Novel Coronavirus Outbreak: Lessons from the Past

While we were watching out for the flu, without warning, along came a severe respiratory infection caused by a novel coronavirus imported (without tariff) from China. This is the kind of news that sets the world on edge. But it also underlines how important the field of infectious diseases is in informing us about the world we live in, along with highlighting our strengths and vulnerabilities.

When it comes to contagious diseases, as John Donne wrote in another context in the seventeenth century, “no man is an island.” Consideration of the emergence of this new infectious agent and its rapid transit from a province in central China to the U.S. coast in a matter of days points out the smallness and connectedness of our world today. We have seen this before in previous outbreaks of infectious disease in our nation and around the world. The deaths due to these events are a reminder of why physicians, governments, and even members of the general public need to think about cooperation and wider provision of healthcare to limit disease transmission on a local, national, and global scale.

Previous disease outbreaks have a lot to teach us, and unfortunately, some of those lessons have yet to be completely learned. But we have learned much; here is some of the most-important knowledge gleaned from previous events.

• We’re in this together: We must recommit our nation to the provision of healthcare and sanitary living conditions to all people living within our borders. We are inextricably bound together in the matter of the transmission of microbial disease, whether from old enemies, such as tuberculosis, or new and yet-to-be-described infections.

• Information equals defense: The emergence of a previous coronavirus infection, dubbed SARS (severe acute respiratory infection), was kept secret for a period of weeks or months, allowing it to spread farther than it should have. Initially, it appeared that Chinese public-health officials sounded the alert within days about the current outbreak, enabling authorities, locally in China and across the globe, to set in motion efforts at containment. External press sources, however, have reported that information on the spread and magnitude of infection were and continue to be censored in that nation.

• Science advances: Development of the science of isolating and definitively identifying pathogenic microbes, whether bacterial or viral, has improved logarithmically. Whereas it took almost nine months to identify the cause (a bacterium) of Legionnaires’ disease in 1976, it took a matter of days to identify coronavirus as a novel viral agent. The speed and accuracy of this identification are crucial in helping us know how to diagnose and deal with the disease.

• Species barriers broken: It appears that the original source of this virus was nonhuman mammals. Although it was previously believed that most viruses, unlike bacteria, adhered to species barriers, avian influenza outbreaks beginning in 1997, West Nile fever in 1999, SARS in 2003, and this current episode have proved that these barriers can be trespassed. In fact, zoonoses (diseases that cross species)—needing an intermediate host, such as a tick in Lyme disease or a mosquito in West Nile—now represent a significant proportion of human disease.

We are still in the early phases of this coronavirus outbreak. We are uncertain about the level of contagion, methods of spread, and case fatality rate, among other factors. While efforts to create a vaccine are underway already, it will take a year for development and manufacture, by which time the infection may have spent itself. It is important for scientists, physicians, politicians, and members of the public to remain informed using the best sources available and to make sure and practice the tried-and-true hygiene measures used to ward off influenza. As for up-to-date information, I recommend the Centers for Diseases Control and Prevention website, as well as historically reliable news sources.

While specific elements of the future are impossible to predict, two things are certain: By the time you read this, the scope of this outbreak will have changed, and because of the evolution of new viruses and the ease and rapidity of travel, we are destined to experience more of these epidemics and pandemics. That is a daunting thought. However, we can and should keep in mind that we’ve also learned much and will continue to build our resources based on the lessons we have already learned.