus is already everywhere.