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The coronavirus, pandemics, and preparing for worst case scenarios

Given the frequency with which new, serious disease epidemics have been occurring, now is an important time to consider readiness for even more challenging infectious disease events.

A Chinese health worker checks the temperature of a woman entering a subway station during the Chinese New Year and Spring Festival in January n Beijing, China. The number of cases of a deadly new coronavirus rose to over 1,300 in mainland China Saturday as health officials locked down the city of Wuhan earlier in the week in an effort to contain the spread of the pneumonia-like disease which medicals experts have been confirmed can be passed from human to human. In an unprecedented move, Chinese authorities put travel restrictions on the city of Wuhan and neighboring cities affecting a population of over 35 million. The number of those who have died from the virus in China climbed to at least 41 on Saturday and cases have been reported in other countries including the United States, Australia, France, Thailand, Japan, Taiwan and South Korea.Kevin Frayer/Getty Images

The emergence of a new coronavirus in China and the diagnosis of human cases in the United States and other countries have prompted concerns about whether this serious outbreak signals the start of another SARS-like epidemic. And for good reason. The SARS epidemic, which began in China in late 2002, went on to sicken upward of 8,000 people across the globe and is estimated to have cost the global economy $40 billion in 2003. We don’t yet know if this current outbreak ultimately will be easily managed or will become much more serious. But we shouldn’t ask only “Is this SARS?" Given the frequency with which new, serious disease epidemics, such as Zika and Ebola, have been occurring, now is an important time to consider readiness for even more challenging infectious disease events.

Researchers from Northeastern University and elsewhere have launched a map that estimates the risk of international spread of the virus, based on daily airline and commuting patterns.Laboratory for the Modeling of Biological and Socio-technical Systems / Northeastern University (custom credit)

As worrisome as the coronavirus outbreak is, there are worse scenarios that may occur. The 1918 influenza pandemic infected an estimated one-third of the world’s population and resulted in upward of 50 million deaths. In today’s highly connected, densely populated world, the impact of a severe flu pandemic could be catastrophic. Experts predict a severe pandemic could kill more than 80 million people and erase up to 5 percent of the global economy. Additionally, with increasing powers of biology, there is also the potential for pandemics to result from either the deliberate or accidental release of dangerous pathogens, including ones engineered for enhanced virulence. Were such a deadly pandemic to occur, the public health and economic toll could dwarf past losses.

There are some encouraging signs that global readiness for infectious disease events has increased since the days of SARS. It appears that, thanks to astute clinicians, health authorities in China received early notification of an unusual cluster of viral pneumonia patients. And unlike during SARS, in 2003, China promptly reported the health event to the World Health Organization. Within weeks, scientists in China isolated from patients a novel coronavirus and published the sequence. German researchers used this information to develop initial diagnostic tests. Neighboring countries responded by ramping up surveillance and began to identify and isolate exported cases. These are exactly the steps that should be taken in response to an emerging disease outbreak, but we should not take for granted countries’ abilities to take them. Being able to conduct surveillance for a new virus requires clinical, epidemiological, and laboratory capacities that must be built and maintained.


Despite these signs of progress, there are many reasons to worry about global readiness for pandemics. Global assessments continue to show that many countries lack basic public health capacities, like laboratories and trained epidemiological personnel. Another key weakness is unprepared health systems that lack resources to safely treat the surge of sick patients that a pandemic produces — which can amplify disease spread within communities.


A severe pandemic will likely require a level of response that exceeds the resources of national governments and intergovernmental organizations like the WHO and the United Nations and will necessitate the involvement of the private sector. The geographic distribution of companies that produce essential medical supplies is limited, and supply chains for the distribution of these products are increasingly lean. In 2018, Hurricane Maria contributed to critical shortages in medical saline. More recently, China’s efforts to curb the spread of the pig disease African Swine Fever have contributed to shortages of the life-saving anticoagulant drug heparin. The private sector, not governments, are the producers of medical supplies and other important resources that will be needed in a severe pandemic. And yet there is no central entity or organized platform to prioritize and facilitate public-private partnerships chronically needed in pandemic preparedness and response planning.


There are important unanswered questions about the coronavirus outbreak. We don’t yet know how easily people transmit the virus or how ill it can make otherwise healthy people. In order to know the true risk posed by this new virus, we urgently need answers to these questions. But we do ourselves a disservice if we assess our readiness only for past threats like SARS. We must also assess our readiness for even more challenging scenarios that could yet still occur.

Dr. Jennifer Nuzzo is a senior scholar at the Johns Hopkins Center for Health Security and an associate professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health.