13 July 2020
The human race has survived recurring disease endemics familiar to an area, wider epidemics of infectious diseases within a region, and pandemics that spread infections across national and regional borders. But never before has the world health system faced a pandemic like COVID-19. A hitherto unknown infectious disease so named for its viral nature, it has engulfed the entire globe in less than two months.
While the earliest pandemic on record is dated much later, prehistoric evidence of an epidemic in 3000 B.C. was found in Hamin Mangha in north-eastern China in the burned skeletons of people who presumably self-cremated with no one left to perform their last rites. The earliest recorded pandemic originated in Athens in 432 BC; crossed over to Egypt, Libya and Ethiopia; and claimed the lives of two thirds of the total population in four countries. In the last three quarters of the twentieth century, 10 to 90 per cent of populations in affected areas were lost to infectious diseases in endemics, epidemics and pandemics.
Resulting from direct or derived human exposure to rodents, mosquitos, pigs, fleas and birds, past pandemics of viral infections invariably spread faster, claimed more lives and lasted longer, as happened with one of the 10 worst pandemics in history, which occurred in Mexico and Central America in 1545. Cocoliztli, which means “pest” in Aztec, was a viral hemorrhagic fever caused by a subspecies of salmonella. It lasted 3 years and claimed 15 million lives. With plagues recurring more often, the other infectious diseases resulting in 20 pandemics in the last 700 years are smallpox, polio, cholera, flu, yellow fever, H1N1 swine flu, HIV/AIDS, Ebola, Zika, SARs and COVID-19.
Like the other pandemics, COVID-19 spreads exponentially. It has reached every corner of the world, and as at 12 July 2020, more that 12.5 million cases had been recorded, and by now, 7.6 million have recovered with or without hospitalization. Tragically, the global loss of lives has reached 561,617.
The Republic of Korea and Singapore, as well as Hong Kong and Taiwan, swiftly mitigated COVID-19 at home and its spillover across borders by following a variation of measures similar to those taken early by the Chinese Government, which included a total lockdown of Wuhan, where the virus originated; an enforceable quarantine of confirmed and likely carriers; nationwide testing for the issuance of new identity cards that distinguish those at low, medium or high risk; and high-tech aerial surveillance to detect and stop any violation of regulations for social distancing in public places.
In looking ahead, a key responsibility continues to rest with WHO as the institutional focal point and the World Health Assembly as the priority agenda-setter for the world health system.
The pandemic continues unabated in other parts of the world, with the largest number of reported cases in Brazil, India, Russia and the United States among the 10 global hot spots. Despite a widely shared assumption that COVID-19 was originally transmitted by a bat, the virus itself has proved too elusive to attack. Current treatments are geared more to the symptoms than the virus, which is normally expected to leave the human body after 10 days. The remaining fragments of the departed virus could stay in the human body and give false positive results that preclude immunity from further infection for those who survive it. This is what happened in the Republic of Korea when new tests of those who recovered also showed a presence of the virus.
“This virus may become just another endemic virus in our communities and the virus may never go away,” said Dr. Michael J. Ryan, the Executive Director of the World Organization (WHO) Health Emergencies Programme on 14 May 2020. The WHO Mental Health Department also issued an alert of an impending crisis of “The isolation, the fear, the uncertainty, the economic turmoil...” resulting from the pandemic, with one third of the world in a lockdown and the rest observing social distancing to evade and contain human transmission. In addition, some model-builders are forecasting another spike in the coming autumn with more fatalities. Daunting in itself, this multiple challenge is further compounded by the risk of global politics intruding in global health as the world faces a virus that knows no borders and has no ideology. And yet, as a totality of human and material resources devoted to global health, the world health system is much better equipped now than earlier in dealing with a recurring pandemic in 2020 or thereafter.
Voluntary and encouraged public participation in observing physical distancing with face-covering and frequent hand-washing are now a new routine in the fight against COVID-19.
In looking ahead, a key responsibility continues to rest with WHO as the institutional focal point and the World Health Assembly as the priority agenda-setter for the world health system. Within its mandate to control and prevent communicable diseases by alerting, informing and advising member States, WHO took the lead in naming the new infectious disease as COVID-19. Since declaring the outbreak of the virus to be a pandemic on 11 March 2020, WHO has involved a spectrum of older and more recent stakeholders in global health for mobilizing additional institutions, people, resources and tools specifically to target COVID-19 by:
- Encouraging new partnerships between and among the fields of medicine, science, industry and philanthropy to collectively attack the virus, with particular attention to research and development.
