Coronavirus: Opacity in the time of an outbreak can kill more people

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China could have contained the spread with very little effort and resources had it been transparent and acted on time. Downplaying and being secretive about public health issues, particularly novel virus outbreaks, as it found out during SARS, and then now, can be very counterproductive.

From quick sequencing of the whole genome of the coronavirus SARS-CoV-2 that causes COVID-19 — after alerting WHO on December 31, 2019 about a cluster of pneumonia cases of unknown cause — and sharing the sequence data on a global database to quickly developing viral diagnostic tests, China has done much to address the epidemic.

As on February 19, mainland China had 74,184 cases and 2,004 deaths. Add to this the speed at which two new hospitals with 2,600 beds were built. Also, the many facilities that became temporary hospitals in the face of growing cases is testimony to China’s ability to pull off the unimaginable in containing the epidemic. Whether the decision to shut down huge cities to halt the viral spread may have actually helped is debatable, but it is important to note that China has done a lot after the initial delay in reporting the disease.

Secrecy can be counterproductive

However, China, given its capabilities, could have contained the spread with very little effort and resources had it been transparent and acted on time. Apparently, China did not apply the lessons it learnt from the SARS outbreak despite strident global criticism. Downplaying and being secretive about public health issues, particularly novel virus outbreaks, as it found out during SARS, and then now, can be very counterproductive.

The manner in which China handled the outbreak is in complete contrast to the way Kerala handled the Nipah virus outbreaks in 2018 and 2019. Transparency, taking the society into confidence and timely action helped the State contain the outbreaks within days, with few cases, deaths only in 2018.

Eerie similarity between SARS and COVID-19

There is an eerie similarity between China’s SARS outbreak response in 2002-2003 and the current epidemic. SARS spread to 29 countries and caused illness in over 8,000 people and killed nearly 800 before it was contained globally in July 2003, nearly eight months after the first case was noticed in mid-November 2002. If, during SARS, it initially withheld information and delayed by three months reporting it to WHO, in the case of COVID-19 it systematically downplayed its scale for nearly six weeks after pneumonia cases of unknown cause were first seen on December 8, 2019.

Virus has a free run

Shockingly, even as it reported the case cluster to WHO in December, and the wet market, thought to be the outbreak hotspot, was closed on January 1, people were kept in the dark thus giving the virus a free run. In fact, eight doctors who sounded an early alarm were detained for “spreading rumours”.

Ironically, even as about 900 patients presented with symptoms each day by late December, as a daily reported, official numbers stayed the same. In fact, after initially reporting 44 cases to WHO, the numbers were reduced to 41 on January 11 and continued to remain the same till January 16, when the city and province’s annual political congress ended.

Even on January 16, WHO was informed of only “limited” human spread, thus putting more people at infection risk. The cases reported began rising slowly since January 17 to reach 121 on January 19 when a community dinner was held in Wuhan. It took a Chinese epidemiologist’s revelation the next day about the outbreak’s severity for Wuhan to start acting decisively.

The lesson is that in the event of an outbreak, secrecy is a killer and transparency the saviour.

Published in The Hindu on February 20, 2020