Could We Have Stopped the COVID-19 Pandemic? And Are We Ready to Prevent the Next One?

Debora MacKenzie
·13-min read
Photo credit: Sohl
Photo credit: Sohl

From Men's Health

Photo credit: Sohl
Photo credit: Sohl

On 11 February 2020, the World Health Organisation (WHO) gave a name to an illness that had emerged only two or three months earlier: CoronaVirus Disease 2019, more commonly referred to as COVID-19.

That day, few would have believed that, a year later, the odd-sounding disease would still be the defining issue for men’s – and everyone’s – health. But it hasn’t just been a year of mounting death tolls, baffling symptoms and economic mayhem. The year has also seen an unprecedented outpouring of science, the invention of effective vaccines and a deeper understanding of how pandemics happen.

So, it’s time to ask ourselves a few things. Could we have stopped the pandemic? Can outbreaks such as this happen again? If so, has COVID-19 taught us how to prevent the next one?

Spoiler alert: during the first lockdown last spring, I wrote a book called COVID-19: The Pandemic That Never Should Have Happened and How to Stop the Next One. Just based on what we knew then, the answer was yes, we could certainly have prevented it, or if not, controlled it better. And, yes, there will be another outbreak like this, of an animal virus that spreads lethally in people. Since last spring, this has become even clearer: if we learn what we did wrong this time and act on it, there is every chance that we can stop the next one. What we don’t have is any assurance that governments facing the economic fallout of this pandemic will do what is needed.

It isn’t as if we weren’t warned this time. The real scandal of COVID-19 is that scientists have been predicting such a crisis for decades. Some of them even warned about this specific family of viruses. I know: I’m a science journalist, and I’ve been reporting the warnings since the 1990s.

They boil down to this: there are many viruses in wildlife that can spread to and between humans – and even kill. This is happening with increasing frequency, as humans live and work in formerly wild areas and encounter more, sicker wildlife. The germs that jump to us spread further and faster as our global connectedness increases, yet we don’t have adequate plans or enough research and development to detect and limit such outbreaks before they spread out of control.

In other words, the conditions that led to COVID-19 have not gone away, and another pandemic could happen at any time. There are worrying viruses just waiting for their chance.

What has changed, however, is that now we all know that this threat is real. BC – before COVID – few people, especially in rich countries, believed that our modern world could be struck down by pestilence. Such an idea seemed like something from the distant past. That, I think, is what ultimately kept us from being ready. For years, scientists warned of the threat and many countries had plans in place for a pandemic – at least, on paper. But when COVID-19 hit, the responses in many places were chaotic and ineffectual.

The Origin Story

In December 2019, doctors in the Chinese city of Wuhan noticed that they were seeing a lot of unusual cases of severe pneumonia. Tests soon revealed a new kind of coronavirus. They found that it was spreading between family members. Viruses that are new to people can’t always go from person to person easily, so they don’t travel far. This one could.

Photo credit: Aitor Diago
Photo credit: Aitor Diago

It was an important observation: the first hurdle is to recognise the problem. But the Chinese authorities decided to play down the outbreak. Doctors were told to stop putting cases in the central reporting system; then, tests were limited, so the official case numbers didn’t climb. In early January, Beijing told the WHO about the outbreak but claimed – to the Chinese public, as well as to the WHO – that it didn’t spread from person to person.

No one apart from those involved knows why. There was a big government meeting planned for Wuhan in January, and officials might have decided to keep things quiet. A similar coronavirus that broke out in China in 2002, SARS, was contained by isolating people with symptoms; perhaps they assumed that the new virus could be stopped just as easily, with sick people confined in hospitals. Comments from the time suggest that, like officials everywhere, they didn’t want to panic people.

As we now know, people without symptoms can transmit COVID-19, so it continued to spread in Wuhan. Eventually, on 20 January, Beijing announced that COVID-19 could spread from person to person, after all, and put Wuhan – now riddled with the virus – in lockdown three days later. By then, however, some five million people had left for their big annual New Year’s holiday, spreading the virus worldwide.