- Earmarking emergency funds to finance acquisition diagnosis, treatment and mitigation, with particular focus on countries and communities that have no access or cannot afford such measures.
- Updating the database for public information, particularly to mute or pause the panic buttons pushed by occasional models to project the inevitability or invincibility of COVID-19.
- Nursing direct community engagement, particularly through self-supporting actions such as improved personal hygiene, face covering and physical space for social distances in public places.
- Providing issue-specific guidelines like those for dealing with wet markets.
The 73rd annual session of the World Health Assembly decided on 21 May 2020 to prioritize COVID-19 and requested the WHO Director-General to initiate an “impartial, independent and comprehensive evaluation” of the WHO-coordinated international health response to the pandemic. The wording of that decision by consensus reflects a global resolve to keep global health immune from global politics by concentrating on the issue without finger-pointing at any WHO member. The membership of WHO and the World Health Assembly is entirely the same as that of the United Nations. The discussion preceding the decision on an evaluation was divided between those who wanted to propose and those who opposed an inquiry into what some members saw as China’s initial delay in informing WHO about a hitherto unknown infectious disease and on early action to prevent its spread across national frontiers. With a continuing risk of this infection spreading through a world population of 7.8 billion, tracing the original source of COVID-19 is an apolitical objective for WHO and the World Health Assembly within their mandates to maintain, promote and restore global health. But singling out one country for such an evaluation at this point in time would be a precedent that ignores the fact that all earlier pandemics also originated in a country or a subregion, and any future calls for retrospective evaluations would drag global health into a political issue between those proposing and opposing it. For its part, China has readily agreed to collaborate with WHO in implementing the World Heath Assembly’s call in the evaluation of international response. Faced with a recurrence of COVID-19 in Wuhan, that region and the Chinese Government are also in the process of regulating and banning the wet market animal trade to mitigate the risk of human transmission with another infectious disease through the consumption of exotic birds and animals.
The World Health Assembly’s decision for an evaluation of the international health response to COVID-19 acknowledges the role of WHO as the coordinator for dealing with a new global health crisis. The evaluation promises to become another landmark if it includes the lessons learned from the experience of WHO in dealing with COVID-19 and sets up a time frame for national reporting of endemics and epidemics at risk of becoming pandemics. On 8 May 2020, we marked the 40th anniversary of the WHO-led eradication of smallpox, which had eluded a medical onslaught for almost a century. In comparison, and as a hitherto unknown infectious disease, the COVID-19 pandemic is now over 115 days old, and possibilities for treating COVID-19 with existing medications or vaccines in use for other illnesses are already being explored. Among those under consideration is an inexpensive and readily available steroid that could reduce the fatality rate by 35 per cent for critical COVID-19 patients on ventilators and by 20 per cent for patients in need of oxygen. Called Dexamethasone and in use for 60 years for treating asthma, arthritis and skin problems, the steroid was put through 2,104 clinical trials, with over 11,500 patients enrolled, to determine its potential for treating COVID-19. The other possible treatment in recent news is Remdesivir, an antiviral drug used for treating Ebola that may reduce the duration and severity of COVID-19. Just by observing personal hygiene and physical distancing, and as the city that singly accounted for more confirmed cases of COVID-19 than any other country, New York is now one of the living examples worldwide of bringing down the required containment rate for community outbreak of COVID-19 to below 1.1.
Pandemics occur and recur, but COVID-19 is less likely to last as long or be as fatal the first time around because the world health system is better prepared than earlier in mitigating its immediate impact and containing its outbreak. More than 120 new anti-COVID-19 medicines and vaccines around the world have undergone trials with at least a dozen having made the grade for manufacturing and global distribution. Voluntary and encouraged public participation in observing physical distancing with face-covering and frequent hand-washing are now a new routine in the fight against COVID-19. Let us hope that the emerging partnerships between science, medicine and the private sector are closer to making a medical breakthrough for preventing the occurrence or recurrence of COVID-19. One of the many steps taken in that direction is the public declaration by over 130 prominent individuals and institutions devoted to public health worldwide that they would provide their collective expertise and resources to fight COVID-19 before it occurs or recurs. Maybe a time will soon come when pandemics are seen as yet another non-military threat to human survival that can be deterred through prevention while the number of fatalities inflicted by COVID-19, a hitherto unknown viral disease, is further reduced.
The author wishes to acknowledge with thanks John Sebesta for advice, the Centers for Disease Control and Prevention for use of the World Map, Shantanu Rana for information gathering and Dr. Narendra Hadpawat for assistance with medical terminology.
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