Around this time last year, Covid-19—the disease that has so far killed more than 400,000 Americans and infected 25 million more—still seemed like someone else’s problem. On the last day of 2019, China’s government had confirmed that dozens of patients in the city of Wuhan were being treated for a mysterious pneumonia-like illness. Ten days later, researchers working with health authorities there published the genome of the virus that was making people sick.
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That was the first story I wrote for WIRED about the coronavirus now known as SARS-CoV-2. During the first days of 2020, the scientific accomplishment of so rapidly sequencing the virus, combined with a commitment to open data sharing, was heralded as a victory for public health. That digital string of genetic code would allow researchers around the world to start making tests to detect the virus, should it show up on their country’s shores. But public health officials in the Western hemisphere didn’t appear overly worried about that possibility.
A week went by. Case counts in China rose dramatically. And the virus started to show up in new places—first Japan and Thailand, then South Korea and the United States. The World Health Organization scheduled a meeting to decide whether or not the outbreak constituted an international public health emergency. One year ago today, on January 22, 2020, I wrote another story, asking public health experts to level with me on one question: Just how bad could this thing get?
Publicly, at least, no one was yet using the “p word.” Although scientists were aware that pandemics were a possibility, like the 2009 H1N1 swine flu, it had been more than a century since the emergence of a virus capable of infecting a third of the world’s population and killing millions of people.
I spoke to Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, on January 21, 2020. And at that time, he told me that coronaviruses just don’t have pandemic potential. Only influenza, he thought, can really go global. That’s what he had certainly believed during the early days of the Wuhan outbreak, although by the time we spoke, he was having his doubts, and he’d just taken the step of telling his colleagues at CIDRAP otherwise. “It is clear now that we will see global transmission of the virus in the next week to 10 days,” he wrote in an email to the center’s leadership team the night before our interview. “In short, I’m certain this will be our next pandemic.”
I spoke to him again this week, and he said he had felt compelled to write that email because it went against what he’d been telling his team for the first half of January. “My initial concern had been alleviated quite a bit when we realized it was a coronavirus, and not influenza,” says Osterholm. At first, after the pathogen was identified, he assumed it would behave like other coronaviruses he’d worked on, like SARS and MERS. If you squish it early with testing, contact tracing, and isolating people who’ve been exposed, it should just go away. In 2003, SARS had spread outside of China, but not widely, he recalled to me. When it arrived in Toronto, for example, the virus had mostly spread among people at hospitals, and those who died had been health care workers—it had not passed through the general population.
But then he started to hear stories from collaborators in Wuhan about families there who had all contracted the virus despite not having had contact with anyone who was visibly sick. Osterholm says he realized it must be spreading before people developed symptoms. That would be a game changer. “Over a 10-day period I went through this whole whiplash of ‘It’s a coronavirus, it’s OK’ mindset to ‘This is a very different kind of coronavirus. This one’s going to go.’”
He had his conviction. But as of yet, he had no proof. And no one wants to be that catastrophist. That’s why he demurred early last year when I asked him if this coronavirus was going to be the big one. As he said to me this week, “Publicly, I had to be very careful about saying it was going to be a pandemic if I wasn’t prepared to back that up,” he says. “At that point I was trying to make certain I had it right. I didn’t say it was going to be a pandemic, but everything in my head said it was going to be a pandemic.”
He only got more sure the next day, when the Chinese government quarantined the entire 11 million-person city of Wuhan. A few days after that, the US Centers for Disease Control and Prevention announced that the outbreak had entered a new phase in the US—the virus wasn’t just showing up in travelers. It was spreading between people in a community. WIRED broke the news that that community was Solano County, in Northern California. Italy, meanwhile, was recording dozens of new infections every day. Things were playing out as Osterholm feared. He says he started calling his contacts at the CDC and the Department of Health and Human Services, where he’d been an adviser on public health and bioterrorism in the early 2000s. “I got a lot of pushback from people there who wouldn’t believe it,” he says.
