The global pandemic caused by the Covid-19 virus has taken the whole world in its wake; causing the coronavirus disease in over 200 countries worldwide. The virus, first emerged in the city of Wuhan, China in a wet market in December of 2019 and has spread at an accelerated, unprecedented rate infecting close to 2 million globally as of April 15th 2020, confounding governments, causing mass scale lockdowns, and putting a massive burden on the health care services. Could it have been controlled?
When the first images of people dying in Wuhan started flooding the headlines globally, the rest of the world did not imagine that it was perhaps only a matter of time before the same scenario will play out in their own neighbourhoods. The scientific community was observing this and raising early red flags; however, many governments were not ready to make tough decisions which were underpinned by strong scientific evidence.
Lack of science-based decision making
Rapid information sharing between scientists had started in early January; they were communicating beyond the national borders on this fast-moving health crisis. Top scientific journals were readily publishing Covid-19 related research; viral genomes were being analysed instantaneously and biologists were sharing their findings on preprints and social media too.
The scientific community stepped up and broke the mould of slow publication times. By end of February, more than 283 papers had already appeared on preprint repositories and 261 published in peer reviewed journals. Many top international research publications had made their coronavirus-related research and data open to enable sharing of information and to find solutions to curb its spread.
Yet many countries, including the U.S., Italy, and UK made early decisions not based on scientific recommendations, but on their political biases. The controversial decision in the UK of not enforcing social distancing, not offering schools or office closings were questioned by national and international community. UK eventually backed down on the approach, which seemed to be based on developing herd-immunity by letting its citizen exposed to virus, but it was clearly too late to halt the spread of the disease and deaths.
Role of central disease control
From the very early days of this crisis, the World Health Organisation was urging nations to prioritise aggressive testing of cases, and quarantining of their contacts, but many nations did not adopt it as declared policy priority. WHO Director-General Tedros Adhanom Ghebreyesus had implored in mid-March saying: “The idea that countries should shift from containment to mitigation is wrong and dangerous.” He added: “You can’t fight a virus if you don’t know where it is. That means robust surveillance to find, isolate, test and treat every case, to break the chains of transmission.”
The Centre for Disease Control (CDC), USA’s foremost agency for fighting infectious diseases and with experience of fighting the Ebola crisis, was conspicuously absent from the centre stage when the country was at the precipice of mass-scale outbreak. A science-based approach was ignored during the early stages of the pandemic when it could have halted or slowed the spread of the virus.
Knowledge gap from China
There was also information gap about the SARS CoV-2 and its spread from where it first took its main casualties – China. A WHO-CDC Joint Mission on Covid-19 report published on Feb 15th 2020, had said that there were key unknowns in a number of areas including the source of infection, pathogenesis and virulence of the virus, transmissibility, risk factors for infection and disease progression, surveillance, diagnostics, clinical management of severe and critically ill patients, and the effectiveness of prevention and control measures. These were knowledge gaps and that China needed to timely fill to enhance control strategies. Even to the date, the doubts persists about the accuracy and transparency in their reporting to the total number of infections and deaths.
The report had clearly highlighted that much of the global community was not ready, in mindset and materially, to implement the measures that have been employed to contain COVID-19 in China. And that the virus could spread with astonishing speed; they recommended highest levels of national Response Management protocols and that true solidarity and collaboration was essential at this time from the international community.
The coordinated response from countries was missing until it was too late. International flights were still flying and people on ‘spring break’ in Europe and North America were travelling between continents and nations; easily carrying the virus from one to many.
Taiwan, closest to China, and most at risk showed exemplary containment of the virus spread. Its troubles with WHO notwithstanding, other countries could have learnt from their protocol and followed suit. Taiwan managed the crisis early and imposed strict border control, case identification and containment. Simple measures such as compulsory use of face masks which was implemented in Taiwan in the very early days is still not commonplace in other countries of Europe and Asia which are actively fighting Corona.
This pandemic is the biggest global crisis to hit the world since the World War and needed global leaders to share information and follow universal protocols that could limit further spread of the virus, share equipment, drugs, PPEs for medical staff, and take contingency measures to prevent the world economy from sinking. Yet, countries have been struggling to fight the burden of the disease alone, whereas its footprints are same everywhere.
Unprepared healthcare systems
The world was woefully underprepared for an this once-in-a-century pathogen that leaders like Bill Gates had been warning about. In an article in 2010, Gates wrote how unprepared the world was for even the H1N1 crisis.
Despite all the warning signs, countries allowed the virus to get ahead, causing a massive burden on the medical staff and infrastructure not just endangering them but also causing a severe strain on hospitals for beds and ventilators.
