13.02.2020

Bats, panic and system failure

What are the origins of the COVID-19 outbreak? How can the spread of this and other new viruses be stopped? James Linney gives some answers...

The first case of human infection by a new virus - now officially baptised by the World Health Organisation (WHO) as COVID-19 - was officially reported by the Chinese government on December 31, although we now know doctors in China were aware of the outbreak at least two weeks before this. At the time of writing the official number of people infected by the ‘novel coronavirus’ is just over 45,000 and the number of deaths 1,100, with 99% of the cases being in China and only two deaths in other countries so far. There are 393 COVID-19 cases outside China, spread across 24 countries. The number of infections is certainly an underestimate and at this point it is very difficult to predict how serious it will prove to be globally.

COVID-19 is ‘novel’, because it is a newly recognised virus, within the coronavirus family. It causes serious respiratory complications, including viral pneumonia and, apart from supportive measures, there is no treatment and no vaccine. Coronaviruses are a well-recognised group, which include the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). Chinese scientists were quick to sequence the DNA of the new virus and then publish it with an ever-growing number of full sequences from patients, in the Global Initiative on Sharing All Influenza Data database. These viral genomes are now being intensely studied to try to understand the origin of COVID-19, how it fits on the family tree of related viruses and to attempt to develop a vaccine.

The origin of the virus is still not fully understood, but a seafood market in Wuhan (the sprawling capital of central China’s Hubei province, with a population of over 11 million) is believed to be implicated in its initial transmission. According to Xinhua, the Chinese state-run news agency, samples from the Wuhan seafood market have revealed strong evidence of COVID-19 and 26 of the first 47 cases visited the market where wildlife was sold. But there were other cases at the same time that have no link to the market.

In many ways the origins and spread of COVID-19 is a familiar story. Like most viruses (including the coronavirus family, HIV, Ebola and smallpox) its journey to humans began via wild-animal carriers. Bats are a common originator of viruses and suspected to be involved in the spread of coronavirus, as they were with SARS and MERS (not, by the way, by being eaten in a soup). It is thought that their strong immune systems drive viruses to greater virulence, which are then more deadly to humans. Viruses often then make the jump to domesticated animal populations before being passed on to humans. The final step involves the virus adapting to allow human-to-human spread. There are many environmental factors along this chain that promote virus propagation to large human populations - some important ones being: close contact to wild animals; large and closely confined populations of livestock/humans; the transport of livestock and meat products globally; and human international travel.

The characteristics of the virus are obviously important too: for example, its predilection to mutate, its mode of spread and whether it becomes contagious before being symptomatic. So, in relation to COVID-19, it is likely that it spreads like most other coronaviruses via air droplets. Ingeniously, by irritating the airways, the infected sputum and secretions are dispersed by sneezing and coughing. It is believed that close (within two metres) and prolonged (more than 15 minutes) contact result in a high risk of spread. There is also a risk that the virus can land on surfaces and survive there for some time - hence why hand washing and simple hygiene measures are so important. Most public health advice, however, is based on the best educated guess - COVID-19 is too new for us to know much about it for sure.

Air droplets and respiratory secretions are a highly effective method of disease spread, and so COVID-19 has travelled globally much faster than, say, Ebola did during the Western African epidemic (2013-16). Ebola spreads via bodily fluids, which requires much closer contact. Ebola is also a much more virulent infection, meaning that the host becomes symptomatic faster and the virus often kills its host before it can be passed on to a large number of people; thus outbreaks can burn themselves out.

Most face masks are unhelpful in preventing coronavirus infection. Only the specialised N95 respirator masks are effective and only when they have been individually fitted and regularly changed. The surgical masks that you see most people wearing are not much use and can actually be counterproductive: partly by inferring protection and thus making the wearer less vigilant with hygiene; but also because, when worn, they create a moist reservoir close to the airways - an attractive invitation for a coronavirus. Due to panic buying there is now a global shortage of masks and other protective medical clothing, meaning many hospitals are struggling to source them.

Inside China

There is more at play in the current coronavirus outbreak than the nature of the virus and the environment within which it is spread: namely human political systems. The political and economic interests of the ruling elite of each country plays a role in hindering their response or, even more scarily, they take preference over preventing the spread of the virus.

Let us look first at the case of the Communist Party of China, where the doctors treating the early cases assumed the likely causative agent was SARS. Li Wenliang was one of these doctors who tried to raise the alarm on social media, but the response from CPC officials was to arrest and accuse the doctors of “spreading false rumours.” Li Wenliang subsequently contracted the virus and died on February 7, inspiring some protests within China calling for greater freedom of speech. After reporting the first case on December 31, the Chinese government appeared to take decisive action to share data and quarantine those infected in Wuhan. But by this time the horse had already bolted, whereas quicker action in the first weeks could well have significantly restricted the outbreak.

