So far, almost 80,000 coronavirus cases (now named Co-Vid 19) have been reported world-wide. Last week at the Muni-expo in Tel Aviv, one cyber entrepreneur and venture capitalist reportedly warned city leaders that a cyberattack could bring another coronavirus epidemic. Nothing like panic to generate funding, right?
Now everybody loves a good conspiracy theory. And if it concerns an epidemic so much the better. Personally, I love reading about epidemics. I followed the SARs saga religiously. On my nightstand is “Pox” by Michael Willrich, a history of the smallpox epidemics that overtook the US at the turn of the last century. One of my favorite made-for-TV movies is called Voyage of Terror, a 1998 production starring Lindsay Wagner about an outbreak on a ship. Move over, Diamond Princess, you ain’t seen nothing.
Strangely, SARS came and went in 2003. And that followed right on the heels of 9/11, and then there was the anthrax scare of 2001-2. Remember them? Nary a word about cyber-hacking. But panic-generating claims did razzle the media. The armed forces were compelled to be vaccinated against both smallpox (yeah, that was about to overtake us, too) as well as anthrax. You must recall Colin Powell on the floor of the UN exhorting that “Saddam had the wherewithal to attach with smallpox.” What a hoax. When our troops finally invaded — all they found in the bio-weapon category was an empty folder that said “Blue-Nile.” Then we all became freaked about anthrax- that is until CDC erroneously let a sample escape from its bio-hazard labs. And then they said it was nothing to worry about.
OK, back to Co-Vid 19. Panic and hysteria scream from the press. A few days ago, this cyber entrepreneur reportedly proclaimed: “Those who know how to hack into financial bodies can also hack pharmaceutical companies and create a virus.” Besides, the obvious financial interest this “gentleman” had in starting the buzz, I would say it’s just plain idiotic. But you be the judge. So first let’s talk about how dangerous the virus is, and then we can consider the logical likelihood a state actor would go to such lengths to create a virus. (Sure it’s possible. So is a nuclear holocaust. The question is how likely is it?).
And then you can make your own decision.
How Dangerous is Co-Vid 19?
The true answer it’s tough to know. And that’s mostly because we can’t be sure China is reporting accurately or timely. So, what’s new? They didn’t report accurately or timely in 2003 with SARS either. Relying on Chinese statistics then to assess the danger level isn’t very reliable. (By the way, The Economist disagrees with me. They think China’s been pretty forthcoming, but the sudden jump of more than 14,800 Chinese cases reported in one day in mid-February makes me kinda wary). Now the focus on fuzzy reporting has shifted to South Korea and Iran.
The best we can do is compare the current situation to the SARs epidemic as it was reported at the time, and assess the two factors we care about in terms of assessing danger: lethality (how many people does it kill) and infectiveness (how many people get infected). The infectiveness depends on how many people one person is likely to infect (its replication rate), and over how many generations the disease can be transmitted (its transmission rate) before the virus loses its potency and hopefully dies out.
SARs generated about 8000 cases worldwide (that we know about, and assuming China released all its case numbers). CoVid 19 has now infected close to 80,000, so we might reach the (erroneous) conclusion that CoVid 19 is more infectious, and that it is transmitted more easily.
The infectiousness of CoVid 19
But several factors militate against quickly jumping to that conclusion. First, as soon as the world got wind of SARS, many countries shut their borders down tight; most employed rigid isolation and quarantine measures. The US was on lockdown – as soon as we got word, no one came in who was diseased or exposed. Flights to the Far East were shut down or restricted. (Well, that’s not exactly true. One doctor who had been doing relief work in Taiwan and got infected was snuck back in, spirited away to a CDC Bio-hazard hospital, and later recovered). So, it’s no surprise that there were only 27 cases in the US. The UK had a similar experience, only 4 cases were reported there. Canada was slower on the uptake. They had 251 cases — and 43 deaths.
