As Chinese coronavirus claims more victims, PETER FRANKOPAN examines the lesson from the past

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The nightmare is all too real. A man arrives at a health centre, complaining of a sore throat, fever and headache. Another person arrives soon after; then another. By lunchtime, there are dozens; within a week, hundreds.

The winter months usually see an onset of influenza. But this time far more people than normal are infected.

That is not the only strange thing. Usually, the flu virus flourishes among the young and the old, with less robust immune systems. But those turning up to see the doctor are primarily in the prime of life, aged 20 to 40, who usually have no problem seeing off what is usually a seasonal bug.

Soon it becomes clear that something is very wrong. It turns out that those who are sick are not coming just to one hospital in a single town; they are turning up everywhere. Literally everywhere. All over the world. A quarter of the world’s population report symptoms. And then people start dying. In large numbers.

The scale is frightening. In the U.S., where a third of the population are infected, hundreds of thousands die. India pays a terrible price as 18 million succumb.

This is no Hollywood blockbuster, hoping to scare its way to box office success. This is what happened 100 years ago as the Spanish flu took hold.

Between January 1918 and the end of the following year, 500 million people had become infected. By the end of the outbreak, perhaps as many as five per cent of all the men, women and children on the planet lay dead.

Only a century on, no wonder health officials have been so concerned about the emergence of ‘2019-CoV’, a new strain of coronavirus that emerged recently in the city of Wuhan in China and which has infected more than 200 people, killing at least three.

The true figure of the dead and infected may well be higher: the Chinese authorities have been accused of covering up the scale of the outbreak, while scientists at Imperial College London have suggested that ‘substantially more cases’ have taken hold.

The new coronavirus strain has been found in neighbouring Japan, Thailand and South Korea, and has infected at least one Briton, backpacker Ashley Shorley, 32, who fell ill while travelling in Thailand and was airlifted to hospital.

It does not even matter where an outbreak of an infectious disease originates. In our interconnected world, a disease can potentially infect billions in weeks or less.

Airlines carry infected people from one side of the planet to another, faster than at any time in history.

London is connected to Wuhan by three direct flights per week. Almost every other city on Earth is a maximum of 18 hours away.

So although the death toll from the new strain of coronavirus has, mercifully, so far remained low, the lesson of history is that global pandemics have struck many times, playing a key role in shaping — and ending — civilisations.

One will strike again: the only question is when. The World Health Organisation has been warning of these dangers for some time, reminding us that global pandemics represent a major threat to human existence.

Perhaps the most famous case was the Black Death that swept through Asia into the Middle East, Europe and Africa in the middle of the 14th century. Those infected with the yersinia pestis bacterium suffered terribly as their organs were attacked in turn, with bags of pus and blood pooling at the lymph nodes in the armpit or groin, then multiplying to cause swellings that could grow as large as an apple.

The haemorrhaging of poisoned blood that turned black gave the outbreak of plague its name.

Large-scale outbreaks of plague have been closely connected to climate change, meaning that the disease moves beyond its local habitat and spreads rapidly.

This is what happened in the AD540s, when the ‘Justinianic plague’ (named after the Byzantine Emperor Justinian) was so devastating that there were said to be not enough people to bury the dead in Constantinople (now Istanbul). Bodies were dumped in empty towers and left to rot, producing a foul smell across the city.

Plague kills quickly: when there is no one left, it dies out, which in turn means that quarantine is a useful strategy against it.

Isolating the infected has been used regularly in Africa in recent decades to contain another devastating disease.

First identified in 1976, ebola virus causes bleeding, vomiting and diarrhoea, weakening the liver and kidneys and often killing its host in a matter of days.

It is highly infectious, being passed through fluid exchange during sex, kissing, from sweat, breastmilk or exposure to an open wound via mucous membranes in the eyes, mouth and nose. Clothing contaminated with body fluids from someone infected can also spread the virus.

There have been outbreaks in Africa — the most recent of which began in August 2018. In the past 18 months, at least 1,700 have died, with the situation becoming so worrying that last summer the World Health Organisation (WHO) issued a global health emergency.

Mercifully, preventive measures seem to have stalled ebola’s progress — at least for now.

Few experts have any illusions, though, of how close we have sailed to the wind — or how poorly prepared we are to face a pandemic.

A study produced by Johns Hopkins University in the U.S. last year warned that there are ‘severe weaknesses in countries’ abilities to prevent, detect and respond to significant disease outbreaks’. Most countries have almost no systems or agreements in place on how to co-operate in the event of a serious pandemic.

So concerned is the WHO that it has identified diseases that demand special attention.

These include the zika virus, which sprang to public attention in 2015 after an outbreak led doctors to urge women thinking of becoming pregnant to wait, so great were the threats of neurological problems and birth defects to unborn children from the mosquito-borne disease.

Most chilling, however, is that alongside well-known illnesses, such as severe acute respiratory syndrome (Sars, of which family the coronavirus is part), the WHO also includes another potential killer.

This is named simply Disease X: ‘a serious international epidemic’ that could be ‘caused by a pathogen currently unknown to cause human disease’.

Like something out of a dystopian film, this could come from a virus that has jumped the species barrier from animals and mutated to infect humans, killing us in huge numbers.

We live in a world where it is cheaper and easier to create and engineer new pathogens in laboratories, by mistake or on purpose. These can, of course, be released intentionally to cause harm — perhaps by a state seeking revenge for international humiliation or by a non-state perpetrator as an act of terrorism. Diseases can also escape by mistake or spill out of control. Any such scenario brings unknown, but potentially devastating, consequences.

The good news is that a century on from the Spanish flu, research capabilities, including the development of antibiotics, as well as improved sanitation, hygiene and medical care, mean we do have some weapons to wield against a major disease outbreak.

The internet and other modern channels for spreading information rapidly and widely would also prove important — but it is likely that, in the event of a new global pandemic, the authorities would have to spend a lot of time countering misinformation online.

In the event of Disease X emerging as a 21st-century plague, it is not inconceivable that airports and perhaps even cities would be shut down and quarantined — and not impossible that those within the quarantine zone would pay a terrible, deadly price.

The Wuhan outbreak may be just another tremor. But few should have any doubts. The problem about nightmares is that they are reflections of realities. As the past shows, sometimes they have come true.

 

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