On Wednesday, the World Health Organization convened an important emergency committee in Geneva to discuss whether to define the new coronavirus pneumonia from Wuhan as a “public health emergency.” Such measures rarely occur, and are usually only activated when major infectious disease outbreaks occur.
But “rarely” is not a rare occurrence in traditional cognitions of “every ten years” or even “every 100 years”. In the public health field, emergencies occur almost every once in a while: swine flu in 2009 (H1N1), the “Ebola” epidemic from 2014 to 2016, the Zika in 2016 … People around the world are finding themselves facing more and more of such large infectious diseases.
Before Wuhan, many experts predicted that the virus that would become the next epidemic in China. It’s not just this new coronavirus, but an avian flu called H7N9. 88% of infected people have pneumonia, three-quarters have received intensive care for severe respiratory illnesses, and 41% have died.
01. Compared with nuclear war, we must be more vigilant against infectious diseases
On March 4, 1918, influenza occurred in a military camp in Kansas, USA. Then China, Britain, and Spain all had similar symptoms: headache, high fever, muscle aches, and loss of appetite.
A few months later, in the fall, this infectious disease, which was eventually named the Spanish flu, has officially become a worldwide epidemic. By the spring of 1920, 1 billion people had been infected worldwide, and about 25 to 40 million (70 to 100 million people) had died. The emergence of Spanish flu directly affected World War I that occurred during the same period. Because no other country in the world had the extra energy to cope with the war, the war ended in the end of 1918.
(a piece of 1918 years old photos of the United States, baseball players are all wearing masks playing games. Source: National Geographic)
The number of deaths from World War I is about 20.5 to 22 million, far less than the number of people who died of Spanish flu. These numbers alone may not make sense, but if we list epidemics and wars with the highest number of deaths:
You will find that fewer people die from epidemics than from war.
Bill Gates argued in an article published a few years ago in the New England Journal of Medicine that both epidemics and wars cost a lot of money, but politicians only take wars seriously-at least in construction This is the case in the military and other areas.
“For soldiers, they are ready to go to war anytime, anywhere. We also have reserve soldiers, which can greatly increase the population ready for war. There are many war games in the NATO organization that let us know whether the personnel have Well-trained. “Bill Gates said in a TED speech. “This should be our preparation for the emergence of the epidemic,” he said.
He also came up with a model saying that if the Spanish flu broke out in contemporary society, it would kill more than 33 million people in 250 days. Although human medicine has made great progress, the development of transportation is also obvious to all, bringing opportunities for the large-scale spread of the virus. Studies have shown that today the number of people traveling across national borders is 50 times that of 1918, and once infectious diseases occur, they may invade all parts of the world with the flow of people. “In terms of speed of transmission, we have created the most dangerous environment ever in human history,” Gates said.
But the reality is always disappointing-in the United States, the total number of all military forces is 1.3 million, while the number of certified doctors is only 950,000.
On the other side of the world, the Spanish flu is still making waves. According to data provided by Juan Carlos III National Epidemic Surveillance, a total of 927 influenza deaths were recorded in 2017-2018.
And as time advances to the new year, more and more countries are choosing to conduct war in a more “civilized” way-after cyber wars, information wars, and trade wars, the number of war-related deaths is far from being epidemic Behind it-the number of new illnesses has nearly quadrupled every decade in the past 60 years, and the number of outbreaks has more than tripled each year since 1980.
In a 1990 paper on “Sciences of Infectious Patients,” Marcia Inhorn and Peter Brown estimated that infectious diseases could take more lives than war and non-infectious diseases. Diseases and natural disasters add up. Infectious diseases are our oldest and deadliest enemy.
They still do today. “In a bumper year, the flu killed more than 10,000 Americans,” said Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention. “In a bad year, it killed people. Five times the original. If a pandemic occurs, the situation will be even worse. H1N1 flu is not considered as serious. However, more than 1,000 American children have died from H1N1! “
02. Treat infectious diseases like war
Gates said, “If something can kill tens of millions of people in the next few decades, it is more likely to be a highly contagious virus, not a war. It is not a missile, but a microorganism.” Not alarmist.
Part of the reason is that we have invested a lot of energy and money on nuclear deterrence, but we have invested very little in systems to prevent epidemics. Humans are not ready for the next big epidemic.
The problem is that we do n’t have any system: we ca n’t find a group of prepared epidemiologists. We can go to the epidemic area to see the pathology and disease development. The cases are all reported by the media. It’s late, and it’s not necessarily accurate; we can’t find a trained medical team; we don’t have a way to keep people waiting; we mobilize thousands of medical staff to reach the epidemic area very slowly.