CoVid19 has generated 77,986 cases reported as of this writing. Of these, 76,291 are from China. That leaves 1695 non-Chinese cases reported world-wide, including 634 on international conveyances (like the Japanese Cruise ship). Over the weekend we saw a surge of 29 cases — in Iran. Now it’s true the epidemic isn’t over yet, but compare these figures to SARs: 2,769 or 34% of the worlds’ cases were reported in countries other than China. In Co-Vid 19, some 2% of cases are located outside China. And that’s even with slower world response, more open borders and greater air transferal of cases.
Sadly, we often don’t see the press breaking down cases by China-non-China. To paraphrase the wolf in Little Red Riding Hood: “the better to scare you, my dear.”
These figures seem to indicate that for whatever reason, China had been sitting on this for a LONG time prior to telling the world – but now that we are on notice, quarantine and isolation seem to be working. It also seems to indicate the replication rate (at least outside China) is low – one person who gets sick doesn’t seem to be able to infect others, and in the rare case where it has been documented, that person doesn’t seem to be able to pass the disease along, meaning the transmission rate is also very low
By comparison, in the case of SARS, we had several cases of “super-spreaders” – individuals on airplanes reportedly infecting dozens of others. The virus was so virulent that even small breaches of safety procedures led to infection. In Canada, for example, SOP required full- suited personal protective gear (moon suit level). In one case, a Canadian nurse who wasn’t scrupulously following sterile procedures –became infected.
So how deadly is Co-Vid 19? The statistic used to measure the lethality of a disease is called case-fatality; the numerator is the deaths and the denominator is the number of cases. (If you want to monkey with the statistics and artificially lower the case-fatality rate, just add more cases to the denominator by increasing the number of reported cases. (Ya think that sudden upsurge of those 14,840 cases that China reported on Feb13 might be related, maybe?)
Strangely, like in SARS, the case-fatality for Co-Vid19 varies across the population. Sure, we expect it to vary by age. But by country? Interestingly, in the SARS experience, the worse-off countries were the most advanced.
Anyway, the overall case-fatality rate for SARs was about 10%. That’s pretty high. About the same as Legionnaire’s disease. China reported a case fatality of 7% – which might suggest manipulation of statistics. But the case-fatality for cases outside of China, was worse, a little more than 16% percent, and those numbers are probably accurate.
By comparison, in the current Co-Vid 19 outbreak, the overall case-fatality rate is 3%. (The Chinese case-fatality rate rises to almost 4%, if you exclude the sudden Feb. 13 case upsurge supposedly attributed to better diagnoses made by CT scan). This is about the same as measles in the US before the vaccine. That’s the good news. The better news is that in cases outside China, the case-fatality is between 1% and 2% (It’s closer to the 1% figure if you exclude the six Iranian deaths reported over the weekend), that makes for 28 deaths out of the 1695 non-Chinese cases.
So, compared to SARs, Co-Vid 19 is a wimp. But it’s not benign.
These numbers will change as the epidemic continues, and as people from the Japanese ship reach home, we can expect to see more cases and greater spread. But following the statistics for several weeks now, the case-fatality seems relatively constant. We can also expect it to decrease. Why?
The answer is something like the thrill of novelty: it’s always more exciting the first time. Same with diseases- any novel disease agent will have a disproportionate effect the first time it’s unleashed. Why? Because the natural immunity of the population is non-existent – no one has previously suffered the disease and few carry natural immunity. (In the French and Indian War, the Indians – who had no experience with smallpox and hence no population immunity – were given blankets with scabs of smallpox victims. Their case fatality was 54% — compared to the average American rate of about 20% at the time.) The first pass-through of any new disease usually will kill (and infect) the most genetically vulnerable, not merely the aged, the infirm, or the immune-compromised.
Bio-Terrorist Threat – Or Natural Disaster?
It’s getting close to Purim, so put your terrorist costume on and pretend you are a state-sponsored terrorist – let’s say Chinese, as I’ve heard suggested on the street. (A non-state terrorist like ISIS or Al Queda isn’t going to have sophisticated gene-editing equipment, laboratories or safety gear to protect themselves from getting sick).
