IN PUBLIC HEALTH,
honesty is worth a lot more than hope. It has become clear in the past
week that the new viral disease, covid-19, which struck China at the
start of December will spread around the world. Many governments have
been signalling that they will stop the disease. Instead, they need to
start preparing people for the onslaught (see article).
Officials
will have to act when they do not have all the facts, because much
about the virus is unknown. A broad guess is that 25-70% of the
population of any infected country may catch the disease. China’s
experience suggests that, of the cases that are detected, roughly 80%
will be mild, 15% will need treatment in hospital and 5% will require
intensive care. Experts say that the virus may be five to ten times as
lethal as seasonal flu, which, with a fatality rate of 0.1%, kills
60,000 Americans in a bad year. Across the world, the death toll could
be in the millions.
If
the pandemic is like a very severe flu, models point to global economic
growth being two percentage points lower over 12 months, at around 1%;
if it is worse still, the world economy could shrink. As that prospect
sank in during the week, the S&P 500 fell by 8% (see article).
Yet
all those outcomes depend greatly on what governments choose to do, as
China shows. Hubei province, the origin of the epidemic, has a
population of 59m. It has seen more than 65,000 cases and a fatality
rate of 2.9%. By contrast, the rest of China, which contains 1.3bn
people, has suffered fewer than 13,000 cases with a fatality rate of
just 0.4%. Chinese officials at first suppressed news of the disease, a
grave error that allowed the virus to take hold. But even before it had
spread much outside Hubei, they imposed the largest and most draconian
quarantine in history. Factories shut, public transport stopped and
people were ordered indoors. This raised awareness and changed
behaviour. Without it, China would by now have registered many millions
of cases and tens of thousands of deaths.
The
World Health Organisation was this week full of praise for China’s
approach. That does not, however, mean it is a model for the rest of the
world. All quarantines carry a cost—not just in lost output, but also
in the suffering of those locked away, some of whom forgo medical
treatment for other conditions. It is still too soon to tell whether
this price was worth the gains. As China seeks to revive its economy by
relaxing the quarantine, it could well be hit by a second wave of
infections. Given that uncertainty, few democracies would be willing to
trample over individuals to the extent China has. And, as the chaotic
epidemic in Iran shows, not all authoritarian governments are capable of
it.
Yet even if many countries could
not, or should not, exactly copy China, its experience holds three
important lessons—to talk to the public, to slow the transmission of the
disease and to prepare health systems for a spike in demand.
A
good example of communication is America’s Center of Disease Control. World Health Organisation which issued a clear, unambiguous warning on February 25th. A bad one
is Iran’s deputy health minister, who succumbed to the virus during a
press conference designed to show that the government is on top of the
epidemic.
Even well-meaning attempts to
sugarcoat the truth are self-defeating, because they spread mistrust,
rumours and, ultimately, fear. The signal that the disease must be
stopped at any cost, or that it is too terrifying to talk about,
frustrates efforts to prepare for the virus’s inevitable arrival. As
governments dither, conspiracy theories coming out of Russia are already
sowing doubt, perhaps to hinder and discredit the response of
democracies.
The best time to inform
people about the disease is before the epidemic. One message is that
fatality is correlated with age. If you are over 80 or you have an
underlying condition you are at high risk; if you are under 50 you are
not. Now is the moment to persuade the future 80% of mild cases to stay
at home and not rush to a hospital. People need to learn to wash their
hands often and to avoid touching their face. Businesses need continuity
plans, to let staff work from home and to ensure a stand-in can replace
a vital employee who is ill or caring for a child or parent. The model
is Singapore, which learned from SARS, another coronavirus, that clear, early communication limits panic.
China’s
second lesson is that governments can slow the spread of the disease.
Flattening the spike of the epidemic means that health systems are less
overwhelmed, which saves lives. If, like flu, the virus turns out to be
seasonal, some cases could be delayed until next winter, by which time
doctors will understand better how to cope with it. By then, new
vaccines and antiviral drugs may be available.
When
countries have few cases, they can follow each one, tracing contacts
and isolating them. But when the disease is spreading in the community,
that becomes futile. Governments need to prepare for the moment when
they will switch to social distancing, which may include cancelling
public events, closing schools, staggering work hours and so on. Given
the uncertainties, governments will have to choose how draconian they
want to be. They should be guided by science. International travel bans
look decisive, but they offer little protection because people find ways
to move. They also signal that the problem is “them” infecting “us”,
rather than limiting infections among “us”. Likewise, if the disease has
spread widely, as in Italy and South Korea, “Wuhan-lite” quarantines of
whole towns offer scant protection at a high cost.
Scrub up
The
third lesson is to prepare health systems for what is to come. That
entails painstaking logistical planning. Hospitals need supplies of
gowns, masks, gloves, oxygen and drugs. They should already be
conserving them. They will run short of equipment, including
ventilators. They need a scheme for how to set aside wards and floors
for covid-19 patients, for how to cope if staff fall ill, and for how to
choose between patients if they are overwhelmed. By now, this work
should have been done.
This virus has
already exposed the strengths and weaknesses of China’s
authoritarianism. It will test all the political systems with which it
comes into contact, in both rich and developing countries. China has
bought governments time to prepare for a pandemic. They should use it. ■
Read more:Covid-19 is now in 50 countries, and things will get worse (February 27th)
To curb covid-19, China is using its high-tech surveillance tools (February 27th)
Covid-19 presents economic policymakers with a new sort of threat (February 20th)
How China’s coronavirus epidemic could hurt the world economy (February 13th)
To curb covid-19, China is using its high-tech surveillance tools (February 27th)
Covid-19 presents economic policymakers with a new sort of threat (February 20th)
How China’s coronavirus epidemic could hurt the world economy (February 13th)
This article appeared in the Leaders section of the print edition under the headline "Going global"
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