COVID-19: An infection without borders

Worshippers circumambulate the sacred Kaaba in Makkah's Grand Mosque, Islam's holiest site, on March 7, 2020. Authorities reopened on Saturday the area around the sacred Kaaba, reversing one of a series of measures introduced to combat the coronavirus outbreak. (AFP / Abdel Ghani Bashir)
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Updated 09 March 2020
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COVID-19: An infection without borders

  • Epidemiologists believe COVID-19 infection is worse than SARS or Middle East Respiratory Syndrome (MERS)
  • Virologists worldwide are racing to produce a vaccine but there is no guarantee that one will be found

LONDON: It is more than 60 days since China first alerted the World Health Organization (WHO) to the emergence of a mysterious new virus in the city of Wuhan.

Since then, the virus has been identified and named — SARS-CoV-2. It has infected more than 100,000 people around the world, caused more than 3,000 deaths, shaken stock markets and prompted predictions of job losses, shortages of food and medicines and even a global economic meltdown.

Certainly, fear of the coronavirus disease 2019 (COVID-19) is affecting events and organizations around the globe, from the cancelation of football matches and conferences to the closure of Asian theme parks and museums in Italy and France.

Saudi Arabia has temporarily stopped entry into the Kingdom by land from three GCC neighbors, with the Ministry of Sports suspending public attendance at all sports events.

Inevitably, a shadow hangs over other major international events, from the summer’s Tokyo Olympic Games to Expo 2020 in Dubai, due to open in October.

FASTFACTS

People in coronavirus-affected countries should avoid large gatherings, handshakes or hugs, maintain “social distancing” from others, cover their nose and mouth while coughing or sneezing, and wash their hands regularly.

Many people who contract the coronavirus will have no symptoms or only a mild version of the disease.

Most deaths so far have been among the elderly or others with long-term health conditions.

The risk of dying after contracting the coronavirus is just 0.9% for someone with no other health conditions, 5.6% for cancer patients.

The risk is 6% for people with high blood pressure, and 7.3% and 10.75% for individuals with chronic respiratory disease and cardiovascular disease respectively.

Despite the WHO’s reluctance to classify the outbreak as a pandemic — a disease that has spread globally — most epidemiologists believe that the window of opportunity for limiting the spread of the disease by banning flights to and from infected countries or shutting borders has long closed.

Is the coronavirus worse than SARS or Middle East Respiratory Syndrome (MERS)? Yes. In two months, it has killed almost twice as many people as those two viral diseases combined, and many epidemiologists believe that the coronavirus will continue spreading widely.

Clearly, the emphasis must now shift to controlling it within individual countries via swift identification and isolation of cases, and the equally rapid tracing, testing and, if necessary, isolating of anyone with whom infected people have come into contact.

For even the best health care systems, this is a challenging task, the success of which will be dependent on a series of still unknown variables.

As virologists around the world race to produce a vaccine — and there is no guarantee that one will be found — so epidemiologists are developing best-guess answers.

One of the teams most experienced in this field is at the Center for the Mathematical Modelling of Infectious Diseases at the London School of Hygiene & Tropical Medicine, where a coronavirus working group is running computer models to look at outcomes based on a range of possibilities.

The team’s initial conclusion, that “in most scenarios, highly effective contact tracing and case isolation is enough to control a new outbreak of COVID-19 within 3 months,” sounds reassuring. But, as their paper published last week in the journal Lancet Global Health points out, success will depend on exactly which scenario emerges.

The findings suggest two crucial steps that every country currently with one or more cases should be taking. Although logistically and economically challenging, the best hope of control lies in mass population testing to identify and isolate infected people before symptoms emerge.

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Resources should also be invested now in creating effective contact-tracing teams. Until more is known about the incubation period of the virus, according to evidence so far patients should be isolated for at least two weeks, and possibly three.

The coronavirus is, of course, not the first epidemic to trigger global panic, but we should take heart from our experience of those that have come before.

Although no longer in the headlines, neither SARS nor MERS, which are genetically related but in many ways different to the coronavirus, have gone away, but thanks to timely and effective intervention failed to live up to their apocalyptic billing.

