The epidemic of coronavirus which is currently raging through China and beginning to
spread further afield is one of the most significant outbreaks of infectious disease in recent years.
The disease is currently causing havoc in China and parts of South Asia. For hundreds of thousands of people, the coronavirus outbreak has meant the loss of modest livelihoods, food security and the power to travel. At least 40 million people are currently locked down in many Chinese cities. There is also evidence that the virus is surging and continuing to spread every day.
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So far more than 20 countries around the world have reported cases of the virus and it has overtaken that of the Sars epidemic. There were about 8000 cases of Sars but so far there have been more than 17,000 cases of coronavirus and 426 deaths with the numbers increasing every day. Deaths also now outnumber the deaths associated with the Sars pandemic.
On January 27, for example, there were 1771 new infections in mainland China, the largest one-day jump since the outbreak started in December.
Sars is estimated to have cost the global economy more than $30 billion. Possibly, coronavirus could have a bigger impact on the world economy.
Coronavirus is not a new disease. It has most likely been around for centuries as a natural infection of wildlife in parts of Asia. Presumably it simply circulated among wild animals, many of whom became immune or only experienced minor infections.
Occasionally an epizootic might take place and it was during such times that other species including humans became most at risk. Once it makes contact with humans, the virus seems to assume a more pathogenic mode, spreading easily and causing many cases and higher mortality. If nothing else, it reveals the strength and importance of the biophysical environment and our continuing ignorance of its importance in our lives.
In addressing this coronavirus and the possibility of another pandemic, we need to appreciate that epidemics and pandemics have two major dimensions.
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In the first case there are simply cases and deaths. In the second, there is a psycho-social dimension involving human reaction, fear, hysteria and panic. Sars and bird flu demonstrated how human reaction could easily outweigh the simple numbers of cases and deaths. Unfortunately this remains one of the major problems in preparing and implementing response plans at the international and national level.
It is also not helped by the dissonance that exists between health experts and ordinary people regarding the concept of risk.
Risk to health experts and governments is a definable, measurable phenomenon, usually arrived at by statistically analysing those exposed to the disease and coming up with a list of cases and deaths.
For most of us, however, risk is not related to empirical evidence but shaped by personal attitudes and the way we view the world around us. Risk for most of us is a social phenomenon, socially constructed, emotional and influenced by the people around us.
There is little doubt that we all harbour deep-seated fears about contagion and irrational
fears about who might be to blame. Unfortunately, national and international official reaction to epidemics such as coronavirus simply concentrates on cases and deaths and the geographical spread of the disease rather than taking into account how people react.
There is little doubt the media plays a critical role in all of this. Media coverage governed to some extent by competition for news, plays up the spectacular side of epidemics, both
visually and by the use of emotive words and headlines.
Epidemics of infectious disease have affected us for more than 1000 years and we continue to underestimate the significance and power of the biophysical environment and the fact that the microbial world reveals a dynamism that confirms the strength of evolution in the natural world.
Our assault on infections such as coronavirus rests on the false assumption that we are confronting a stationary target against which we can simply level a magic medical bullet.
We also tend to believe we are the dominant species in a world which almost by accident contains disease agents. There is an alternative view which sees humans as just one of a series of competing species in a world where many processes are cyclical, waxing, waning and evolving.
Microbes, as with all living things, have been selected for survival and mutate and change with ease against the drugs we develop and level at them. The coronavirus outbreak, like Sars and bird flu, reveals just how much we have underestimated the complexity of our environment and the capacity of species to adapt and evolve and the fact that we have placed too much reliance on antibacterial and anti-viral drugs to free us from disease.
The coronavirus outbreak also demonstrates the destabilisation of the historically often fragile relationship between people, animals and the biophysical environment.
The equilibrium between humans and microbes has been honed by centuries of contact, by the development of the human immune system, by social, economic and political mores and by human behaviour.
Periodically, this delicate relationship can be disturbed, ether by environmental change such as natural disasters, by changes in human behaviour such as interacting with natural animals for the purpose of food as seems to have happened in the coronavirus outbreak, and by the way we alter and modify the biophysical environment by such things as deforestation, road construction, agricultural development, irrigation, dams, mining or by urban expansion.
Such factors could initiate the emergence of a new infection by disturbing natural disease reservoirs, changing the ecology of micro-organisms and/or by exposing humans to new pathogens.
Coronavirus is a good example of all this and reveals just how vulnerable we remain and that we tend to ignore the role of the microbial world and the biophysical environment.
So what does our future hold? Well, barely a year goes by without the appearance of a new viral disease or an older one re-emerging. There is little doubt that we are living in an era of infectious disease and I have real doubts we fully recognise this or know how to handle it.
• Auckland-born Peter Curson is Emeritus Professor of Population & Health with the Faculty of Medicine & Health Sciences at Macquarie University