Epidemics and pandemics are frightening. We all ask the same questions: How much risk do we face? How do we keep our families safe? The first U.S. case of pneumonia caused by a novel coronavirus from Wuhan, China, appeared in Everett. Following news reports, the patient sought care for symptoms, was isolated and treated at Providence Medical Center. Happily he had access to care. And happily, Snohomish has a skilled public health office. Everyone did their job.
Chinese public health and medical authorities quickly made the full genome of this virus shared and diagnostics available. Species jumping (“spill over”) isn’t new. Instances will continue as humans and animals become ever more crowded on Earth. Coronavirus is an RNA virus (as are ebola and influenza) and prone to mutate as they transmit through populations. Their danger is not predictable. The best way to contain risk is quickly stopping transmission among humans, which is what we are seeing now. On Thursday, the World Health Organization declared the outbreak a global health emergency, and on Friday China had reported a total of more than 200 deaths.
Global and local public-health organizations have moved into action against this novel threat, applying hard-won lessons from previous coronavirus outbreaks. Severe Acute Respiratory Syndrome (SARS) is a coronavirus that emerged in Guangzhou, China. SARS jumped species and geography in 2003-2004, causing more than 8,000 cases and 774 deaths with a mortality rate of approximately 10%. Middle East respiratory syndrome virus (MERS), also a coronavirus, jumped species and geography, and continues to simmer in the Arabian Peninsula.
This new coronavirus can pass from person to person, as was reported in a case in Chicago. We know the outbreak in Wuhan as of Friday infected nearly 9,800, with cases reported in 21 other countries. At least 15 Wuhan health-care workers became infected. What can be done to combat risk in the U.S.? Success containing this infection hinges on four factors:
• Access to health care. If protection matters in our country, we are going in the wrong direction. Regardless of politics, fewer people with ready health-care access means higher transmission risk to family, neighbors and co-workers. Viruses are incredibly democratic — they don’t care if hosts are Democrat or Republican, regardless of race or creed. Health-care access is not equal: Transmission will be higher in communities where access is poor. Across this wealthy country, care access has been going down, not up. With reduction of the Affordable Care Act, one third of our citizens are outside the umbrella of protection.
• Worldwide global health is local public health. What do you know about the public health department in your city, county or state? Do you know your public health authorities’ plan if a pandemic reaches your community? From SARS we learned that ill individuals should not travel. Hong Kong’s enforcement of a “no fly” list proved effective based on tracking patients’ contacts. “Locking down” cities and preventing Lunar New Year travel was difficult and unpopular. In the disastrous Spanish Flu of 1918, which killed more than 5,000 people across Washington state, Seattle Mayor Ole Hanson and Health Commissioner Dr. J.S. McBride lowered contagion by closing movie houses and schools, but suffered political backlash.
Washington has 36 health departments for 39 counties. Policing powers for quarantine and other health measures rest with counties. Our entire state needs to be on alert, and the state Department of Health has an important role. Despite more billionaires than most, our state funds public health through sales and B & O taxes. While serving as Washington’s AIDS Director I learned how revenue fluctuations sap vital programs. Health seems to be an easy budget to cut.
• Collaboration among human- and animal-health experts. When SARS emerged, coronaviruses were little known, causing 15% of human “colds.” We doctors had little initial interest. Our veterinarian colleagues, on the other hand, were well acquainted with infections in cows, pigs and cats. Importantly, they developed effective vaccines. We still have a lot to learn from one another. The One Health concept of collaboration across disciplines has produced new insights. Washington is fortunate to have two centers of excellence, the University of Washington and Washington State University, with deep expertise in both. We should increase that collaboration to meet the challenge of new infections.
• International trust, collaboration and communication. The economic loss from pandemics can be enormous — those losses are everyone’s business. About half of the 4.3 billion air travelers in 2019 crossed international borders. In 2018, more than $17 trillion in goods and services were traded globally. From 1994 to 2007, our UW team worked with the White House persuading the Asia Pacific Economic Cooperative to create a Health Working Group as the pace of these emerging infections increased. After SARS (2005), the World Health Organization issued International Health Regulations mandating that every country contain outbreaks within their borders. International pandemic cooperation hinges on trust, coordination and support of resource-poor countries by rich countries. The U.S. is moving away from this critical multilateral path in a solo trajectory.
Microbes like this coronavirus change rapidly. This one may prove mild, as with the H1N1 influenza, or become more dangerous. Success defeating pandemics rests on the weakest link in the chain. As we look to an increasingly interconnected world, we need to understand the critical role of trust and cooperation, access and robust public-health prevention to the health of our human family.