Harriet Clifford sheds light on the current crisis and answers the questions: what is a pandemic and how do we fight one?
‘We don’t need to panic, hoard cans of spaghetti and go down to the basement, but we do need to get ready’ – the somewhat ominous words of Bill Gates in a 2015 TED Talk, in which he outlined the steps the world needed to take in order to prepare for the next pandemic. Things have changed dramatically since then, and now hoarding food and staying indoors is very much part of our daily lives – although one of those is more sensible than the other – and scientists and healthcare workers all over the world are working night and day to battle an invisible enemy.
But what is a pandemic? If you’re anything like me, pandemics were not really something you worried about this time last year. Maybe you spent so much time worrying about climate change, nuclear war and natural disasters, that the fear of an illness spreading all over the world just wasn’t on your radar. Naïve, perhaps, but I imagine quite normal. In a matter of months, the words ‘pandemic’, ‘epidemic’, ‘self-isolation’, ‘social distancing’ and ‘quarantine’ have become part of our everyday vocabulary, and the fear of this threat has overtaken almost everything else. The incredible people who work for the NHS or social care and the heroic supermarket workers are described as being on the ‘front line’, emphasising the scary fact that this is a war we’re fighting. For most of us, our lives have changed beyond recognition, with lots of people working extra shifts, working from home, or not working at all. The economy is plummeting and businesses, charities and retailers are suffering, sometimes irreversibly. I could write a whole article about the devastating effects being felt all over the world, but in order to reduce the panic and the fear of the unknown (sometimes the scariest thing), it’s helpful to understand the nature of the beast.
The word epidemic is used to describe any problem that has grown out of control, so is used to refer to a disease which is actively spreading and affects a high proportion of a population. Pandemic is used to refer to the geographical reach of a disease and describes something which affects an entire country or the whole world. To be even more specific, the words come from the Greek, with epi meaning ‘on’, pan meaning ‘all’ and demos meaning ‘people’. There have been many large-scale outbreaks of disease throughout history, but pandemics only really came into existence during the agricultural revolution 10,000 years ago, when permanent settlements started springing up in the Middle East in which humans and animals existed side by side. Before this, people were not in the same place long enough for viruses and bacteria to spread on such a large scale. The proximity to animals is also significant, as many viruses originate in livestock, such as birds and pigs, before jumping from animals to humans. In the case of the current crisis, COVID-19 is a type of coronavirus – a family of viruses causing disease in animals – which has made the leap to people.
Historically, there have been a number of significant outbreaks worth mentioning, most of which you’re probably familiar with, although some may be new. The ‘Great Mortality’ (later called the Black Death by historians) of the 14th century started in China and went on to kill millions of people worldwide, while influenza, the greatest pandemic ever, is constantly circulating between the southern and northern hemispheres. Flu is usually mild, but every 20-40 years the virus mutates dramatically, with the deadliest mutation in history spreading over the globe in 1918. Spanish flu killed an estimated 50 million people (livescience.com) and World War One is now thought to have been partly responsible for the spread, with the cramped, dirty living conditions enabling fast transmission.
In today’s interconnected world, viruses can be transported across the globe within a matter of hours – all it takes is one infected person to get on a plane. The 21st century has seen its fair share of epidemics and pandemics, including SARS (severe acute respiratory syndrome) in 2003, a strain of flu called H1N1 (Swine flu) in 2009, MERS (Middle Eastern respiratory syndrome) from 2012-13, Ebola in 2014 and the Zika virus in 2015. There have been countless others, and all of them have been panic-inducing, economically devastating, and deadly.
As part of my research for this piece, I watched a six-part Netflix documentary series released earlier this year (filmed pre-COVID-19) called Pandemic: How to prevent an outbreak. Instead of making for depressing viewing, I found the programme surprisingly reassuring, as it highlights the scientific and medical work going on all over the world 24/7, regardless of whether there is a pandemic. It’s not as though all the scientists working around the clock right now have been taken off other projects to do this crucial work – they dedicate themselves to researching epidemics every single day of the year. Most of the work covered in the programme was centred around creating an influenza vaccine against any and all flu viruses. Perhaps deadlier than many of us realise, seasonal flu kills an estimated 290,000 to 650,000 people each year (who.int) and is continuously being treated as an epidemic around the world. The documentary focuses in particular on India and the US, but if it had been created by British documentary-makers, the same thing would apply – hospitals are overrun by flu patients every winter, and thousands of them sadly die.
Rather ominously, the scientist presenting the documentary says, ‘Every epidemic is an opportunity to learn. We do this all the time – we are constantly monitoring, because you never know when something is going to show up in an animal and then make the leap to humans.’ But what happens when it does? According to the World Health Organisation (WHO), there is a clear pathway followed by most outbreaks which can be viewed alongside a series of response interventions taken by scientists and governments.
In the early stages, emergence of a virus is anticipated by scientists who are routinely testing animals for the flu. While an outbreak can’t be predicted, these tests can anticipate epidemics and enable preparedness plans accordingly. Once a new virus is detected, containment measures can be put in place as quickly as possible, which would include isolating infected patients and the widespread use of personal protective equipment (PPE) in healthcare settings.
Once a disease has reached an epidemic or pandemic level, the goal of governments and healthcare systems is to control the rate of infection and mitigate its mortality rates and its impact on society. In this current crisis, in the UK and elsewhere, we have seen social distancing, self-isolation and shielding measures implemented by the government, as well as financial grants and furlough schemes to support businesses and the self-employed. The provision of PPE has also increased, while testing is being rolled out nationally in order to reintroduce workers back into the key workforce as quickly as possible. As we have seen, it is unlikely that the steps taken by the government to control and mitigate the spread of a disease will satisfy everyone, so criticism from the media and certain groups within the population is likely to cause further unrest. As I write in the midst of the COVID-19 crisis, our country is still in this stage of the process and there is uncertainty as to when it might end.
When it does, which (as they say in every daily government briefing) it will, the next stage is elimination and eradication, which means that the disease is no longer considered a public health issue, but surveillance and monitoring are needed to avoid re-emergence of the illness. In our case, this stage seems confusing – how will we get back to ‘normal life’ without simply causing another outbreak? Clearly, the government can’t just reopen all the shops, bars, restaurants and gyms overnight and tell everyone that they can leave their houses – it’s going to have to be much more strategic than that, and highly qualified people are undoubtedly working on these plans behind the scenes.
One of the things that keeps coming up in my research is that pandemics are closely linked with panic. While we have seen this on a large scale, with fearful and xenophobic reactions to others, supermarkets stripped bare and fake news circulating social media, we have also seen that a crisis like this can actually bring out the best in people. Thousands and thousands of people have signed up to volunteer with the NHS, 18-year-old healthcare assistants are powering through unbelievably long shifts, minimum-wage workers are putting themselves at risk by showing up to work, children are drawing rainbows to stick on their windows, streets are united in clapping for key workers on a Thursday night, businesses are offering services for free to help people cope, and young people are delivering supplies to elderly neighbours. The list goes on. When all this is over, we will look back with sadness at the lives that have been lost, but I believe we will also have been reminded of the importance of community, selflessness and being kind. Will things ever go back to how they were? Maybe it wouldn’t be so bad if they didn’t.