Is the current outbreak of the coronavirus a pandemic? Thankfully no—at least not yet. Pandemics are epidemics of disease that spread worldwide, and these are fairly rare. In my lifetime there really has only been one: the slow and inexorable spread of HIV/AIDS. There have been outbreaks of epidemic disease, such as Ebola in West Africa in 2014, which was truly horrific, killing more than 11,000 people by 2016. But it did not spread worldwide, being confined primarily to Guinea, Sierra Leone, and Liberia. And although seasonal influenza makes its way around the globe annually, the last two major influenza pandemics were before my time in the late 1950s and 60s. Each of these killed over one million people worldwide, yet up to ten times that number were killed by the Great Influenza of 1918 which sickened about one-third of humanity. It’s shocking and sobering to recollect such a thing.
So with this background knowledge, I have been following with great interest the current situation unfolding with the novel coronavirus, designated “2019-nCoV,” that has been front page news for the past several weeks. Experts are saying that with some determined public health measures, there is hope of preventing this coronavirus from developing into a true pandemic. Even so, it is probably still too early to know for sure whether widespread disease will break out on multiple continents. We can all pray it does not.
Indeed, pandemics have shaped human history, and will likely continue to do so in the future, yet most people have probably never heard of coronavirus before this current news story. They have largely flown below the radar by not normally causing serious disease, being well-adapted to their host. Like the many non-pathogenic bacteria that live in and on us, we also co-exist with viruses. It is only the rare one that makes us sick. Only recently has coronavirus been recognized as causing epidemics—it turns out that the coronavirus family is very diverse, and has a large genome for an RNA virus. It has four main branches in its genetic family tree, and has been found in many mammal and bird species including alpacas, bats, cows and dogs, beluga whales, and of course, people. Interestingly, coronaviruses cause a significant fraction of the common cold in humans, and, being well-adapted to us, they get passed around far and wide, and don’t typically kill us.
A big part of understanding why the 2019 coronavirus makes us so sick has to do with how viruses work in general, and ties in with other pandemics mentioned earlier. In fact, influenza (flu), HIV, Ebola, and the novel coronavirus, all share the quality of having “jumped” species from another animal to humans. In the case of influenza, usually only a part of the pandemic virus is derived from a different animal species (hence the common names: bird flu, swine flu). In the process of switching species, the virus accidentally makes its new host very sick, as it discovers it is able to replicate very well using the cellular machinery of its new host species. It is never to the advantage of a virus to make their host so sick that they are bedridden or dead. A dead host means a dead virus, and a bedridden host is unable to spread the virus. A more successful virus may still cause a cough or sneeze, and yet allow the victim to feel well enough to continue walking around among crowds of other people. It’s to the advantage of a virus to cause mild disease, and over time, viruses develop less severity, until we end up with a virus that coexists within individuals of a particular animal species.
But every now and then, an animal virus makes that jump into the human population. Perhaps this virus also happens to make a person very sick, and maybe there is a period when the person is still walking about with a sneeze or cough before the worst symptoms appear. Maybe this new virus has an uncanny ability to spread easily, persisting in the environment. When various combinations of these conditions occur, there is the potential for an epidemic or pandemic. This is what public health officials worry about. What is not yet known is how well or by what precise means the novel coronavirus is able to spread. Also, we do not yet know the death rate for the new coronavirus, since the actual numbers of infected people are not easily determined. Comparisons are being made to MERS (2012) and SARS (2003), two other coronavirus outbreaks, where the spread and death rates were estimated at approximately 35 and 10 percent, respectively. SARS killed approximately 800 before it was brought under control. All indications are that the novel coronavirus is likely to be less than 3 percent fatal, but when tens of thousands are infected, then even low percentages add up to a lot of suffering. On about February 10, 2020, the number killed by 2019-nCoV surpassed the number killed in the entire SARS outbreak.
What lessons can be learned from the current outbreak? First, we should recognize the importance of good public health infrastructure. The ability to quickly recognize that an outbreak is happening is critical to the ability to isolate and block transmission. A second lesson is that the release of a novel human pathogen from the wild can happen at any time, and is unpredictable. As such, rather than placing blame on where it started, we should face the fact that such events will inevitably happen. Rather than directing blame on a particular city, province or country, we should celebrate those heroic individuals like the late Dr. Li Wenliang who aided in quick identification of such threats and the medical personnel who put their lives at risk to help others. A spreading virus knows no borders, and does not care whether we are rich or poor. This fact should highlight the common plight of all humanity living on planet Earth. We are in a battle to survive, and we need to work together, across political and cultural borders to solve big problems.
In the future, with more knowledge of the origin and biology of such viruses, we may be able to take steps to minimize our exposure to this danger. In the distant past, such epidemics certainly happened, but had no way to spread farther than a small village. Today it is easy to unknowingly carry such a new virus halfway around the world in a very short time. An understanding of emerging diseases is not new to the scientific community; I think of Laurie Garrett’s brilliant book The Coming Plague which documented the problem over 25 years ago. Yet, for many, it is only now, as this novel coronavirus has spread to 24 countries in about two months, and killed over 1000, it is only now that most people are coming to grips with this new sobering reality. It’s a developing story, and we should all follow it closely. I recommend the World Health Organization’s Situation Reports for 2019-nCoV, which are being released every day.
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