The coronavirus pandemic has been a human disaster. More than 1.7 million people have died; some £8 trillion has been wiped off the global economy; and the wider social costs – from poverty to mental illness – are impossible to quantify but undoubtedly catastrophic.
Yet, in purely epidemiological terms, COVID-19 is a relatively benign virus.
It kills less than one per cent of people it infects. For the young and healthy, the risk of succumbing is small: teenagers in the UK without underlying conditions are more likely to be struck by lightning than die of coronavirus. The UK government doesn’t even officially consider it a high consequence disease. It saves that title for the real (if less viral) monsters: Ebola, bird flu, Nipah virus – all merciless killers with fatality ratios north of 50 percent.
Which is to say that on that fateful day when this piece of genetic code jumped the species barrier, it was good fortune — though it doesn’t feel like it now — that while it was capable of astonishingly rapid transmission, it was not a more ruthless human killer.
We might not be so lucky in the future; another virus is likely at some point to make a similar leap with far more ruinous consequences. Epidemiologists do not talk about if this will happen but when. “There is likely to be a more deadly pandemic at some point,” a spokesperson with the Chatham House think tank tells VICE World News. “We have got off lightly this time.”
So what could we expect from such a disease? What would happen in the days, months and years after the emergence of this existential threat? And would a Tory government still let the Cheltenham Festival go ahead?
A new virus in a faraway land
There are an estimated 1.67 million unknown zoonotic viruses circulating on this planet. It requires only one especially mean little blighter to infect a human to usher in an age of catastrophe.
“If you had something with the ability to cause the kind of calamitous symptoms which Ebola does but which transmitted while still in the incubation period, like SARS-CoV-2 [commonly known as COVID-19), that would be your worst nightmare,” says Dr Nathalie MacDermott, a lecturer in infectious diseases at King’s College London.
Human encroachment onto wild habitats is bringing us into ever-closer contact with viruses we know nothing about (it was in this way that HIV emerged in humans). Meanwhile, the expansion of industrialised farms – where millions of animals are packed in oft-filthy conditions – have created what are essentially pathogen playgrounds, vast reservoirs of immunocompromised life in which they can thrive, mutate and grow more dangerous. Both swine and bird flu began life like this.
Most likely a new patient zero for our new human virus – let’s be optimistic and give it a mere 25 per cent fatality rate – would come from South East Asia or Latin America, according to a pandemic risks map drawn up by the NGO EcoHealth Alliance. Both regions have high levels of wild encroachment and minimally regulated mass farming.
The good news is that global health surveillance – formalised under the 2005 International Health Regulations framework – should detect it quickly. The World Health Organisation would issue immediate warnings. Scientists would scramble to unravel the genetic code.
The bad news? Amid the confusion and government opacity, initial containment may – as we saw this year – pretty much be impossible. The virus would be halfway around the planet before humanity had its boots on.
Planes grounded and hospitals in tents – before the first case arrives
Here’s a possible worry: the way the UK would deal with an especially deadly virus would not be materially different from what we’ve experienced this year.
“We’ve used our A-game on coronavirus,” says Professor Lucy Easthope, a member of the Cabinet Office Emergency Planning College and a fellow in mass fatalities and pandemics at Bath University. “The tools for dealing with a pandemic – lockdowns, contact tracing, emergency vaccine – have all been deployed. There is not much left in reserve.”
What one would at least hope for with a 25 per cent killer is less dither.
Its very emergence, even on the other side of the planet, would be the cue for a government to move to a war footing.
Even before a first registered case here, hotels would probably be requestioned as quarantine facilities; a rush would begin not just for PPE but full-on biohazard suits; the army would begin planning vast field hospitals. These wouldn’t be limited to conference centres. “We are talking canvas tents in actual fields,” says Easthope.
Travel into the UK would be limited to essential only. Essential would not include Atletico Madrid playing Liverpool in the Champions League.
Yet, in a country which sees 12 million people arrive every single month – and which imports 45 per cent of all its food – stopping a new virus gaining a toehold would be pretty much impossible.
A desperate attempt to contain
Considering how a deadly pandemic might play out is nothing new. Governments and international organisations have run simulations for years. Only months before COVID-19 emerged, the John Hopkins Center For Health Security held something called Event 201: it imagined 65 million people dying from a virus which originated at a Brazilian pig farm.
What such exercises have in common, says Easthope, is that the first aim is always containment.
With something especially deadly, that probably wouldn’t mean (to take a scenario at random) a prime minister telling Londoners not to leave the capital before watching thousands of them gum up the roads and railways as they fled.