Since this time we have seen the full force of the Chinese military-police state come down on Wuhan. Given the CPC’s pathological secrecy and its tight control of the internet and media, it is difficult to get an accurate picture of its infection control measures. But what is clear is that the authorities are rounding up large numbers of citizens and putting them into newly built or converted ‘hospitals’ - pictures on social media of the inside of some of these buildings show what looks more like large, densely packed detentions centres rather than hospitals. Given that a diagnostic test to confirm COVID-19 takes days (although a more rapid test has been developed, it is not widely available), it is likely that large numbers of non-infected people are being swept up and placed in these detention centres, which undoubtedly then become breading grounds for the virus.

The speed and extent to which millions of people have been quarantined has been praised by the WHO. But it has been made possible by the pre-existing police-state infrastructure and extensive surveillance systems - weapons designed by the party to ‘quarantine’ political threats, as witnessed during the Hong Kong protests last year. China is probably the only nation that could have implemented such a large-scale quarantine programme (46 million people in the Wuhan area alone) in such a short amount of time. Quarantine is obviously an essential part of controlling the outbreak, but, when done is such a brutal way, it acts to simply further stress an already panicked and scared population and is likely to deter some infected people from seeking medical attention: similarly, those in the asymptomatic incubation phase of the illness are much more likely to flee.

One motivation for the Chinese government to initially try to cover up or downplay the seriousness of the outbreak was economic. Although it is too early to assess the impact on China’s international trade, once news of the significance of the virus broke, the markets responded quickly and Chinese stocks suffered the worst day since 2015. For this reason, some in the US government saw the outbreak as a gift - hence US commerce secretary Wilbur Ross’s comments hours after the outbreak began:

I don’t want to talk about a victory lap over a very unfortunate, very malignant disease. The fact is, it does give business yet another thing to consider when they go through their review of their supply chain ... So I think it will help to accelerate the return of jobs to North America.

As well a chance to get one over on China in the US trade war, the coronavirus also presents an opportunity for Trump to stoke more xenophobic fear and strengthen his immigration policies; it will no doubt be sold as another reason to build walls in his coming election campaign.

Global response

In the UK COVID-19 has only had a tiny impact so far: there have been eight confirmed cases. However, there will certainly be more, but at this point it is impossible to guess how many. In a situation where the UK faced a similar outbreak as is happening in China, it would be overwhelming for a national health service already at crisis point. In such a scenario, the Tory cuts - which have already resulted in never-before-seen GP, A&E and hospital waiting times - would undoubtedly have resulted in thousands of unnecessary deaths.

What of the response of the community of ‘independent’ world scientists? The WHO forum on COVID-19, which met in Geneva this week, gathered experts from all over the world - most no doubt genuine in their endeavours to cooperate towards a better understanding and ultimately a vaccine. Yet, the idea that there is an international scientific body, able to work independently of the interests of their states, towards a greater scientific understanding for the benefit of all, is a fallacy. The research into viruses and development of vaccines to a serious global disease like COVID-19 is hostage to the will and profit of pharmaceutical corporations. Remember how Tamiflu (Oseltamivir) was once touted as a proven and effective treatment for flu during the pandemics in 2005 and 2009? Recommendations by the WHO, the Food and Drug Administration and European Medicines Agency led to governments stockpiling the drug, earning its manufacturer, Roche, billions of dollars - only for it later to be revealed that Roche distorted the drug’s effectiveness by burying data from studies that reflected badly on its product.

This is a perfectly legal and widespread practice of pharmaceutical company drug testing. We need only look at the experience of another, previously unknown virus, which was identified in the 1980s and has killed more that 30 million people: HIV. When an effective anti-viral treatment was eventually developed, the defining criteria for whether a sufferer was given the treatment were based on profitability.

There is no suggestion that the COVID-19 infection is going to have a global impact comparable to HIV. So far the fatality rate is estimated to be somewhere around 1% - much lower than SARS (9.6%) and MERS (34%) - although, if a 1% fatality rate is accurate, then this could still potentially have a devastating global impact. If, for example, it infects as many people as the annual influenza virus (fatality rate of 0.1%), this would result in several million deaths. However, so far there has been only a minimal impact outside China and within China the daily new case and death rates have reportedly fallen for the first time over the past 48 hours. Hopefully the first signs of the virus in retreat.

We can never stop the development of new viruses: they are a product of the same evolutionary processes that are responsible for every living thing around us. But we can take steps to reduce the likelihood of them infecting humans and reduce their impact when they do. The current coronavirus outbreak reminds us that capitalism is a wholly inadequate system for doing this. It creates the conditions that favour infectious disease-spread, keeping the majority of its people in densely populated, squalid cities. When infectious diseases do break out, capitalism prioritises profit over the health of the global population - even in the face of a devastating worldwide health crisis.

In overcoming capitalism, the working class does not just have its chains to lose: it also has the unleashing of its potential to gain. A potential that would be exponentially better suited to deal with future environment and biological challenges.