Run from Wilbur!
In the sixth century, the Justinian Plague—the first iteration of the bubonic plague—killed about a quarter of the world’s population. It began when fleas carried the disease to host rats and cats, who proceeded to spread it to humans. Scientists had not yet developed vaccines or cultivated a robust understanding of infectious disease. Instead, many saw it as the inescapable wrath of God.
In the fourteenth century, the Black Death—the second iteration of the bubonic plague—killed a third of all human beings living on the planet at the time. Medical knowledge at this time had advanced very little since the first outbreak, eight centuries prior.
In the early twentieth century, the Spanish Flu—most likely hosted and transmitted by pigs—killed between 50 and 100 million people. Only recently did researchers trace this as the origin of the modern H1N1 strain of the swine flu.
Epidemics and pandemics have increasingly become part of our modern reality, despite medical innovation. In 2003, SARS—originating in Guangdong, China—infected thousands of people and caused hundreds of deaths worldwide. The animal of origin? Most likely bats. In 2014, Ebola, also caused by bats, caused over 10,000 deaths worldwide before the outbreak subsided. In 2015, the Zika virus caused potentially lethal microcephaly in infants with mothers carrying the disease and was spread by mosquitoes.
Within this school year alone, Yale students received cautionary messages about both a spike of Eastern Equine Encephalitis (EEE) within the state of Connecticut and a potential outbreak of the coronavirus. The coronavirus has now spread to every inhabited continent and has spread at a much higher rate than influenza. As the coronavirus rapidly becomes an international crisis, shutting down major cities and making social distancing necessary, it is clear that we still lack the global infrastructure to mitigate animal-borne pandemics. In a highly interconnected world with casual international travel and few visa requirements among nations, the implications of a new animal-borne pandemic could permanently change global relations.
When examining the effects on the human body and international hardship caused by EEE and Coronavirus, they are quite dissimilar. However, like about seven out of ten all-new human diseases, both are products of genetic mutation of animal diseases and a process called zoonosis.
At the beginning of this year, the entire Yale community received an email warning of an increased number of Eastern Equine Encephalitis (EEE) cases within Connecticut. Like Zika, EEE is an arbovirus that was originally transmitted between horses, and which people now transmit to each other through mosquitoes. Since the beginning of the twenty-first century, the transmission season for EEE, and all arboviruses, has been growing with the increase in global warming. Without the winter cold to kill them, the mosquitoes will keep on biting.
As Yuan-Po Tu, doctor of Internal Medicine at Washington State University’s Everett Clinic explained in an interview with The Politic, “Of course, if there’s no snow, the mosquitoes don’t die, then they’re going to bite and infect more people… However, as I mentioned previously, a majority of these infections are subclinical.” EEE is by no means a new disease, and while it kills about one-in-three symptomatic patients, the vast majority of cases of EEE are asymptomatic.
The major concern with EEE, Tu continued, is that it can be just as lethal in children as in older adults and seniors due to—not despite—the robust responses produced by their immune systems. Very few arboviruses have safe vaccines and, as of now, there are no viable vaccines for EEE.
Later in the year, the Yale community received another email warning of another zoonotic disease—the coronavirus.
The first known case of the coronavirus in America was documented in mid-December of 2019. It was recorded in Everett, Washington, and it was eventually traced back to Wuhan, China. While EEE has been observed in North America for decades, the coronavirus is new. Originally suspected to originate in snakes, it is now widely believed that this disease, like SARS and Ebola, originates in bats. It has already caused international panic and aggressive containment efforts, causing Yale students to evacuate campus to contain the virus.
Like all viruses, there is very little that can be done to treat a person infected by the coronavirus. Like influenza, coronavirus tends to be fatal in people within the 65+ age group. As of now, there are no viable vaccines, and one may not be made available within the next calendar year.
Zoonotic viruses, which started in the massive bank of animal disease, have mutations that allow them to add human beings into their host range. When the human population has no developed immunity, it can lead to anything from a few asymptomatic cases to millions of deaths. The danger comes in the crapshoot.
