Thanks to significant progress in medical research, advance means of diagnosis and rapid response systems in place, as a species, we have an outstanding ability to detect, handle and contain a new outbreak. Surely competent nations must have invested heavily in disease prevention and control, and repeatedly tested readiness and preparedness under both real and simulated conditions.
For a century, the 1918 flu pandemic remained the benchmark against which all other outbreaks have been evaluated. Just over a couple of months ago, the world witnessed a new epidemic of a novel coronavirus infectious disease, coined Covid-19, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus apparently emerged in China and has since been exported to at least 114 other countries. Limited data indicate that Covid-19 can seed more than two secondary cases for every primary case. The World Health Organization (WHO) was quick to declare the epidemic a Public Health Emergency of International Concern, before reclassifying the disease as pandemic, on the 10th of March.
Alas, unlike the Greek myth of Pandora’s box, SARS-CoV-2 did not arise from a jar. Its RNA sequences closely resemble those of viruses that normally co-exist in bats. Epidemiological evidence pinpoints a virus originating from bats and infecting one or more unidentified animal species, presumably sold in a live-animal market, in Wuhan, China. We have recently seen many such emerging zoonoses, including the 2003 bat-coronavirus– derived SARS.
Like many others, I too have been somewhat baffled by the draconian measures being taken by countries worldwide in the fight against the common enemy. Isn’t it fascinating that despite a century worth of breakthroughs in medical research, including the discovery of insulin, victory over many forms of cancer, the advent of antibiotics and vaccines against killer diseases such as measles, rubella, diphtheria, mumps, polio, etc., we remain susceptible to the most microscopic enemy? I couldn’t help but wonder what all the fuss has been about!
Much ado about nothing?
If for most people, Covid-19 is predicted to be a mild illness, then why are countries across the world closing borders, businesses and schools?
Could it be because according to an analysis published by the World Health Organization (WHO Interim Guidance 13 March 2020), 14% of all those affected with Covid- 19, are predicted to develop severe form of the disease that will necessitate hospitalization and oxygen support, and 5% will require admission to an intensive care unit? So, if we do a simple mathematical calculation, assuming that in a country 100,000 people acquire the virus, a whopping 14,000 will become severely ill and a significant 5,000 will require intensive care. The question therefore is how many intensive care beds are there in any given regional hospital such as the SSRN Hospital? OK, so perhaps it is unfair to put the spotlight on Mauritius. Let’s take a major hospital like the St George’s Hospital in the UK, which serves 1.3 million inhabitants in South West London. It has a respectable 1 300 beds, of which only 60 are within the critical care unit.
Assuming hypothetically that 100,000 inhabitants in its region got Covid-19, how will this part of London cope with the estimated 5,000 critically-ill patients requiring intensive care? The plain truth is that no nation to date can cope with such a demand at any one time. With just 60 critical care beds, who gets priority and who does not, and who gets to make such life and death decision? These are questions we probably need to start asking whether we like it or not. This simple calculation illustrates the rationale of “flattening the curve” which big nations have been going on and on about for weeks. A huge peak in the illness will overwhelm any healthcare system.
OK, so assuming we manage to somehow flatten the curve and spread the peak over some weeks or even months, what’s next? The Chinese scenario? Yesterday has been a landmark for Wuhan where after nearly two and half months of ordeal, only one domestic case of Covid-19 was reported. Ironically, the province also recorded 20 imported cases! So where does this end? If China does not regulate its borders, is it probable that the country faces another outbreak?
We have all heard of the hypothesis of “herd immunity”, that is the virus keeps spreading until the outbreak fizzles out. However, the caveat remains that like any other virus, what happens when this one mutates and becomes capable of re-infecting all over again, similar to the seasonal flu. What would our response be? Another global lockdown?
The point is crystal clear. This is unprecedented. We have had countless analysis of the potential impact of the outbreak on businesses and the economy. However, it is fair to say that without its people, the workforce, an economy would hold little value. So, what could be the implications for an under-populated island like Mauritius where a significant proportion of its people have co-morbidities such as diabetes/uncontrolled blood sugar levels, heart disease or hypertension and nearly 20% are elderly?
Although one would argue that this is perhaps the first time in a hundred years that we are faced with such a challenge, shouldn’t we begin to question whether there is sufficient investment on global preparedness and readiness to novel infectious diseases? Shouldn’t we question whether enough is being invested in medical research?
Diseases have always been man’s greatest threat. Interestingly, measles and smallpox viruses were the first to infect humans over 200 years ago. Two centuries later, mankind remains vulnerable to the most minute biological agent which cannot even replicate on its own!
By Dr Reshma Ramracheya
Director of Pharmaceutical Operations at CIDP, Mauritius Diabetes UK RD Lawrence Research Fellow, University Research Lecturer and Senior Fellow at Wolfson College, University of Oxford.