SARS, which was first reported in Asia in February 2003, spread to two dozen countries, infecting 8,098 people worldwide and killing 774, before the outbreak was contained in July the same year.

The virus succumbed to strict isolation, quarantine and tracing of contacts and there have been no known cases anywhere in the world since 2004.

MERS, first identified in Saudi Arabia in 2012, continues to kill, but on a much-reduced scale. Between Dec. 1, 2019, and Jan. 31, 2020, Saudi Arabia reported 19 cases of MERS infection, with eight deaths, bringing the total number of cases globally since 2012 to 2,521, with 919 deaths.

But although the new coronavirus is related to the others, each operates in subtly different and potentially confounding ways, which makes lessons learnt from one difficult to apply to another.

For example, the Spanish flu was an unusually deadly strain of avian influenza, a viral infectious disease that killed possibly 50 million people worldwide over about a year in 1918 and 1919.

With SARS, symptoms came on rapidly, which meant cases could be identified quickly, leading to swifter and more effective isolation and treatment.

When swine flu, the disease caused by the then-novel H1N1 virus, emerged in the US in April 2009, the world again seemed to be facing a pandemic disaster. In the event, swine flu infected one-tenth of the global population and killed as many as 575,400 people worldwide. But by August the following year the WHO declared it had run its course.

Today swine flu is just one of the seasonal influenzas that flare up annually around the world, which is not to say it is of no consequence. Every year, despite vaccines, various mutating strains of flu infect an estimated four million people, causing almost half a million deaths.

We have, in other words, learnt to live with flu, a grim reality that should at least help us to put into perspective the threat posed by the coronavirus.

Most of the fatalities so far have been in China, where the disease originated, and experience with other coronaviruses tells us that if effective control measures are put in place in other countries, we can limit the damage.




A couple wearing facemasks smear their faces with colored powder to celebrate Holi, the Hindu spring festival of colours, in Hyderabad. (AFP)

There are, however, still many uncertainties about the true scale of the spread of the virus.

For a start, because many people seem to contract only a mild case of the coronavirus, it is certain that the incidence of the disease around the world is being significantly under-reported.

Many carriers will have no symptoms and even those with only a “lite” version of the key symptoms — a slightly elevated temperature, tiredness and dry cough — will not visit a doctor, will recover without medical help and will not be counted in the statistics.

The upside of this is that the overall death rate from the disease — currently provisionally estimated at 2 or 3 percent — is undoubtedly exaggerated. The downside is that these silent carriers can still spread the disease, undetected.

For now, the immediate future course of the coronavirus cannot be predicted with any accuracy and we certainly cannot assume it will go the same way as swine flu, MERS or SARS.

On March 2, when WHO raised its assessment of the threat of the coronavirus to the highest level, Michael Ryan, director of health emergencies, said that this was a reality check for every government in the world.

“Wake up. Get ready,” he said. “This virus may be on its way, and you need to be ready.”

This time, luck might not be on our side.

 


Trump officials say Israel’s plans helped lead the US into Iran war

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Trump officials say Israel’s plans helped lead the US into Iran war

