The pandemic of the 21st century shows no signs of abating. There have been more lethal blights but COVID-19 is the scourge that is forcing the world to collectively think on its feet. It is a disease that is indiscriminate, easily diagnosed but so insidious that it appears to defy a predictable cure. Countries with the most advanced healthcare research and the most knowledgeable scientists have essentially the same defences as healthcare workers in less-developed countries: quarantine, lockdown, masks, social isolation, old drugs and rudimentary ventilators. As editor of the The Lancet , one of the most respected medical journals in the world, Richard Horton was at a vantage point to view the pandemic germinate, proliferate and overwhelm the world. In The COVID-19 Catastrophe , he encapsulates the key events in the evolution of the virus and the response across the world.
Origins in China
He begins his account from December 30, 2019, when a patient with a mysterious pneumonia tested positive for a new kind of coronavirus. The virus’s similarities with the Severe Acute Respiratory Syndrome (SARS) coronavirus (SARS-CoV-1) provoked uncomfortable memories of the original SARS outbreak in 2003 in Asia that infected more than 8,000 people and killed at least 774. There’s an account of how the ophthalmologist Li Wenliang first discussed this new virus, SARS-CoV-2, on Weibo but then was gagged and the virus’s origins traced to a seafood market in Hunan province before the World Health Organization was eventually informed. There are details on the WHO’s response and the steps involved in deciding if it is a pandemic or a Public Health Emergency of International Concern.
While U.S. President Donald Trump condemns the WHO for being in cahoots with China, suppressing evidence of the potency of the virus, Horton reminds us that unlike in the case of SARS- CoV-1 it had taken only “thirty days and not eight months to issue WHO’s highest category of international alert. The world had been warned. And it was still only January.”
Early reports on the virus’s origins, case reports from China and indications that the pulmonary and organ damage it was causing made it different from flu passed through the pages of TheLancet . Horton’s book will serve as an authoritative account that future research will benefit from.
Why did the West stumble?
He comes down heavily on ‘Western democracies’ for their public health response. He pillories America’s response that begins with President Trump first describing confirmation of the virus in the country as a ‘giant hoax’ and as it got progressively worse explaining it away with ‘under control.’
The West shuffled its feet on implementing non-pharmaceutical interventions — washing of hands, improving cough etiquette, avoid touching your face and the recommendations on physical and social distancing. He ponders on the toll that social distancing and work from home can have on mental health. “Are these new behaviours simply examples of wise caution at a time of danger? Or do they represent a catastrophic loss of social trust, a fissuring in our communities, a fragmentation of our solidarity? The degree of isolation we live with has important implications for mental health.”
Language of war
He critiques the use of the ‘language of war’ that politicians started to deploy (‘We are at war with an invisible killer’) and says that while this conveys a sense of urgency in dealing with the epidemic, it also poses challenges of creating an atmosphere where “dissent and criticism of government policy are discouraged, possibly even branded as a kind of betrayal.” The latter is a sentiment that is exemplified in the risk communication of several governments globally from the Centers for Disease Control in the United States or the Indian Council for Medical Research in India where disease risk, extent of community transmission were actively sought to be downplayed to maintain the illusion that the disease could be controlled — in stark contrast to what epidemiologists were warning.
Horton reserves particular wrath for his home country, the United Kingdom, and castigates the scientific leadership for being unwilling to speak truth to the political leadership. Despite the United Kingdom having identified the ‘pandemic influenza’ as the greatest risk the country was facing, and via a simulation being warned that 200,000 could die, it didn’t shore up preparedness, says Horton.
While the world took a nationalistic turn, the virus has exposed a fundamental flaw — isolationism provides fertile ground for a pandemic.
Unless there is a sharing of knowledge and information transcending borders, a catastrophe is inevitable. “We are social beings. We are political beings. COVID-19 has taught us that we are mutual beings too.”
The COVID-19 Catastrophe: What’s Gone Wrong and How to Stop it Happening Again ; Richard Horton, Polity Press, ₹665 (Kindle price).