With inadequate healthcare spends, across the world and with persistent budget cuts for research for communicable diseases and vaccines, scientists and medical fraternity was already in a tough spot to deal with such a serious influx of patients and the burden of disease.
In a hugely populous country like India, expenditure on health is 1.6% of the country’s gross domestic product and total spending by the government on the health sector is approximately 1% of GDP. This is hardly commensurate with the expected fight power of the medical fraternity, if there is a full-scale community transmission on the horizon.
The worst is not over yet
When the Spanish flu first appeared in early March 1918, it only looked like a seasonal flu, albeit a highly contagious and virulent strain. It spread quickly in the army installations.
Cases dropped off over the summer of 1918, and there was hope at the beginning of August that the virus had run its course. In retrospect, it was only the calm before the storm. From September through November of 1918, the death rate from the Spanish flu skyrocketed.
In the United States alone, 195,000 Americans died from the Spanish flu in just the month of October. The second wave was far more deadlier. An estimated one third of the world’s population was infected with the virus– resulting in at least 50 million deaths.
History lessons are important as they have in them solutions and mitigations responses too. As cases of new infections in countries like China, South Korea and Singapore are being reported, there are rising concerns of a second wave. This is the ‘wait and see’ stage and testing an tracing are important as ever. A rapid development of a potent vaccine that induces mass immunity is the key to fight Covid-19.
Vaccine and treatments:
As the world is facing the worst public health crisis of our generation, the teams of dedicated scientists are going full speed ahead with the vaccines and drug development to combat the situation. The vaccine or drug development is a tough, long and arduous undertaking. Human safety is the foremost concern of any new vaccine or drug development, and therefore lots of regulations are in place to ensure rigorous evaluation of new drugs before it makes it to the humans.
We as global citizens should be thankful for the organisations like CEPI, the Coalition for Epidemic Preparedness Innovations, which was established in 2017 as a global collaboration between public, private, philanthropic and civil society organisations upon recognition that a coordinated plan is required to both develop and deploy vaccines in order to prevent future epidemics. The record speed with which vaccine development against COVID-19 is taking place is because of CEPI’s vision to fund many innovative vaccine technology platforms in the past.
A few of these technologies namely DNA or mRNA based approaches for vaccines are now already made it to the early phase clinical trials for safety in humans. Moderna , Curavac, BioNTech and Inovio are some of the small biotech companies benefited by CEPI, and now driving rapid the translation of these vaccines. Among mega pharmaceuticals, GSK, Sanofi, Johnson and Johnson are also in the race of producing safe vaccines to fight against COVID-19.
Among treatments, there are many antiviral compounds are currently being screened for their effectiveness against COVID-19. A few have been tried in Wuhan as investigational new drugs. A combination of two drugs Lopinovir/ritonavir turned out to be not effective in patients. Dozens of new trials are going on in Philadelphia, New York, Seattle, Germany and UK in unbiased controlled studies. One combination drug that is getting lots of attention is hydrochloroquine with azithromycin. Data regarding their success or failure may start to show up in next 3-6 weeks.
There are early indication of success of use of human plasma from individuals who were infected and recovered from COVID-19, suggesting that antibody against virus are effective in reducing the symptoms of severe disease. Blood drives are being organised in many countries to collect plasma from infected and recovered individuals so more people can be treated for severe disease.
Success stories from many nations:
While it is true that many people have died of COVID-19; however, if it were not for the long and tireless efforts of our health care workers throughout the world, there may have been four times more fatalities. The frontline doctors, nurses and health care staffs are risking their lives every day to save many more lives. If we are to show our gratitude for their sacrifices, we must maintain social distancing so new infections do not flood the emergency rooms. Remember the Ro value for this virus is 2.3, meaning each infected person is on average infecting 2-3 more people.
There are reports about protective effects of BCG immunisations, it is based on the fact that many European or north American nations do not have BCG in their childhood immunisation program, and the number of infections and deaths are higher in these countries. The counter argument is that, BCG is given in China, so why so many people got infected and died. India also has BCG immunisation program and yet the rate of infection is on the rise. So while it may offer some protection, by no means it is a full proof against the infection.
We can say with full confidence that social distancing works; it is our duty as a global citizen to help fellow humans by staying away from them. Taiwan, South Korea, Singapore are good examples to follow in the absence of a cure. They can do it so can we. It is difficult to go back in time and fix the issues of global leadership, rapid control of infection at the origin, coordinated and forceful efforts worldwide; however, we still learn, and can help control this pandemic at local and national level. Our habitat is beautiful and is worth saving.
Views are personal.
Sita Awasthi is research professor, Infectious Disease Division, Medical School of University of Pennsylvania. Vineeta Dwivedi is assistant professor, business Communication and head, digital communication at Bhavan’s S.P. Jain Institute of Management and Research.