WASHINGTON: The Trump administration and its allies in Congress presented a shifting new justification Monday for the US attack on Iran, with House Speaker Mike Johnson suggesting that the White House believed Israel was determined to act on its own, leaving the president with a “very difficult decision.”
The Republican was speaking late Monday after a classified briefing at the Capitol, the first for congressional leaders since the start of the war, a joint US-Israel military campaign that killed Iran’s Supreme Leader Ayatollah Ali Khamenei and has quickly spiraled into a widening Middle East conflict. Hundreds have died, including at least six US military service personnel.
Johnson said the attack on Iran was a “defensive operation” because Israel was ready to act against Iran, “with or without American support.” He said President Donald Trump and his team determined that Iran would immediately retaliate against US personnel and assets.
“The commander in chief has said this is going to be an operation that is short in duration,” Johnson said. “We certainly hope that’s true.”
The remarkable shift in the Trump administration’s stated rationale comes as the hostilities deepen and widen across the region. The president himself estimated the war could drag on for weeks. The administration plans to seek supplemental funds from Congress to support the military effort, lawmakers said, in stark contrast to the president’s America First campaign not to entangle the US in actions abroad.
Secretary of State Marco Rubio said the “hardest hits are yet to come” as the US is determined to continue attacking Iran for as long as it takes with an “even more punishing” next phase in the war.
Rubio described what was essentially a potentially ripple effect that he said posed an “imminent threat” to the US
“We knew that there was going to be an Israeli action,” he said. “And we knew that if we didn’t preemptively go after them before they launched those attacks, we would suffer higher casualties.”
Rubio said that while the US would like to see the Iranian people rise up and be rid of the regime, “that’s not the objective,” he said. “The objective of this mission is to make sure they don’t have these weapons that can threaten us and our allies in the region.”
Trump’s shifting rationale sparks detractors
Rubio, Defense Secretary Pete Hegseth and other administration officials delivered the classified briefing as Congress weighs a war powers resolution that would restrain Trump’s ability to keep waging war without approval from the House and Senate.
Trump himself, speaking at the White House, laid out four objectives for the war, saying US forces are out to destroy Iran’s missile capabilities, wipe out its naval capacity, stop the country from obtaining a nuclear weapon and ensure “that the Iranian regime cannot continue to arm, fund and direct terrorist armies outside of their borders.”
“This was our last, best chance to strike — what we’re doing right now — and eliminate the intolerable threats posed by this sick and sinister regime,” Trump said.
Trump met repeatedly with Israeli Prime Minister Benjamin Netanyahu as they sought to curb Iran’s nuclear program, including last month at the White House.
Hegseth earlier Monday vowed this is not an “endless war,” even as he warned more US casualties are likely in the weeks ahead.
But Sen. Mark Warner, the top Democrat on the Intelligence Committee, said: “There was no imminent threat to the United States of America by the Iranians. There was a threat to Israel.”
Warner said he has now heard four or five stated reasons for the attack. He demanded that Trump “come before Congress, and for that matter, the American people,” to make his case for war — and the exit plan.
Several Democrats delivered blistering speeches against the war. “Are we now such an enfeebled nation that Israel decides when we go to war?” said Sen. Jeff Merkley of Oregon, voice rising.
War powers as a check on presidential power
The moment is a defining one for Congress, which alone has the authority under the US Constitution to declare war, and for the Republican president, who has consistently seized power during his second term with his own executive reach.
Trump took the nation to war at a particularly vulnerable time, as the Department of Homeland Security is operating without routine funds because of a standoff with Democrats over their demands to restrain his immigration enforcement operations. The potential wartime costs in terms of lives lost and dollars spent are dividing the parties, and potentially Americans themselves.
Unlike the run-up to the Iraq War in 2003, which included long debates in Congress in the aftermath of the Sept. 11, 2001, attacks, or the more recent US military strikes on Venezuela that proved to be limited, the joint US-Israel military attack on Iran, called Operation Epic Fury, is well underway, with no foreseeable end in sight.
“It’s worrisome,” Rep. Adam Smith, the top Democrat on the House Armed Services Committee, told The Associated Press.
Smith said of Trump: “He is not trying to making his case to the Congress or the American people. He unilaterally decided to do this.”
In fact, Congress has declared war just five times in the nation’s history, most recently in 1941, to enter World War II a day after the Pearl Harbor attack. Over time, presidents of both major political parties have accumulated vast authority to engage in what are often more limited US military strikes.
Johnson said tying Trump’s hands right now would be “frightening” as he works to defeat the war powers resolution.
Even if Congress is able to pass the measure this week, the House and the Senate would be unlikely to tally the two-thirds majority needed to overcome a presidential veto.
Next steps for Iranian people uncertain
As the Trump administration encourages the Iranian people to rise up and choose new leaders, there did not appear to be widespread US support for any effort at democracy- or nation-building.
“We would love to see this regime be replaced,” Rubio said. “If there’s something we can do to help them down the road, we’d obviously be open to it. But that’s not the objective.”
A top Trump ally, Sen. Lindsey Graham, R-S.C., said he never bought into the you-break-it-you-own-it concept in wartime.
“If there’s a threat to America, deal with it,” he said over the weekend. “That doesn’t mean you own everything that follows.”