So on February 24, 2020, he coauthored an op-ed in the New York Times warning that what had happened in Wuhan was likely to play out elsewhere, including the US, and urging governments to conduct Covid-19 preparedness drills. As models to follow, he pointed to places like Hong Kong, where citizens were being given surgical masks, and Singapore, which was bulking up disease surveillance and warning people to avoid large gatherings. These were the places where health officials had realized that if people are asking whether or not a disease is going to become a pandemic, you kind of just have to start acting like the answer is yes. “‘Pandemic’ isn’t just a technical public health term,’ Osterholm wrote. “It also is—or should be—a rallying cry.”
But in the US, it was more of a rallying whimper. The federal government’s coronavirus response limped and stuttered from the beginning, first with testing, then with getting adequate protective equipment for health care workers. States fought each other over supplies. Federal officials, including former resident Donald Trump, downplayed the danger. Parts of the US locked down, but others did not, and there was no real plan for reopening. Then things got political. And all the while the virus spread.
“It was a catastrophic failure,” says Larry Gostin, director of the O’Neill Institute for National and Global Health Law at Georgetown University, a failure driven in large part by pandemic denial. “We should have jumped on it fast and hard and never let go, like so many other countries did successfully. But we refused to face the facts that were right in front of us. The reality was right there on television—what happened in Wuhan, and then this huge wave going across the ocean to Europe. We just didn’t pay attention.”
All the things Gostin says the US should have done a year ago—to massively ramp up testing capacity, hire scores of contact tracers, help people isolate themselves if they’d been exposed—are exactly what the Joe Biden–Kamala Harris administration proposed this week. The only thing that’s different is that now there are vaccines. “The rest of the playbook is the same,” says Gostin. “If we’d had that available even as early as March, we could have literally avoided hundreds of thousands of deaths.”
Anne Rimoin, a UCLA epidemiologist who studies emerging diseases in the Democratic Republic of Congo, has for years pushed for more investment in a global surveillance system to pick up pathogens with pandemic potential before they have the opportunity to spread globally. But, she says, finding the money and political will has been challenging. That kind of threat has felt too far removed, too hypothetical. “Hopefully, we understand at this point that it isn’t hypothetical how many lives are at stake,” says Rimoin. More Americans have died in this pandemic than during World War II. “It’s much more devastating than a war,” she says.
That’s why she’s encouraged to see that one of President Biden’s first executive orders was to rejoin the WHO, from which Trump began withdrawing the US in mid-2020. The health authority has taken some heat for being too deferential to China in the early days of the outbreak, especially as that government was censoring the flow of information out of Wuhan. But when the US’ most urgent health and security problems are truly world problems, which can’t be solved by sealing the borders and hoping for the best, it’s better to be a part of an organization with eyes and ears all around the globe.
“I think the lesson to be learned from all this is that an infection anywhere is an infection everywhere, especially if it’s a respiratory virus,” says Rimoin. It’s true, she acknowledges, that this respiratory virus, SARS-CoV-2, evolved an insidious new trick; it replicates so fast that people are most contagious days before they develop symptoms, if they develop symptoms at all. And it took scientists too long to notice that, and to update their priors on how coronaviruses operate.
But adding to that problem, she says, was that detailed epidemiological data was slow to arrive in those early days. Case numbers and death rates can help give an outbreak shape, but without information about where and how people got infected, it’s impossible to know how that shape will move and change. In the DRC, she’s accustomed to having imperfect data, to trying to assemble the puzzle of how a pathogen works with only a few pieces. But outside of sub-Saharan Africa, that’s not how scientists are used to doing things. And without good information, it’s easier to fall into that faulty “absence of evidence being evidence of absence” trap, and to mistakenly downplay the risks. “The only way to combat that is to have a real, substantive, and strong investment in viral surveillance and mechanisms to share that information, in the same way you would for any other issue of national or global security,” says Rimoin.
As part of the same executive order, Biden’s administration called for establishing an interagency National Center for Epidemic Forecasting and Outbreak Analytics, whose mission will be to modernize global early warning systems for emerging biological threats. That’s good, says Rimoin. But the trick will be keeping such systems running and well-funded even in biological peacetimes. That’s how to not miss the signal the next time. And with the way things are headed, says Rimoin, “it’s unlikely we’ll have to wait another 100 years for another devastating pandemic to come knocking on our door.”
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