How Have We Contained Epidemics Like the Novel Coronavirus in the Past?

The fast-spreading novel coronavirus (nCov) has the world worried. From Wuhan, China it has already infected people in nearby countries such as the Philippines, Singapore, and South Korea. Western countries such as the United States, Germany, and France have also seen a small number of cases.

The epidemic has been recognised as a global health emergency by the World Health Organization (WHO) while the global death toll has now risen to 493 from a total of 24,551 confirmed cases. And although hundreds of people have recovered, no one can tell how far this epidemic will spread, considering there is still no specific treatment for the virus.

According to the WHO, the total number of cases is expected to be much greater in the coming weeks. Given the effects of globalisation, the intense mobility of human populations, and the density of modern urbanisation, it is likely that the virus will spread a lot further.

Viruses mutate as they spread which can affect their ease of transmission. For example, it was initially believed that nCov spread through animals but only weeks after the outbreak, experts confirmed it could indeed be transmitted via human interaction.

The Chinese government has placed Wuhan on lockdown and created a 1,000-bed hospital to isolate those infected by the virus. And yet it continues to spread.

Researchers estimated that in the two weeks leading up to the lockdown, there were about 10 million trips to Wuhan and 12.5 million trips from the city.

“This is more and more like flu, which is like trying to stop the wind. The seeding is out there. It’s going to take off, there’s more than enough matches thrown into the forest to set it on fire,” Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota’s medical school, and an expert on biosecurity and epidemics told Bloomberg.

Countries with infected patients are now stricter with airport quarantine, while some like Japan, Vietnam, and Indonesia have opted to temporarily bar all flights to and from China. This is despite the fact that the WHO has spoken out against such bans.

“The WHO doesn’t recommend and actually opposes any restrictions for travel and trade or other measures against China,” WHO Director-General Tedros Adhanom Ghebreyesus said.

He also said that travel bans "unnecessarily interfere with travel and commerce."

As the city goes under lockdown, roads out of Wuhan have been barricaded by the police. Photo by Hector Retamal/AFP.

However, Ghebreyesus noted the importance of containing the virus in China.

“If we invest in fighting at the source, then the spread to other countries is minimal and also slow. If it’s minimal and slow, what is going outside can also be controlled easily. It can get even worse. But if we give it our best, the outcome could be even better,” he said.

Like nCov, both SARS and MERS were epidemics that caused pneumonia-like symptoms and originated from wild animal markets.

SARS was first discovered in 2003, quickly spread throughout Southern China, and then the world, resulting in more than 8,000 cases of infection in 29 countries. It progressed rapidly and those hit by the epidemic were hospitalised and isolated to prevent them from spreading the virus further.

According to the WHO, the strategy used to prevent more SARS cases was similar to the ones applied to other viral respiratory infections: avoiding close contact with affected individuals, washing hands with soap and water, and encouraging people with viral respiratory infections to cover their mouth when coughing or sneezing.

The SARS outbreak eventually came to an end in 2004, when the last case was recorded. However, the WHO continues to monitor disease activity worldwide and has established guidelines for emergency preparedness and response should another SARS outbreak ever emerge.

This includes studying information about all outbreaks and enforcing an “event management” system for communications between key international public health professionals, including WHO regional offices, country offices, collaborating centres, and partners in the Global Outbreak Alert and Response Network.

The book SARS: How a Global Epidemic Was Stopped notes that “transparency is the best policy” to prevent such outbreaks. At the time, countries affected by SARS failed to acknowledge the virus and downplayed its effects. Had they been transparent, the virus could have been contained earlier.

China has been criticised for its delayed response to the nCov outbreak, causing the virus to spread further. The government admitted to these shortcomings and said that it would punish officials who failed to deal with the crisis earlier. It also promised a crackdown on illegal wild animal markets, since nCov is believed to have started in a wet market in Wuhan.

The MERS coronavirus (MERS-CoV), which originated in Saudi Arabia in 2012, caused a similar panic as SARS. The WHO recommended precautions in handling live camels — the source of the disease — including their raw meat and dairy products. Patients were also quarantined and isolated to slow the spread of the disease.

MERS-CoV didn’t spread as rapidly from person to person as SARS but continues to infect some people today. Two cases were recorded just on January 9 and 13 of this year, bringing the total number of people infected to 2,506; 862 have died because of it.

For now, isolating those infected is still the most common strategy to keep viruses from spreading. However, since nCov has infected more people than both SARS and MERS, many are now questioning whether China’s massive lockdown is actually effective.

Several Chinese cities, including Wuhan, are now on lockdown, preventing over 35 million people from leaving. Isolating infected patients works but some experts question if it makes sense to ban travelling at such a large scale.

“If you continue to quarantine more and more places in China, you’re going to start to really break normal societal interaction, normal movement of goods and people and medical supplies and food and medicine,” Dr. Tom Inglesby, an infectious diseases specialist and director of the Johns Hopkins Center for Health Security told The New York Times. “At a macro level, it seems to me that it’s more likely to be harmful than helpful in controlling the epidemic.”

Since nCov has already spread internationally, a city-wide quarantine might be too late.

“You can’t board up a germ. A novel infection will spread. It will get out; it always does,” Lawrence O. Gostin, director of the WHO Collaborating Center on National and Global Health Law, told The New York Times.

Infectious diseases can really only be stopped for good with vaccines but creating one will take time. At least 12 drugmakers are currently developing vaccines and antivirals to fight against the virus but they say it will take at least 12 to 18 months. Usually, as in the case of SARS, vaccines are only made available after the virus has been contained.

Cover photo: Staff members of a funeral parlour in protective suits, undergoing disinfection after transferring a body in a hospital. Photo by STR/AFP.

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