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What happens next in the coronavirus outbreak? We mapped 8 scenarios.

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We are at a crucial moment in the outbreak of the new coronavirus in China. Depending on who you ask, we are already in a pandemic, which means that there are continuous epidemics of the virus on two or more continents; we rush to one; or we are on track to avoid a spiral crisis.

As of February 6, more than 28,000 people have been infected with 2019-nCoV, as the respiratory virus is known, and 565 people have died. There are also nearly 200 cases in 26 countries besides China, including one death in the Philippines. This number represents a tragic and surprising increase over a month ago, when there appeared to be no more than 50 patients with the virus in Wuhan, the city in mainland China where the virus is believed to have originated.

There is still so much we don’t know about 2019-nCoV, including how exactly it is being broadcast, where it is spreading and how deadly it is. And that uncertainty is important because viruses have fun ways to surprise us: the “swine flu” H1N1, which was a pandemic, proved far less deadly than feared. (A disease can be pandemic and not particularly serious.) Meanwhile, Ebola has been known to science for decades and has behaved in a way that surprised infectious disease experts by surprise during the 2014-2016 outbreak in Africa West.

Given the unknowns on 2019-nCoV, in the coming days and weeks, some twists and turns await us. For now, many experts believe that this outbreak could worsen: overload the Chinese health system, spread to the poorest countries with weaker health systems and get sick and kill thousands of people along the way. Alternatively, it could improve a lot, with new cases and deaths steadily falling. These are the key factors that will determine which path you will take.

 

4 ways this outbreak could get worse

 

1) China cannot contain the new coronavirus
China first reported this outbreak to the World Health Organization on December 31, 2019. Since then, scientific reports have emerged suggesting that the disease probably started to spread several months earlier, sometimes last fall. In any case, this means that in a few months the virus has infected at least 28,000 people in China and has spread worldwide. This is an unusually rapid increase for a new virus. It’s also surprising when you consider the draconian measures that China has taken to control the virus, including an unprecedented quarantine of over 50 million people.

 

And there is a very real possibility that the real number of cases will be even greater, since China may not be able to find and detect new cases, people with mild diseases may not go to the hospital and therefore do not know how to count. and other countries may not look for cases (we’ll talk more about it in a second).

In addition, there were also questions about China’s willingness to share the data and whether officials honestly tell us the extent of the problem. According to a new model, published in The Lancet by academics from the University of Hong Kong, 75,000 people could have been infected only in Wuhan by January 25th.

What does all this mean?

“Apparently, if it continues to accelerate, a pandemic is very likely to occur,” said Tony Fauci, director of the National Institute of Allergy and Infectious Diseases. There will be more diseases and deaths not only in China, but also in other countries of the world, as cases grow from single travelers or small groups to full-blown outbreaks.

He also suggests, he added, that “don’t try to control [the virus] because it’s already everywhere”. Therefore, public health officials would move away from trying to contain the virus to mitigate its impact, setting up hospitals to isolate and treat patients, make recommendations for “social distancing” (such as cancellation of public events) and propose evaluation protocols. for the many people who may need hospital treatment.

 

2) The new coronavirus is widespread in countries with weak health systems.
Of particular concern is the potential for the virus to start spreading to countries with weaker health systems, where officials would have more difficulty limiting the spread than China. Or maybe it already is. “As far as we know, this is already endemic in several countries,” said Tom Frieden, former director of the Centers for Disease Control and Prevention. “If this spreads widely like the common cold, China can’t control the common cold either.”

China is a high-middle-income country with a world-class network of scientists, a reasonable number of health workers per person and a solid disease detection network aimed at detecting new outbreaks as they occur.

 

But many countries around the world don’t have these advantages. This is part of the reason, for example, it took months to identify the 2014-2016 Ebola epidemic in West Africa, which eventually made more than 28,000 people sick and killed 11,000.

Saad Omer, director of the Yale Global Health Institute, says that outbreaks in these low-income settings are a particular concern, and not just because they are more likely to be overlooked.

“We know that the [mortality] of a disease differs by population,” said Omer. “It’s better when a healthcare system is more robust and worse when the healthcare system is a problem.” So even though this new coronavirus doesn’t look very deadly in China at the moment, the same may not be true of African countries. And Africa could run a special risk because of its ties to China, with over a million Chinese workers there.

3) The virus is indeed more deadly than it appears at the moment

A distinctive feature of the Spanish flu pandemic of 1918 was that it not only benefited young and old; He killed seemingly healthy people in the midst of life. And even if the mortality rate, or the number of deaths per infected person, was only 2.5%, because the world population was naive towards the virus and the virus could easily spread and kill large sections of the population, Quel 2 , 5 percent meant 20 million to 50 million people who died at the end of the pandemic.

With the new coronavirus, “deaths still seem to be in people at risk of dying from other respiratory diseases: the elderly and people with underlying conditions,” said Jennifer Nuzzo, an infectious disease expert and scholar at the Johns Hopkins Center. for health security. So unlike the Spanish flu, the virus novel doesn’t seem to kill young, healthy people yet.

But the 2019-nCoV mortality rate is also around 2% right now, added Nuzzo at the same time. (It may be a little higher in Hubei, the worst hit province in China and home to Wuhan.)

If this is true, “it would be bad because of the numbers it is infecting.” In the worst case of a global pandemic, a 2% mortality could “translate into many diseases and deaths”.

 

4) Travel bans isolate countries, spread xenophobia and aggravate outbreaks

Last week, Russia, Singapore and Australia sealed their borders with China while the United States government. UU. He significantly increased his response, declaring a public health emergency, issuing his high-level travel warning (which basically says “don’t go to China”) and temporarily prohibits the entry of foreigners who have recently been to China.

The consequences of these movements are influencing much more than public health; Threaten everything from the global economy to the Chinese manufacturing industry, and even the business in Chinese restaurants away from the hot zone.

Reports are already piling up to suggest this virus and the global reaction to it has exacerbated anti-Chinese sentiment, with Chinese individuals facing new types of discrimination. And this adds to the shortages of food and medical supplies in China.

Beyond the psychological and economic costs, isolating China could have far-reaching effects on the response to the outbreak, that is, spreading fear and pushing cases into hiding.

“[Send] a signal to other countries that may fear that the United States [or other countries] will ban travel and make things difficult in other ways,” said Nuzzo. And that’s not exactly an incentive to honestly report outbreaks beyond China. Indeed, other countries may have an incentive to hide cases.

“Right now we are focused on the disease that comes from China to the United States,” said former “Tsar Ebola” Ron Klain, “but may soon come from other countries in the United States.” If countries do not report what is happening within their borders, stopping the spread of this disease will be even more difficult.

 

 

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