LAST week, the World Health Organization raised its assessment of the global risk from the novel to Very High – its maximum level. The virus has escaped containment in at least four countries.
But the WHO is eager for nations to keep practising containment measures (see “Why the WHO won’t use the p-word”). These can slow the spread of the virus in countries that only have a few cases. But as long as it is circulating somewhere in the world, new cases will continue to crop up in countries even if they have effective containment practices.
Mike Ryan of the WHO said on 28 February that the goal isn’t to stop the virus spreading, but “to slow its spread so health systems can prepare”. But what will that take? Can countries around the world handle a pandemic? The short answer is no. “Health systems, north and south, are just not ready,” Ryan said emphatically.
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When the epidemic started in the city of Wuhan, in China’s Hubei province, a rapid build-up of severe cases overwhelmed medical staff. There wasn’t enough medical protective gear and there were insufficient intensive care beds – along with oxygen and ventilators needed to help people with severe pneumonia breathe – to meet the high demand. It also strained the delivery of ordinary medical care.
Bruce Aylward of the WHO, who led an international mission to study China’s response, noted last week that containment stopped the virus spreading generally and overwhelming healthcare in every Chinese province but Hubei, and mitigation measures aimed at preventing contact between people are driving case numbers down in Hubei. But this isn’t permanent: China is still building hospitals, growing public health capacity and buying more ventilators for when cases rise again, he said.
Countries whose health systems struggle during a bad winter flu season, or which can’t build new hospitals in days or lock down whole cities, could struggle to repeat China’s success in slowing an outbreak.
In theory, the world has been preparing for a pandemic since concerns about bird flu spiked in 2006. “There has been some progress,” says Tom Inglesby of the Johns Hopkins Center for Health Security in Maryland. “Many governments have done some kind of pandemic planning, improved their labs, set up emergency operations centres and improved surveillance systems.”
Yet progress has been patchy. In 2017, the Coalition for Epidemic Preparedness Innovations was launched to develop vaccines for potentially pandemic viruses, and it has candidates for the covid-19 virus. However, it will take months to develop and test these.
In the meantime, we could do with treatments to help those who develop severe covid-19. But an effort to set up a similar international project for antiviral drugs failed for lack of investment. Fortunately, some researchers have found possible anti-coronavirals, and these are currently being tested.
Even in advanced economies, the coronavirus is striking at a time when many health systems are under pressure due to ageing populations and increasingly expensive health technologies. Between 2000 and 2017, global health spending grew , despite increasing demand.
Health systems that could be strained by a pandemic include those in Australia, the US and the UK, as well as those in many developing economies. According to , 56 countries – rich and poor – cut health expenditure as part of austerity measures after the 2008 financial crisis. Some of the poorest countries have cut public sector wages, affecting public hospitals and healthcare workers.
In the US, emergency capabilities have been dismantled under president Donald Trump, who shut down the National Security Council’s global health unit, which was put in place after the 2014 Ebola crisis, and disbanded the team charged with coordinating government agencies in a pandemic response.
To get better prepared, Inglesby lists where the world needs to invest more money: the development of drugs, vaccines and rapid diagnostics, and their fast mass manufacture and distribution; disease surveillance; building stockpiles of protective equipment; and expanding capacity so that demand for ventilators doesn’t outstrip the number of machines available.
An unexpected area that needs more understanding is quarantine. Of the more than 3000 people quarantined aboard the cruise ship Diamond Princess in Yokohama, Japan, after they were exposed to an infected passenger, at least 31 have fallen ill since leaving the ship. But the quarantine period was long enough that anyone infected should already have fallen ill by the end of it.
This suggests that, while most of the 634 cases detected while still on board or when disembarking were infected before quarantine began, the virus must also have spread during quarantine, says Stephen Lauer of Johns Hopkins University. That shouldn’t be possible.
Clearly we have work to do. “Hopefully this tragic epidemic will galvanise not only a very strong response to the coronavirus at hand, but will also bring about major positive changes in our level of investment and commitment to pandemic planning going forward,” says Inglesby. Until then, it could be a rough ride.
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