EMERGENCY RISK REDUCTION

This Coronavirus has hit and its impact has been severe! I am dumbfounded and staggered to see the speed with which it has moved, and the toll it has taken – physically, socially, economically.  There is so much to say, and you may know that I am opinionated, so here goes.

Along with a degree in Emergency Management and advanced degree in Agriculture, I somewhere along the line got a certification in ‘Animals in Disaster’. Why is this relevant?  Over the years, I’ve witnessed  livestock disasters from three primary sources: 1) floods, 2) fires/wildfires, and 3) diseases. Flooding and fires are sad and can be disastrous, but are usually localized. Diseases are different, and can be catastrophic, widespread, and a cost into the billions.  Why linger on animal diseases during a coronavirus discussion? Because 2/3 of all diseases are “zoonotic”, i.e. transmissible from animals to humans. This includes every major viral outbreak in the 20^th and 21^st century.

Pathogens are fascinating to study. Virus ‘sub-types’ cover the H-N complex of proteins that invade living cells, kill them, and then move on to the next. Ultimately the animal or human can die. Some viruses are more virulent than others. The four human pandemics in the past hundred years have been: H1N1 (1918-20), H2N2 (1957), H2N3 (1968), and H1N1 (2009).  The first, Spanish Flu, was stunningly lethal for all human age groups, with an estimated 500 million contracted and 100 million dead.  Its viral cousin 90 years later, nH1N1 was scary, but fortunately ‘low pathogenic’, and much less deadly, with approx. 12,500 deaths. The health community felt it had dodged a bullet. I was at a World Congress on Disasters and Emergency Medicine at the time of the outbreak. Many attendees were scurrying in and out for conference calls with worried looks of their faces. It was warranted.

Allow me to backtrack to 2003 when SARS (Sudden Acute Respiratory Syndrome) hit. It was considered an epidemic, reaching 24 countries, infecting 8000, and killing 775.  Not earthshaking but important because it was the first ‘novel’ (new) coronavirus strain. Coronavirus is a well-known family of viruses, two of which are the common cold.  Epidemiologists saw nSARS-CoV as a shot aimed directly at them that missed.  Then came the novel H1N1 in 2009, as mentioned above, which also missed.

MERS (Middle Eastern Respiratory Syndrome) erupted in 2012 but garnished little Western press, because it was centered in Saudi Arabia. MERS infected approx. 2500 and killed 858, so was a virulent strain. As importantly, it was yet another novel coronavirus. And epidemiologists knew they needed to create a plan of attack.

From 2014-16, Ebola hit and hit hard. Mainly centered in West Africa (Guinea, Liberia, Sierra Leone), it reached at least a dozen countries, with 28,600 reported cases, and 11,325 deaths – a notably lethal virus. Thankfully, an unusual characteristic of Ebola is that it dies out by itself – it kills its ‘host’ too fast and therefore doesn’t spread very far.  Epidemiologists and virologists know that if the proteins in the Ebola virus ‘reassort’ (i.e. mutate) to where it does not kill its host as quickly, look out!  It could make CoV look like a sore thumb in comparison.

The above sequence of viral outbreaks has been instrumental in the response to the coronavirus which began in Wuhan, China in December and January. Sadly, China knew of this CoV outbreak and tried to cover it up. Had the information been shared early, this pathogen could have been contained, or at least the spread reduced. By the time of China’s acknowledgement, the spread was international and uncontainable.  The WHO should have pressured China, instead of diddling around (during critical days of the spread) to find a ‘politically-correct’ name that would offend no one.  But, having worked in the past for the UN, I will stay away from politics!

Only after the pathogen had firmly anchored itself in numerous countries did health professionals and then politicians call for adaptive behavior from its citizens – social distancing, hand washing, etc.  But this was too late for some countries, esp. cultures that differ from our own (i.e. Italy, Spain, Iran), and some large cities already with overburdened health care systems (New York, New Orleans).

The adaptive behavior has taken several forms. My daughter Rachel and I visited family in the US for a few weeks, returned March 16, and have been in a 14 day self-quarantine. I thought this was unique until realizing that most of Canada seems to be in a lockdown. You may know that borders are largely closed,  ‘non-essential’ travel is banned, and most ‘non-essential’ businesses have closed. Had Rachel and I delayed a week, we probably would not have been allowed to travel.

My personal opinion (yes, I am opinionated!) is that the pendulum which started its movement too slowly at first, became appropriate for some days (i.e. shutdowns and personal adaptive behaviors), has now swung too far and is now causing more harm than help at this time.

I will explain more in the next blog. Thanks for reading.

Be well.

Monty