Why the World Health Organization Made the Right Call Not Declaring a “Public Health Emergency of International Concern”
There are three key and missing data points that are needed to make a designation of the magnitude and cost of the World Health Organization declaring a Public Health Emergency of International concern. These missing data points are:
How many of those infected, have mild symptoms and recover? This is the most important question. Another formulation of the same question is: does everyone with the virus have serious symptoms? Or, how many people who have been infected have developed antibodies and experienced mild symptoms?
If most people with the virus do not experience devastating symptoms, then the number of known people with the devastating symptoms of the infection are the only ones who are counted.
Those with mild symptoms feel better and are never counted. This means the number of infected is far higher than is now known.
(Update at 16:40, now we know the answer: most who are sick have mild symptoms and recover.)
On the other hand (and this, in my view, is highly unlikely) if everyone infected becomes sicker over time until they don’t recover, then the death toll will rise significantly, vastly increasing the mortality rate.
To wit: if the recent British estimate of 4,000 infected in Wuhan is accurate, and the official death toll of 17 is accurate, then the mortality rate is 17/4,000 x 100 = 0.425%.
But, if the official Chinese figure of only 546 infected (not the British estimate of 4,000) is accurate, and the official 17 dead number is also accurate — it means the mortality rate is 17/546 x 100 = 3.11% — which is reasonably higher than the lower end estimate of the 2.5% mortality rate of the 1918 Spanish flu. (It should be noted that the 1918 Spanish flu could have easily had a mortality rate of 3% to 5%. The U.S. Centers for Disease Control puts the number infected with the 1918 Spanish flu at 500 million, with 50 million dead — a mortality rate of 10%.) There are other credible estimates that 100 million died.
Right now, using only the Chinese official figures — which the British simply do not believe — puts the mortality rate of the Wuhan virus in the lower realm mortality rate estimates of the 1918 Spanish flu that killed millions.
We, us humans, right now, simply do not know if the Wuhan virus has a slightly higher mortality rate than the average influenza epidemic (about 0.1% mortality) or if it something else.
What is the incubation period? This data is necessary to get a handle of how many people could be infected and not know they are infected. This has a profound impact on the speed and geographic disparity of how far the virus spreads. The Wuhan virus incubation period is unknown.
How does it infect humans? Does infection occur easily and often? What is the Modus Operandi of human-to-human transmission of the virus? When health care workers become ill with the virus, it causes great concern within the professional community that manages global pandemics. Infected health care workers (doctors and nurses) are taken as direct evidence of human-to-human transmission and, specifically, that the virus could cripple the public health system and health care infrastructure when it is needed most.
However, a key part of human-to-human transmission of the infection is the efficiency of transmission. If the efficiency of the Wuhan virus is low, like SARS’ transmission efficiency was low, then this is a highly mitigating factor and makes the virus’s ability infect via human-to-human transmission, far less serious.
Incidentally, the Wuhan virus looks a whole lot like SARS, leading many to believe the Wuhan virus transmission will be just as inefficient as SARS.
Time will answer these three key questions. Over the next two weeks we will know what kind of new virus we humans are dealing with and its danger to humanity.
But odds are this is not going to be a global pandemic with a mortality rate in the realm of the Spanish flu — it could be, but it’s in all likelihood it’s not.
The next “Spanish flu” will undoubtedly come from China and be an Avian or Bird Flu. The most deadly Avian or Bird flu in China is H7N9 — forget a mortality rate of 10% or 5%. H7N9 has a mortality rate of 60%, according to Dr. Dennis Carroll, Director, Emerging Threats Unit, U.S. Agency for International Development. But, H7N9 has a very, very inefficient human-to-human transmission method. So, we are safe. Right up until it mutates into a version that can spread easily from human-to-human.
In Netflix’s series Pandemic, Dennis Carroll explains that the worst outbreak in the global history of the Ebola virus was primarily in three countries in Africa, from 2014 to 2016, and spread to 30,000 to 50,000 people.
But H1N1, otherwise known as “swine flu,” spread globally in 12 months and infected 2,000,000,000 (two billion) people, while the non-flu virus Ebola, infected 50,000 people, in two years.
A novel flu virus — swine flu or H1N1 — infects 2 billion people and makes its way into every country on Earth, in 12 months. Now, you see why this new, non-flu, coronavirus is not really that worrisome. A new Bird flu or Avian flu out of China, that is something that could be quite worrisome.
And there will come a day when the next “Spanish flu” will have a very high mortality rate and an efficient human-to-human transmission rate. It is the most likely candidate to cause mass death on Earth that is not man-made or the result of a biological, chemical or nuclear weapon.
To put it in perspective, more people died from the 1918 Spanish flu than the total dead in World War I and II. And over human history, the general consensus is that viruses have killed more than all the wars combined.
To wit, the next pandemic, most likely an Avian flu that comes out of China, could and will likely kill more than 500 million people and travel to every corner of the planet.