If they had acted later, it would have been far worse for both China and the rest of the world. If they had acted earlier, they might, in theory, have stopped the pandemic completely. Yet epidemiologists suspect that no authorities would have acted aggressively enough, or early enough, to stamp out the virus before they knew much about it – especially that people without symptoms could spread it. After all, many authorities, including in the US, were reluctant to take strong actions even after they knew far more.

But if we had known about this earlier, maybe more countries could have deployed tests, isolated infected people and their contacts and limited or quarantined travellers, before the virus got far. Singapore, South Korea, Vietnam, Taiwan and New Zealand acted swiftly once the truth was out, significantly limiting their epidemics. If more countries had done the same, it wouldn’t have stopped the virus completely but it might have meant far less suffering and death until a vaccine was ready.

Poor Communication

Wherever the next outbreak occurs, we need to make sure that we rapidly have access to the complete information. The Chinese officials are far from unique in wanting to keep diseases quiet. In the 1990s, most European countries denied that there was mad cow disease on their farms, long after scientists knew that it had to be there. African countries reluctant to report cases slowed the response to the 2014 Ebola epidemic. The former US president Donald Trump downplayed COVID-19 early on to avoid upsetting people – or the stock market.

So, how do we make sure that this doesn’t happen again? Trump blamed the WHO for not warning the world that the virus was contagious. Yet the WHO had no way to find out if Chinese authorities didn’t tell it or even let WHO experts in.

Even though we are all at risk when a disease breaks out, the treaty that governs this – the International Health Regulations (IHR) – puts the country with the outbreak solely in charge. The WHO can’t demand to investigate, even if it suspects that it hasn’t heard the whole story, because that would violate national sovereignty, which is sacrosanct in international relations.

This is dangerous in a world as closely connected as ours, where a contagious disease anywhere is soon everywhere. How do we reconcile the need for countries to be independent with the need to make sure that they act in all of our interests, and quickly, when needed? Other international treaties use verification. Under the treaty banning chemical weapons, countries declare their chemical activities and inspectors verify that what they have declared is true. Something similar happens for nuclear material. Countries set aside sovereignty in these limited ways for everyone’s safety.

The IHR now requires countries to declare novel outbreaks, and China did – just not completely. What if the WHO had been able to say, “Thanks, our inspectors will be there tomorrow to check it out”? The truth could well have emerged earlier.

And if countries had to make these declarations regularly, inspectors could come in and check that they really are looking hard enough to know that they have no new or worrying diseases. In the case of poorer countries at high risk, other nations could help them build that capability.

That’s what we really need: disease surveillance everywhere. The IHR requires rich countries to help poor ones do that now, but according to global health experts, it isn’t happening.

That’s just one idea for how we could somehow all take charge of this problem. However, we need a more foolproof early warning system soon, because we will get more outbreaks like this.

History Repeats

Back in the 1970s, scientists were convinced that we had largely beaten infectious disease with public health, sanitation, vaccines and drugs. That was until HIV – originally a chimpanzee virus – went pandemic in the 1980s. It still is pandemic.

Shaken, experts realised that other germs could jump from animals to people. And many have. One estimate is that around five do so each year, and that figure is rising. Some of these diseases fizzle out, or do very little. Others spread clumsily, and we beat them back – as we did with SARS and its cousin MERS, which emerged in 2012. A few just keep circulating as people develop immunity, as with the four flu pandemics since 1918. And some haven’t – yet – evolved the ability to spread between people, such as bird flu.

But there are viruses that are trying. When I ask disease researchers what scares them most, many say Nipah. This virus is carried by the big fruit bats of Asia and Africa. Some of these animals were driven out of deep forests by fires in 1998 and flocked to farms, where they spread the virus to pigs, then to people, in Malaysia. The final scenes in the Steven Soderbergh movie Contagion (2011) were based on Nipah.

This virus scares scientists because it has a 75% death rate. It is moving – first into Bangladesh, now across India – and has started to spread from person to person. Sure, it isn’t travelling very far, for now. But that could change.

The WHO has a watch list of scary viruses like this. COVID-19, for example, has cousins. In 2005, a Chinese virologist, Zhengli Shi, found dozens of viruses that are very similar to SARS in common insect-eating bats.