Rather, it would (should) be decisive and immediately enforced. Public transport would be stopped in its tracks and police roadblocks set up. This local lockdown would not be one where B&Q got to classify itself as an essential store. Even supermarkets might be closed, with the state requisitioning food supplies and dropping rations at every door in the shutdown city. “A proper lockdown,” says Easthope, whose second book The Disaster Planner is out next year. “Not a nip-out-for-Easter-eggs lockdown.”
There would be no self-isolation either. If you displayed symptoms or came into contact with someone who had, you would be required to spend time at a guarded quarantine site, probably a hastily fenced off hotel.
For one city or region, this would be a challenge but well within the capabilities of an efficiently functioning state. Certainly, containment can work. It’s the reason why, if you’re reading this anywhere outside of Africa, you’ve never had to worry about the Marburg virus, which has an 80 percent mortality rate.
The problem is if our virus is transmissible while being symptomless, pinning it down becomes almost unachievable. As the road blocks went up around Manchester, there would already be infected people walking around Leeds.
Thousands dead: the grim middle game
Humanity has proven effective at two things in terms of virus fighting. The first is the initial containment. Dozens of deadly diseases have been prevented from wider global spread this way. The second is developing vaccines. As a species, we have eradicated smallpox. Polio is on the ropes. It is, however, the bit in between those two poles that cause biosecurity experts sleepless nights.
“We have a strong end game once there is a vaccine, and we have a strong opening game if countries contain an outbreak,” Jeremy Konyndyk, of the Center for Global Development, told the Nature journal earlier this year. But, he said, it was the “middle game” where the weakness lay.
Which is to say, it is about now in our own scenario that things get grim.
Once containment failed, we would be looking at death figures in the hundreds within days, and in the hundreds of thousands within months. Even with a lockdown.
There would be no debate about if the NHS could cope. By its own admission, it couldn’t. There would be no questions about attending funerals either. People would be buried in mass trenches. Any nascent test and trace system – assuming a diagnostics test had been developed – would be so overwhelmed as to probably be useless. It would, in essence, be the Great Plague all over again.
The realignment of society
In the face of such a biological onslaught, how could a modern western society – one which weeks earlier was probably debating something Piers Morgan had said about a custard slice – even begin to cope? What memes would we fall back on?
This remains, it seems, the great unknown of pandemic planning. How we’d cope, not the memes. “With those numbers of fatalities, you would need a complete realignment of society,” says Easthope. “The equivalence would be World War II but probably more extensive changes.”
How precisely that would work, of course, depends on the virus itself.
Food shortages would probably lead to rations and a requisitioning of farmland, industry and transport. As the economy collapsed, healthy people may be conscripted into an expanded army, a new agricultural force, an enlarged health service and even into a big pharma programme. Social disorder would be entirely possible, but by no means inevitable. One astonishing thing about London’s Great Plague of 1665-66 – in which a quarter of the city’s population perished – is that a sense of social cohesion somehow remained.
On those memes, by the way: you might not even get to look at them. In order to keep other essential services running, there may be limited internet availability. Quite possibly limited electricity too as reduced supplies were directed to places of most need.
“With a bad enough pandemic, we’re talking about an end scenario of smoking embers,” says Easthope. “The real challenge would be, once it has burnt out or a vaccine has been found, how do you build back a new world.”
Coronavirus: the pandemic that saved the planet?
Don’t have nightmares, though! There is a positive: it may be that the dreadful year we’ve just lived through actually ends up saving the world from a worse disaster.
Consider Taiwan. In 2003, some 70 people died there after the emergence of SARS. Our old friend containment eventually averted real catastrophe there but, for a while, it was touch and go. Taiwan had looked down the barrel of an existential threat.
Seventeen years on, just seven people in the East Asian nation have died from COVID-19. Controls and surveillance systems established after its previous experience are credited with limiting the impact. The earlier crisis meant it was better prepared for the later one.
The hope among epidemiologists is that Europe and the world will be stung into similarly better arming themselves against future pandemics.
As Professor Alex Faulkner, lecturer in sociology of biomedicine at the University of Sussex, puts it: “You can prepare for events in other parts of the world but without first-hand experience, it can be difficult to instil that sense of emergency.”
The globe now has that sense of emergency. There is every chance historians may pinpoint coronavirus as the precise moment humanity upped its pandemic game – and averted a future catastrophe.
“We can’t prevent new viruses emerging but we can reduce that risk by working against deforestation, addressing climate change and propagating more appropriate farming methods,” says MacDermott. “But even if you accept some new outbreaks will inevitably occur, you can still build a world where their survival becomes much harder. You build better detection methods, reduce global malnutrition and global conflict, and develop more rapid treatments and vaccines. The aim is you prevent those inevitable outbreaks becoming pandemics.”