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.
China’s taken a lot of criticism for its response to COVID-19. But the fact is, what if COVID-19 had emerged in Chad, which has 3.5 doctors for every 100,000 people?
What if it had emerged in the Democratic Republic of Congo, which just released its last Ebola patient from treatment?
The truth is countries like this don’t have the resources to respond to an infectious disease, not to treat people and not to report on it fast enough to help the rest of the world.
I led an evaluation of Ebola treatment centers in Sierra Leone. And the fact is that local doctors in Sierra Leone identified the Ebola crisis very quickly. First as a dangerous, contagious hemorrhagic virus, and then as Ebola itself.
But having identified it, they didn’t have the resources to respond. They didn’t have enough doctors; they didn’t have enough hospital beds, and they didn’t have enough information about how to treat Ebola or how to implement infection control.
Eleven doctors died in Sierra Leone of Ebola. The country only had 120 when the crisis started. By way of contrast, Dallas Baylor Medical Center has more than 1,000 physicians on staff. These are the kinds of inequities that kill people.
First, they kill the poor people when the outbreaks start, and then they kill people all over the world when the outbreaks spread.
If we really want to slow down these outbreaks and minimize their impact, we need to make sure that every country in the world has the capacity to identify new diseases, treat them, and report about them so they can share information.
COVID-19 is going to be a huge burden on health systems. I’m not going to talk about death rates in this talk because, frankly, nobody can agree on the COVID-19 death rates right now.
But one number we can agree on is that about 20% of people infected with COVID-19 are going to need hospitalization. Our US medical system can just barely cope with that.
But what’s going to happen in Mexico? COVID-19 has also revealed some real weaknesses in our global health supply chains. Just-in-time ordering LEAN systems are great when things are going well, but in a time of crisis, what it means is we don’t have any reserves. If a hospital or a country runs out of face masks or personal protective equipment, there’s no big warehouse full of boxes that we can go to get more.
You have to order more from the supplier, you have to wait for them to produce it, and you have to wait for them to ship it, generally, from China. That’s a time lag at a time when it’s most important to move quickly.
If we’d been perfectly prepared for COVID-19, China would have identified the outbreak faster. They would have been ready to provide care to infected people without having to build new buildings.
They would have shared honest information with citizens so that we didn’t see these crazy rumors spreading on social media in China. And they would have shared information with global health authorities so that they could start reporting to national health systems and getting ready for when the virus spread.