These viruses, like all viruses, are especially a concern on a college campus. As any Yale student knows, if one student gets mono, we all get mono. If one student gets the flu, we all get the flu, and so on depending on the rate of infectivity (Ro) of the disease. For reference, measles, one of the most highly infectious diseases in the world, has an Ro value of somewhere between 12 and 18. HIV has an Ro of about 1, and Ebola’s Ro range is thought to be between 1.5-2.5. EEE is not all that infectious; as for the coronavirus, its quick international spread sparks deep concern about what Ro value will be. Preliminary estimates suggest that it could be 3.5 or higher.
With modern industrial farming practices, increased human-animal interactions, and the world’s massive human population, pediatrician Paul Offit understands the inevitability of global outbreaks. “If you want to guarantee that there will be no more animal-borne pandemics, move to another planet,” he said in an interview with The Politic.
Offit explained, “This is all part of the viral genetic roulette. Sometimes you get nothing —something passed off as the common cold—and sometimes you get a disease as severe and panic-inciting as Ebola… There are more pigs in China than there are people, so if a disease happens to spread to humans from swine, people living there are in big trouble.” In terms of the devastating impact of zoonotic viruses, Coronavirus is quickly becoming the most terrifying example of the 21st century.
Pharmaceutical companies and drug developers often prioritize developing income-generating “lifestyle products” over new vaccines. As Dr. Offit contends, “Pharmaceutical companies make their money in the drugs that people have to take every single day. There is no such thing as a blockbuster vaccine, but there are such things as blockbuster lipid-lowering agents.” While investing in vaccines over elective drugs seems like the obvious ethical choice, many American medical companies principally seek to maximize profit for their shareholders. As state after state within the United States declares a public health emergency to allocate more funds towards containment efforts, our inadequate resources to contain disease becomes more visible and more daunting.
However, Harsha Thirumurthy, professor of medical ethics and health policy at the University of Pennsylvania, contends that it makes both financial and moral sense to build a more humane global health infrastructure. She estimated that 1.7 trillion dollars are lost across the globe each year in trying to contain and treat infectious diseases. Conversely, the amount of resources needed to create stronger public health systems within low-income nations only would be about 3.4 billion dollars globally. Yet achieving this system would require significant international cooperation. As Thirumurhty explained, “The 3.4 billion dollars is a commitment of resources that the international community needs to make to protect everyone. This money needs to come from high and middle-income countries.”
At the end of the day, in this era of globalization, once a single outbreak occurs, containing it within the borders of a single nation is nearly impossible.
Thirumurthy continued, “It’s not a question of if future outbreaks occur… It is a question of when. When looking at the US specifically, we have looked into the investment of strong health systems globally as a matter of economic interest as well as national security… As a high-income nation, the money needs to come from us.”
All of this speaks to the response to the problem. What it does not acknowledge, however, is that human beings are also culpable for pandemics on the preemptive side of the issue, whether through the impacts of unsustainable farming practices, the booming human population, or the way we interact with the environment. These pandemics call attention to the necessity of human-animal-environment health balance, a field now called “One HEALTH.”
To see One HEALTH in action, look no further than the European Commission, who in 2018 released an extensive report purporting One HEALTH as the only sustainable solution to zoonotic disease. This vision for health systems is one of the first to acknowledge the symbiosis between environmental, animal, and human health. One HEALTH also encourages international investment in a strong global health system, before the next bubonic plague—or the next coronavirus—arrives.
The impact of the coronavirus upon the international population has gone far past wearing face masks in public or chronically disinfecting their homes. As “Gloria” (who asked to remain anonymous), a Chinese citizen working in health explained, the outbreak of Coronavirus decimated public life in Beijing, the consequences of which were particularly painful during Chinese New Year.
“Family reunion, parties, banquets, celebration events are [the] most common activities during this festival season. However, [they] had to be canceled due to the outbreak,” she continued.
International travel is all but canceled. Schools are closed. ICU beds are filling up at alarming rates. People are isolating themselves in their homes. Anyone who claims to know exactly what will happen yet is blowing smoke in our faces because zoonotic diseases are a genetic roulette.
The coronavirus could change everything. And even if this one does not, no one knows how long it will be until there comes one that does.