By 2017, she and her colleagues had found the SARS virus itself, and others that could already infect human airway cells and cause disease, straight from the bat. They warned that these were “poised” for human emergence. There was little response – no drugs, or vaccines, or diagnostics developed, nor surveillance started. And then one eventually emerged and caused COVID-19.

Photo credit: Aitor Diago
Photo credit: Aitor Diago

It is hard for humans to catch a virus from ordinary wild bats – those in the US carry rabies, for example, but very few people catch it. One way we could have stopped COVID-19 happening would have been to severely limit contact between humans and bats.

Bats are eaten across Africa and south Asia, but normally not the kinds that carry COVID-19, and there is no evidence that this is how it emerged. Some early cases in Wuhan had links to a market that sold wildlife for food, but many had none.

Andrew Rambaut of Edinburgh University says that the virus’s genes show that it jumped only once, probably from one bat into one or a few people, then spread from person to person from there. The cases from the market might simply have been because people crowd together there.

China has shut down sales of wildlife for food since then, which is wise, given all the unknown germs that they carry. But bat viruses can spread in other ways. Powdered bat guano, for example, is used widely in China as a traditional remedy for eye ailments.

The bigger problem is that humans around the world are having more and more close encounters with wildlife just by trying to earn a living. The Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES), a group of scientists who advise governments on biodiversity, reported last October that thousands of viruses in wildlife can probably spread to humans – and increasingly, they actually do.

A Stronger Defence

So, how can we stop this? The EcoHealth Alliance, a non-profit organisation based in New York that works on both wildlife disease and conservation, helped to discover and warn about the SARS-like viruses in bats. Peter Daszak, head of EcoHealth, tells me that we need to look for wildlife viruses that can invade humans, and design drugs and vaccines for them before they emerge – not after a pandemic is raging, as we are now.

Experts must also try to ensure that humans aren’t exposed to those viruses by working with people to stop risky behaviour. This means making industries that stress and displace wildlife and bring it into contact with people – farming, lumbering, mining, road-building, the wildlife trade – far more careful in their actions.

But no existing organisation can do all of that. “It would need a coalition of the willing,” says Daszak: groups from the WHO and conservation organisations, plus varied industries and researchers brought together by a specific, government-level pandemic prevention council, in order to get the important work done.

The answer is certainly not to kill the animals. “Bats don’t cause disease emergence,” says Andrew Cunningham of the Zoological Society of London. “People do, by destroying bats’ habitat.” Besides, bats save billions of dollars’ worth of crops yearly in the US alone by eating insect pests – never mind that they are the sole pollinators of the agave plants used to make tequila. And that’s not all. Without fruit bats spreading seeds, says Cunningham, “There would be no rainforest, with its vital role in controlling the climate.”

Instead, IPBES calculates that for around $50bn per year, the world could control the global wildlife trade and reduce risky changes to land use enough to cut the risk of pandemics. This is around 1% of the cost so far of COVID-19. IPBES hopes that this obvious bargain might inspire governments and industries to find the necessary funds.

It seems a no-brainer. The US is the world’s biggest importer of wildlife – mainly pets – and the trade spares little thought for viruses. In 2003, US children caught a virus related to smallpox that had been brought in with pet African rats. Land-use change, such as converting tropical forests to palm oil plantations, released a third of the dozens of new germs that have invaded people from animals since 1960, says IPBES. Both could be managed better.

Meanwhile, climate change also stresses and displaces wildlife. It contributed to the forest fires that drove out the Nipah-carrying bats. Restoring the forests would massively reduce greenhouse gases, while giving the bats somewhere safer to go.

A win-win, then. Yet while the leaders of the world’s 20 biggest economies, the G20, promised in March to “substantially increase” spending on “a global initiative on pandemic preparedness and response”, their second statement in November mentioned no such spending or initiative: just “advancing global pandemic preparedness, prevention, detection and response”, and the “continued sharing of timely, transparent” information. There was no mention of trying to prevent any more failures of transparency.

The good news is that, one year and many deaths after we named a lethal new disease COVID-19, we have a better idea of how it happened and how we could stop the next one. Governments that are reeling from its economic impact may need some convincing. But the G20 was right – we need to channel more resources into preparing for, preventing, spotting and responding to pandemics. And we can’t afford to wait long.

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