A global epidemic is currently rocking humanity’s sanity. Severe Acute Respiratory Syndrome Coronavirus 2, shortened to SARS-CoV-2, is the official name for the virus that causes the disease known as Covid19. The virus is genetically related to two previous Coronavirus outbreaks.
SARS first caused global panic in 2003. That outbreak lasted from November 2002 until July 2003 (with a small, quickly contained secondary outbreak in early 2004). As at September 2003 World Health Organisation announced 8,098 total cases, 21% of which occurred in health care workers. 9.6% of all cases died, known as the Case Fatality Rate (CFR).
In 2012 Middle East Respiratory Syndrome Coronavirus (known as MERS) emerged from Saudi Arabia. Another relative of SARS, MERS had a much higher CFR of 34.45% among the 2,494 cases confirmed by laboratory tests. Despite this high proportion of deaths the virus managed to travel to and infect people in 27 countries. The majority of cases have been in Saudi Arabia, where 19.4% of all cases have occurred in health care workers exposed to sick patients.
Neither of these new diseases spread easily in comparison to other viruses, at least in part due to their high case fatality rates. Enough people with the capacity to transmit the disease were too sick and / or died before they could come in contact with others. Illness and death are good barriers for human to human transmission. Except, as with another infamous and lethal virus, Ebola, for those taking close care of the sick and dying.
Australia’s insanity mascot for the Covid19 epidemic is toilet paper. Panic buying has turned viral, causing a secondary epidemic of sorts. For a virus that causes influenza-like symptoms (fever, breathing difficulties) the focus on toilet paper seems comical. Police had to taser a man in the toilet paper aisle of one store, after an argument broke out between two customers. Fear of running out of toilet paper. The official term is acartohygieiophobia.
Elsewhere the insanity is mirrored in other ways. A friend in Phnom Penh described driving past an expensive western-style supermarket last night, where hand sanitiser has increased in price from $3 a bottle, to $27 a bottle. A recycling scavenger was sitting on the kerb with a small child, eating plain rice with their fingers from a plastic bag and laughing together. Metres away a family were piling excessive amounts of groceries into the back of their luxury car and shouting at the children to get in the car quickly.
CoVid19 is a mild virus for 80% of people infected. The CFR at this point is 3.4% but the disease pattern is still emerging and the true CFR may not be known for some time yet. The CFR also increases with risk factors such as older age and underlying chronic conditions, whilst it seems to decrease in children infected. The lower (in relation to SARS and MERS) rates of severity and fatality are major factors allowing the virus to spread quickly as the infected continue to go about their usual daily activities, including coming into close casual contact with multiple people everyday whilst probably unaware that they are infectious. The expected number of people likely to catch Covid19 from one infectious case is between 2 to 2.5.
The majority of infected people can be cared for at home, so that they keep away from busy places like GP and hospital waiting rooms. This is an excellent precaution to reduce human-to-human transmission of the virus. The point being, if you have mild symptoms such as fever, dry cough and some mild shortness of breath: stay at home until you feel better; or if your symptoms become more severe. When coughing or sneezing, cover your nose and mouth – preferably with a clean tissue (or some squares of all that extra toilet paper), which should be discarded immediately; or else by putting the crook of your elbow over your face – to avoid coughing onto your hands which easily spread organisms to anything you touch.
Because the virus may sit on surfaces for significant amounts of time, all of us should be washing our hands regularly, particularly after touching publicly shared objects such as door knobs and supermarket trolley handles (whilst leaving the loo rolls on the shelf). Try not to touch your face with your hands because if the virus is on your hands, you’re presenting it to the ports of entry (nose, mouth, eyes) into your respiratory system. Wearing masks is only useful if you are sick and trying to prevent your illness from spreading to others, especially when out in public. A mask is not protective against other peoples’ illness. Masks lose their integrity quickly once you’ve been breathing into them for a while, so they require changing regularly and must be worn properly to have any protective effect.
Places like Australia will fare much worse in the face of the panic epidemic taking hold of us, than we will from Covid19. To date we have had 60 cases of CoVid19 with 2 deaths. As at 2 March 2020, so just two months into the year, there have been 12,713 confirmed cases of Influenza in Australia. Every year in Australia, Influenza accounts for up to 300,000 GP consultations; 18,000 hospitalisations and 3,500 deaths. Yet it never seems to lead to en-masse acartohygieiophobia, stock market crashes or other evidence of group panic.
Whilst there are still unknowns about Covid19, such as:
- is it going to become (as Swine Flu did) just another virus in the usual human transmission chain?
- what is the case fatality rate going to be?
- where is it going to spread globally and where is it not going to spread?
it is also time for calm and common sense. During the post-9/11 terrorism fears our government promoted the slogan “be alert, not alarmed”. Now is another time for this slogan to enter the national conscience.
Whenever global anxiety takes hold, the most suffering happens in poor countries. In Cambodia the government spend $183 per person per year on total health care expenditure. That means total costs for health staff salaries, medical equipment and all health care resources. It translates to if you get sick, you are going to pay for everything out of your own pocket. Where the poorest earn less than $1,000 per year, this translates to immense unnecessary suffering and death. The infectious disease with biggest impact in Cambodia, Tuberculosis, has a case fatality rate of 7% in official reports. This is possibly much higher due to inefficient surveillance systems and very low access to basic health care among those at highest risk to TB, such that people die invisibly.
One case of Covid19 has so far been reported in Cambodia, in a Chinese man who traveled from China and became unwell on arrival in late January. Another case was diagnosed this week in a man who traveled to Cambodia from Japan and became unwell, but was only diagnosed after he returned to Japan. His close contacts in Cambodia have been quarantined as a precaution but so far there are no further cases in the local Cambodian population. A friend said to me this week “I am sure those contacts of the Japanese case will get sick. Not from Covid19 but from panic”. During the SARS 2003 and MERS 2012 epidemics, Cambodia experienced zero cases. Why? Is poor surveillance the reason? Or is there something about the Cambodian environment that stops the efficient spread of coronaviruses?
The Cambodian government this week committed to cutting expenses across their ministries in order to find $30 million to investigate Covid19. Maybe I am missing something but in a country where cardiovascular and chronic disease, neonatal deaths, fatal accidents and Tuberculosis cause mass suffering and mortality, with zero support offered to, and crushing debt foisted upon, most if not all casualties, this focus on what appears to be a small threat seems like more insanity?