Epidemics expert Jonathan Quick: ‘The worst-case scenario for coronavirus is likely’
The former chair of the Global Health Council talks about the mentality that left the world vulnerable to the Covid-19 epidemic and what can be done to minimise its effects
In 2018 global health expert Jonathan D Quick, of Duke University in North Carolina, published a book titled The End of Epidemics: The Looming Threat to Humanity and How to Stop It. In it he prescribed measures by which the world could protect itself against devastating disease outbreaks of the likes of the 1918 flu, which killed millions and set humanity back decades. He is the former chair of the Global Health Council and a long-term collaborator of the World Health Organization (WHO).
Your feeling as to which is more likely, as of today, 27 February?
The worst-case scenario is looking increasingly likely. We’ve now seen cases on six continents, apparently “silent” – that is, at least partly asymptomatic – chains of human-to-human transmission both inside and outside China, with additional countries reporting cases within the last week – bringing the total to 47 – and new, accelerating outbreaks in Iran, Italy and South Korea. If it becomes a pandemic, the questions are, how bad will it get and how long will it last? The case fatality rate – the proportion of cases that are fatal – has been
just over 2%, much less than it was for Sars, but 20 times that of seasonal flu. There are still many unknowns – we may have underestimated the period during which a person is contagious, for instance and the variety of ways in which the virus spreads.
You have said that time and trust are critical to good epidemic management. What do you mean?
The delay between the frontline health workers noticing something unusual, in the form of an emerging disease, and that information travelling up the line to central decision-makers is critical.
To illustrate that, a 2018 simulation that the
Gates Foundation conducted of a flu pandemic estimated that there would be 28,000 after one month, 10 million after three months, and 33 million after six months. The virus used in that simulation was more contagious and deadly than Covid-19 – though they are both respiratory viruses – but the example shows how all epidemics grow exponentially. So if you can catch an epidemic in the first few weeks, it makes all the difference. As for trust, it’s critical to disseminate dispassionate, evidence-based information, and not to try to mislead the population. If you do, they will stop cooperating. Let’s hope that doesn’t happen in China.
