Full text of global health expert Alanna Shaikh’s talk: Coronavirus is Our Future at TEDxSMU conference. In this talk, she explains about the current status of the 2019 nCov coronavirus outbreak and what this can teach us about the epidemics yet to come.
Listen to the MP3 Audio: Coronavirus Is Our Future by Alanna Shaikh at TEDxSMU
I want to lead here by talking a little bit about my credentials to bring this up with you.
Because quite honestly, you really, really should not listen to any old person with an opinion about COVID-19.
So I’ve been working in global health for about 20 years. And my specific technical specialty is in health systems and what happens when health systems experience severe shocks.
I’ve also worked in global-health journalism. I’ve written about global health and biosecurity for newspapers and web outlets. And I published a book a few years back about the major global health threats facing us as a planet.
I have supported and led epidemiology efforts that range from evaluating Ebola treatment centers to looking at transmission of tuberculosis in health facilities and doing avian influenza preparedness.
I have a master’s degree in International Health. I’m not physician. I’m not a nurse. My specialty isn’t patient care or taking care of individual people.
My specialty is looking at populations and health systems — what happens when diseases move on the large level.
If we’re ranking sources of global-health expertise on a scale of 1 to 10 — 1 is some random person ranting on Facebook, and 10 is the World Health Organization — I’d say you can probably put me at like a 7 or an 8. So, keep that in mind as I talk to you.
I’ll start with the basics here because I think that’s gotten lost in some of the media noise around COVID-19.
So, COVID-19 is a coronavirus, and coronaviruses are a specific subset of virus, and they have some unique characteristic as viruses. They use RNA instead of DNA as their genetic material, and they’re covered in spikes on the surface of the virus, and they use those spikes to invade cells. Those spikes are the corona in coronavirus.
COVID-19 is known as a novel coronavirus, because, until December, we’d only heard of six coronaviruses. COVID-19 is the seventh. It’s new to us, it just had its gene sequencing, it just got its name; that’s why it’s novel.
If you remember SARS – severe acute respiratory syndrome – or MERS – Middle East respiratory syndrome, those were coronaviruses. And they’re both called respiratory syndromes because that’s what coronaviruses do. They go for your lungs. They don’t make you puke, they don’t make you bleed from the eyeballs, they don’t make you hemorrhage, they head for your lungs.
COVID-19 is no different. It causes a range of respiratory symptoms that go from stuff like a dry cough and a fever all the way out to fatal viral pneumonia. And that range of symptoms is one of the reasons it’s actually been so hard to track this outbreak.
Plenty of people get COVID-19, but so gently, their symptoms are so mild that they don’t even go to a health care provider. They don’t register in the system.
Children, in particular, have it very easy with COVID-19, which is something we should all be grateful for.
Coronaviruses are zoonotic, which means that they transmit from animals to people. Some coronaviruses, like COVID-19, also transmit person to person. The person-to-person ones travel faster and travel farther, just like COVID-19.
Zoonotic illnesses are really hard to get rid of, because they have an animal reservoir. One example is avian influenza, where we can abolish it in farmed animals, in turkeys, in ducks, but it keeps coming back every year because it’s brought to us by wild birds.
You don’t hear a lot about it, because avian influenza doesn’t transmit person to person, but we have outbreaks in poultry farms every year all over the world.
COVID-19 most likely skipped from animals into people at a wild animal market in Wuhan, China.
Now for the less basic parts. This is not the last major outbreak we’re ever going to see. There’s going to be more outbreaks, and there’s going to be more epidemics. That’s not a maybe; that’s a given.
And it’s a result of the way that we, as human beings, are interacting with our planet. Human choices are driving us into a position where we’re going to see more outbreaks.
Part of that is about climate change and the way a warming climate makes the world more hospitable to viruses and bacteria. But it’s also about the way we’re pushing into the last wild spaces on our planet.
When we burn and plow the Amazon rainforest so that we can have cheap land for ranching, when the last of the African bush gets converted into farms, when wild animals in China are hunted to extinction, human beings come into contact with wildlife populations that they’ve never come into contact with before.
And those populations have new kinds of diseases: bacteria, viruses — stuff we’re not ready for.
Bats, in particular, have a knack for hosting illnesses that can infect people. But they’re not the only animals that do it.
So as long as we keep making our remote places less remote, the outbreaks are going to keep coming.
We can’t stop the outbreaks with quarantine or travel restrictions. That’s everybody’s first impulse: Let’s stop the people from moving, let’s stop this outbreak from happening.
But the fact is it’s really hard to get a good quarantine in place. It’s really hard to set up travel restrictions. Even the countries that have made serious investments in public health, like the US and South Korea, can’t get that kind of restriction in place fast enough to actually stop an outbreak instantly.
There’s logistical reasons for that, and there’s medical reasons. If you look at COVID-19, right now, it seems like it could have a period where you’re infected and show no symptoms that’s as long as 24 days.
So people are walking around with this virus showing no signs. They’re not going to get quarantined. Nobody knows they need quarantining.
There’s also some real costs to quarantine and to travel restrictions. Humans are social animals, and they resist when you try to hold them into place and when you try to separate them.
We saw in the Ebola outbreak that as soon as you put a quarantine in place, people start trying to evade it. Individual patients, if they know there’s a strict quarantine protocol, may not go for health care because they’re afraid of the medical system, or they can’t afford care, and they don’t want to be separated from their family and friends.
Politicians, government officials, when they know they’re going to get quarantined, if they talk about outbreaks and cases, may conceal real information for fear of triggering a quarantine protocol.
And, of course, these kinds of evasions and dishonesty are exactly what makes it so difficult to track a disease outbreak.
We can get better at quarantines and travel restrictions, and we should. But they’re not our only option, and they’re not our best option for dealing with these situations.
The real way for the long haul to make outbreaks less serious is to build the global health system, to support core health-care functions in every country in the world so that all countries, even poor ones, are able to rapidly identify and treat new infectious diseases as they emerge.