A large epidemic requires us to mobilize hundreds of thousands of people. Before the epidemic arrived, no one was studying the direction of treatment, and no one was thinking about what method to use. What tools to use-Gates said it was a global failure.
The main way to prevent epidemics is early detection. This means good surveillance. Unfortunately, only 64 of the 194 members of the World Health Organization (WHO) have sufficient surveillance procedures, laboratories and data management capabilities to meet their obligations under agreements reached under international health regulations. In addition, the role of the World Health Organization is to monitor epidemics, not to do early prevention research.
Modern medicine deserves some protection before a new epidemic. But experts say we are likely to have a vaccine shortage, not even antibiotics. The Ebola outbreak killed more than 11,000 people in 2014, although people are no stranger to the virus-it has been killed every year since its discovery in 1976. But so far, there are still no drugs or vaccines that can compete with it-because the market is not big enough, pharmaceutical companies have no reason to make them.
The speed of scientific research out of the laboratory is still not fast enough. To accelerate this process, the Gates Foundation announced this year the establishment of the Bill and Melinda Gates Medical Institute. Unless we can develop vaccines or use other means to prevent the most devastating infectious diseases, the world’s poorest people will not be able to lead healthy and productive lives.
In addition to early detection, the entire world needs to respond better institutionally and technically. As we all know, WHO has slowed down when it comes to the Ebola outbreak, and it is widely believed that it is too cumbersome and bureaucratic to cope with the rate at which emerging epidemics are strangled. Some people say that it is necessary to establish a special international epidemic prevention organization.
Of course, these tasks are still ongoing.
03. Ebola and Spanish flu revelations
A steel trader flew from Nigeria to Nigeria in 2014. At that time, Ebola was raging in West Africa. The businessman had a fever on the plane and fell down before leaving the airport. He was taken to a hospital in Lagos, Nigeria, one of the largest cities in West Africa.
Fortunately, the highly infectious pathogen met people who knew how to deal with infectious diseases in the city. The doctor trained by the United States CDC found this businessman in the crowd and those he met on the plane. , And the people they met-in the end, the list surpassed more than 20,000 people.
Finally, 19 people on this list died. But this list could be even more numerous if there is no professionally trained doctor looking for those who are potentially infected.
More than 10,000 people died during the Ebola virus outbreak. All the dead were in three countries in West Africa. There were three reasons for the non-proliferation: First, many heroic deeds of health care workers, they found Patients, and prevent more people from getting sick; the second reason is the nature of the virus, Ebola virus is not transmitted by air, wait until you have enough infectious power, most people have been bedridden; the third reason is The virus did not reach the metropolitan area, and it was purely for good luck. If the virus reaches large cities, the death toll will be much more than that.
Wuhan pneumonia this time, obviously we are not so lucky. Airborne viruses are imperceptible. The Spanish flu of 1918 provided us with a model of the virus transmitting through the air: the virus would spread to the world at a rapid rate, and eventually 30 million people worldwide would die from the disease.
Gates suggested that in fact we can build a good response system. We can use mobile phones to collect and publish information, we have satellite maps to see where people are and where they are moving, and our advances in biology can also greatly reduce our time to find the pathogen and find it in a short time Vaccines and antidote. So we have tools, but these tools must be integrated into a global health system, otherwise they are ineffective.
Also we must be ready at all times. How do we prepare? The best example comes from preparing for war. For soldiers, they are ready to go to war anytime, anywhere. We also have reserve soldiers, which can make the prepared populationIt has increased a lot. NATO even has a mobile team that can move quickly. There are still many war games in NATO to test whether the personnel are well trained-and these are actually things we should prepare for when facing an epidemic.
What are the key things? First of all, there must be a developed health system in poor countries, mothers can produce safely, children can be vaccinated, and we can detect outbreaks at an early stage; we need reserve medical units, and a lot of Trained professionals are always ready to bring their expertise to the affected area. We can even use the army to cooperate with medical personnel. Take advantage of the rapid movement of the army for logistics and security.
We also need to do some scenario simulations, germ games to see where the defense loopholes are, and finally, we still need a lot of research and development work on vaccines and pathology.
Although we can’t estimate how much of this budget is required, Gates is convinced that compared to losses, it must be cheaper. According to World Bank estimates, if we have an influenza outbreak, the global economy could lose more than $ 3 trillion and millions of people die.
If there is any enlightenment that Wuhan pneumonia can bring to us, it is that the establishment of this global health system is urgent. If there is any positive impact of the global virus over and over again, it is to let us sound the alarm early, wake up, and be prepared. If we start now, we can be ready before the next outbreak.