Laurie Garrett wrote her first bestselling book, THE COMING PLAGUE: Newly Emerging Diseases in a World Out of Balance, and below is an editorial she wrote on what it will take to stop the Wuhan Corona Virus. This editorial first appeared as part of a longer editorial on CNN called What it will take to stop the Wuhan coronavirus.
“The virus is already everywhere.”
By Laurie Garrett
Updated 11:40 PM ET, Fri January 24, 2020
“First, the flow of people who are infected has to stop and transportation across the entirety of China must be monitored or restricted. The Wuhan animal market from which nCoV2019 arose is located less than 0.5 miles from one of the city’s train stations, where several high-speed rails stop. It must be assumed that people, and their live animals, walked that short distance earlier this month to take the trains — possibly carrying the virus with them to cities across China. A post from Wuhan Railway that has since been deleted said 300,000 people traveled out of Wuhan by train on Wednesday.
It is imperative that the tough lockdown measures unfolding this week presage nationwide travel restrictions. During the SARS epidemic, a brave military physician leaked medical documents to Time magazine, providing proof that SARS patients were secretly being treated in People’s Liberation Army facilities in Beijing. Once word was out, I watched as tens of thousands of Beijing residents climbed onto trains, fleeing the city — and taking SARS to every corner of the country. After the exodus from Beijing in 2003, authorities erected fever check stations in every air, bus and train terminal in China, and placed policed health stations along the nation’s highways.
Fever-check stations were so abundant that I was typically tested 10 to 12 times a day in Beijing, and every 10 to 20 miles while driving on major highways. The Chinese government has started erecting a network of fever stations in transit hubs, and I expect this will ramp up considerably over the coming week. Social media posts already show several photos and videos of officials erecting roadblocks, barricades, and traffic diversions to police-manned fever stations and similar measures reminiscent of what I witnessed in 2003. Currently, family members of known nCoV2019 patients are tested for infection and placed under surveillance. Chinese authorities are already tracking hundreds of close contacts of known patients, and this will escalate radically over the coming days. Apartment complexes and hotels that are known to have housed a nCoV2019-infected person will also be scoured.
There must also be a safe place to quarantine people who are running temperatures. In 2003 I watched in frank astonishment as teams of Chinese workers erected entire hospitals — complete with air filters, special sewage systems and electricity — in just days, province-by-province. A similar effort is now underway in Wuhan. By far the most important measures to stop the Wuhan coronavirus will be those related to hospitals and how well medical teams can contain the virus.
Both MERS and SARS spread like wildfire through unprepared medical facilities, regardless of the comparative wealth and sophistication of the hospitals. Most of the SARS cases in Hong Kong went to two hospitals: one had just a single healthcare worker infected, while the other suffered terrible losses in both health workers and patients who were being treated for other medical ailments. The key difference? The teams in the better hospital had years of infection control training, which taught staff to work in teams and make sure that any contaminated protective gear was safely removed without contact with the skin, face, eyes or hands.
Over the last few days, many Chinese social media users have posted dramatic videos and photos of over-crowded hospital emergency room facilities, in which frantic patients and family members are crammed together and healthcare workers are hard-pressed to control the influx, as the infectious spread of the virus is surely occurring. In the SARS epidemic, hospitals eventually realized the need to set up fever check stations outside the facilities, screening would-be patients, and ushering febrile individuals into an entry separate from other hospital admissions. In Toronto and Singapore, which have remarkably good healthcare systems and state-of-the-art facilities, hospital workers struggled mightily to stop the spread of SARS, and healthcare workers who were infected died. In some of my discussions with physicians and nurses that went through the SARS nightmares, I have learned that the wealthier facilities were, perhaps, at greater risk because they had more equipment and procedures to apply to patients, including intubation and lavage, which was used to remove fluids from the lungs that built up in response to infection.
When SARS hit Hanoi, patients were originally taken to the prestigious French Hospital, where modern interventions were used, but the virus readily spread, taking the lives of doctors and nurses. When patients were moved to the far less sophisticated Bach Mai Hospital, which lacked some of the more advanced equipment, windows were open due to a lack of air conditioning. According to some of the doctors, this slowed the spread of the virus by preventing it from adhering to surfaces and people in the hospital. China is likely to take a serious economic hit as a result of the nCoV2019 virus. The SARS epidemic cost the global economy $54 billion, according to a World Bank estimate, and the Wuhan coronavirus is likely to affect Chinese tourism and trade. Seventeen years after SARS, China — now the second-largest economy in the world — is likely to experience a higher scale of costs and burdens to execute nationwide containment strategy. But Beijing has no choice. The virus is already everywhere.”