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Commentary: We know more about the novel coronavirus but uncertainty remains about how virus spreads

The viral spread of anxiety and bigotry is as dangerous as the virus itself, says NUS Saw Swee Hock School of Public Health’s Clarence Tam.

Commentary: We know more about the novel coronavirus but uncertainty remains about how virus spreads

A hospital employee dons protective gear inside the holding area for patients suspected of being infected with COVID-19 in the Philippines. (Photo: AFP/Ted ALJIBE)

SINGAPORE: In the past week, the World Health Organization (WHO) declared the epidemic of the novel coronavirus a Public Health Emergency of International Concern.

This has previously been done for epidemics of swine (H1N1) influenza, polio, Zika and twice for epidemics of Ebola in west and central Africa.

Classifying the current epidemic as an international emergency signifies the need for a concerted international effort to curb the spread of the novel coronavirus.

This decision has been precipitated by a number of factors, including the dramatic pace at which the epidemic is evolving, the detection of cases linked to international travel in an increasing number of countries, and the growing recognition of disease clusters outside of China that have resulted from person-to-person spread rather than travel to Hubei province.


But there is still uncertainty about some key issues – how widely the virus will spread outside China, what impact this will have, particularly in countries with fragile health systems, and exactly how severe this illness is.

What we know so far is that the virus seems less deadly but more transmissible than SARS. 

Of the hospitalised cases detected in China, about 2 to 3 per cent have died compared to SARS’ 10 per cent fatality rate.

Of these, most had underlying health conditions that are likely to have contributed to their risk of death. There is also increasing evidence that the virus can be passed on by people with mild or no symptoms.

A new study by German researchers published in the New England Journal of Medicine on Thursday (Jan 31) found a cluster of cases from China and Germany in which the virus appears to have spread before patients showed symptoms. All these cases were reported to have mild illness.

At least seven people have been confirmed to have the Wuhan virus in Malaysia. (Photo: Bernama)

It is likely that a much larger pool of people have been infected but are not recorded in official statistics, because they do not experience pneumonia-like symptoms.

One study published on prestigious medical journal The Lancet estimates than more than 75,800 have been infected in Wuhan alone, with the virus expected to reach its peak only in April or May.

A more conservative estimate by China’s Bureau of Disease Prevention and Control estimates 25,000 infected but projects that the number of infections will double every six days.

These uncertainties pose challenges for containing the epidemic, if people can pass on the virus to others before they know they are infected and before they can be isolated.

For most healthy individuals, the risk of dying from a novel coronavirus infection is low, although we should be particularly concerned about those with pre-existing health conditions.

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Studies have shown that the first few cases saw a majority of those infected to be above 50.

SARS had a fatality of 10 per cent but that jumped to 50 per cent in people over the age of 50, explained Vineet Menachery, an immunologist at the University of Texas Medical Branch said in an interview with Quartz, suggesting that seniors are more susceptible because of a weaker immune system.


As we work to resolve uncertainties about the biology of this new virus, it is important to remember epidemics have an important social dimension borne out of human development – which have little to do with peculiarities unique to China.

Of the six epidemics that have been declared international emergencies, five involved viruses that ultimately originated in animals, including the current novel coronavirus.

A health worker fills a syringe with Ebola vaccine before injecting it to a patient, in Goma, Democratic Republic of Congo, August 5, 2019. (File photo: REUTERS/Baz Ratner)

Viruses routinely jump between species. In the past, these jumps were more likely to happen when humans and animals came into contact in remote areas.

It was more difficult for these viruses to gain traction in humans, because there were fewer people to pass the virus on to.

But as epidemics of SARS and Ebola have shown, with human migration and greater urbanisation, when these viruses are introduced into large, densely populated cities, they can spread rapidly and with devastating impact.

This is bad news when there are about 600 cities with a population exceeding 1 million people today.

But the astounding rise of China has seen urbanisation rates explode – 60 per cent of its population today live in urban areas and this figure is expected to rise to 70 per cent in the coming decade.

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Together with increased human encroachment into animal habitats and the intensification of food animal production, the emergence of animal viruses capable of causing similar international emergencies may become the new normal.

The larger lesson to take away is this: If we are to successfully prevent and control the threat of such future epidemics, we urgently need global investments in urban planning, robust health systems and biosecurity.


With the rapid spread of the novel coronavirus, we have also seen the viral spread of misinformation.

Misinformation about the virus has spread widely since its outbreak in China. (Photo: AFP/Nicolas Asfouri) Misinformation about the mystery virus has spread widely since its outbreak in China AFP/NICOLAS ASFOURI

The upside of the potential for social media to facilitate rapid communication of scientific knowledge and health information emerging from this epidemic is being challenged by its use that fuels anxiety, fear and hatred.

Conspiracy theories, malware, unfounded rumours and bigoted opinions have grown.

Pictures of  restaurant and store windows in South Korea and Japan with signs saying, “No Chinese allowed” have gone viral on Twitter and other social media platforms.

Much of this incites social tension, distrust in governments, health authorities and scientific evidence, and demonstrates extreme and disturbing prejudices on the basis of nationality and ethnicity.

As countries implement stricter travel restrictions and social distancing measures in an effort to curb epidemic spread, there is a real danger that as a society we may be aiding the spread of hatred and xenophobia.

By the end of the epidemic, thousands of people will have been placed in isolation and quarantine and millions will have had their movements severely restricted through no fault of their own.

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The vast majority of these individuals will turn out to pose little or no threat to others, but are being asked or ordered to temporarily forfeit their freedoms for the good of the wider community.

We should not look upon these individuals with fear, hatred and distrust, but rather with gratitude, kindness and compassion.

In time, we will bring this epidemic under control and lessen its impact on humanity, but in doing so we must not lose sight of what it means to be human.

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Dr Clarence Tam is Assistant Professor at the NUS Saw Swee Hock School of Public Health.

Source: CNA/sl


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