So, assuming you have your little lab, your protective equipment, AND you have a method of deployment (How do you plan on spreading the little bugger? Missile? Warhead? No good, it would explode too high to reach the breathing zone, – that is if the little beasties survived the explosion. Crop duster? Sky writer? Balloon? Maybe? Has anyone reported a bunch of those flying over-head? Not very stealth are they?)
Ah – drones. Ok, let’s work with that. You’d need a whole bunch of buzzing drones to infect 80,000 people all over the world, that is assuming the weather is right. It can’t be sunny, because sunlight kills most viruses.
OK, got all our ducks in order. Let’s get to the lab and start tinkering.
Ah, I’ve got one more question:
Why would anyone bother creating a bug that mostly infected mostly your own country-men?
Here’s a hunch: Maybe, there’s a new eco-terrorist that wants to do population reduction?
Great. Then why would you create a bug with merely a 3% case-fatality rate? Frankly, if it were me, I’d go for Hanta-virus – it’s got a case-fatality of 36% – and you don’t need crop dusters or drones. It’s spread by rats. You don’t even need a lab to engineer it – it already exists.
In fact, why would I go to the bother and expense of genetically engineering any bio-terrorist agent? You can cause a heck of a lot of havoc by leaving your mayonnaise open for 24 hours and putting some Salmonella-infected sandwiches in your local cafeteria. (There’s a reason Israel carefully inspects its egg imports). Now salmonella is not quite as potent as hanta-virus, but it “spreads like the plague” and with a case-fatality that could range as high as 15% in certain areas of the world, you sure would get more bang for your buck than gene- editing a cold-virus. Mother Nature is pretty good at generating bio-agents. It’s not likely we’ll eclipse her soon.
So if not Terrorists, then who? Or what? And why China?
After a good deal of research, the conclusion of the SARS researchers was that, like many diseases, this arose in animals and jumped species or naturally mixed with human genes. The close animal-human interface common in China would lend itself to this explanation. The viral-species jumping could happen from uncooked food or through animal handlers. Alternatively, there could be a natural animal-human genetic interchange. Some researchers theorized that a recent earthquake in China about the time of the SARS epidemic stirred things up.
Guess what? Within the month prior to the CoVid 19 outbreak, the Wuhan province suffered a grade 5 level Earthquake. Co-incidence? Who knows?
Looking forward and looking back
In case you, dear reader, haven’t guessed, I have a personal bug about people falsely spreading bio-terror panic, and especially entrepreneurs who sing cyber-threat at every passing folly. These diseases are serious. But focusing on ghosts and ghouls isn’t going to help. And spending money on developing inapt equipment isn’t going to help either.
Closing our borders to China and banning certain international flights, as we might have done in 2003, is no longer as an option, what with China’s increased prominence in global trade and leisure travel. But holding people on a ship has got to be one of the most questionable public health responses in decades. We don’t know exactly how this disease is spread, most likely droplet infection – or through the HVAC- or as some research in the SARS epidemic showed, via the sewage system. Holding people in a closed container (a ship) who are breathing the same recycled air, eating with recycled silverware and food prepared with unsterilized equipment, and exposed to ship personnel who are tracking debris (and maybe microbes) as they move from cabin to cabin just can’t be a good thing. (By the way, the anthrax bacillus in the 2002 epidemic was spread in the DC post office by shoes and postal equipment). And sharing overburdened sewage facilities? Not too smart.
Yes, there are better means to disinfect air circulation. Ships and trains and planes could incorporate UV filters. These kill most viruses. But that costs a bunch.
Quarantine and isolation do work. But as our experience with Ebola taught us, not everyone will voluntarily quarantine themselves. Can the law compel this? Maybe.
It’s time to take a closer look.
Oh, and by the way – if you plan on taking a cruise – bring an extra two weeks supply of whatever medicine you normally use. And if you get quarantined- keep your silverware.