Coronavirus: Teaching us a bit about disease, and a lot about ourselves

SINGAPORE — If, as they say, where you stand depends on where you sit, there was little doubt where Cambodian Prime Minister Hun Sen has chosen to place himself.

On Friday, he showed up at the seaport in Sihanoukville to receive the cruise liner Westerdam that had been turned away by five countries, including Thailand which dispatched a battleship to escort it out of the Gulf of Thailand.

Not a man known for softness, Mr Hun Sen, China’s staunchest friend in Asean, showed up portside holding roses for the 1,455 disembarking passengers since it was Valentine’s Day.

Cambodians “who are currently working or studying in China, including those in Wuhan, have to remain there and join the Chinese people to fight this disease”, Mr Hun Sen was quoted saying earlier, in a speech in Phnom Penh on Jan 30. “Don’t run away from the Chinese people during this difficult time.”

True friendship emerges in times of adversity, Chinese Foreign Ministry spokesman Hua Chunying has said repeatedly in recent weeks. Yet, not all countries – North Korea and Russia included, surprisingly – have been quite so considerate about Chinese feelings.

Thailand, whose tourism is critically dependent on China, turned away the vessel although there was no known case of the coronavirus disease, Covid-19, on board. It has banned exports of face masks, standing against manufacturers who shipped 226 million masks last year, three times the previous year’s figure.

Some countries have been simply tactless; after the US announced severe restrictions on travelers from China and put it on par with Afghanistan and Syria on a “Do Not Travel” advisory, Beijing officially complained of overreaction.

In this digital age, when first mentions of viruses draw visions of smartphones and electronic tablets, it is startling to find ourselves recoiling at the thought of actual germs that might have jumped from animal species to us, and which attack our respiratory systems, sometimes leading to death. But there you have it.

The World Health Organization (WHO) now calls the Covid-19 outbreak a global health emergency.

The frightening thing about the outbreak is that no region – not even North America – is fully equipped to handle an outbreak of this magnitude. It gets worse when it comes to regions like Africa, home to 1.2 billion people, including a million Chinese, yet with only six laboratories with the capability to detect the coronavirus.

An equal worry is densely populated South Asia, particularly the swathe of territory from Karachi in Pakistan to India’s Gangetic delta where government doctors often have poor attendance records, and onward to Bangladesh.

When United States Senator Tom Cotton, who sits on the Senate Armed Services Committee, asked the top brass in charge of each US command about how prepared nations in their areas of responsibility were to combat a virulent disease outbreak, each officer at the hearing stressed how unready these nations were.

WHO director-general Tedros Adhanom Ghebreyesus said: “My biggest worry is that there are countries today who do not have the systems in place to detect people who have contracted the virus, even if it were to emerge. Urgent support is needed to bolster weak health systems to detect, diagnose and care for people with the virus to prevent further human-to-human transmission and protect health workers.”

It is not that we have not seen this coming. Three years ago this month, Microsoft founder Bill Gates, who has funded one of the world’s biggest philanthropies active in public health, told the Munich security conference that whether it occurs by a quirk of nature or at the hand of a terrorist, epidemiologists believe that a fast-moving airborne pathogen could kill more than 30 million people in less than a year.

“And they say there is a reasonable probability the world will experience such an outbreak in the next 10 to 15 years,” Mr Gates added.

Scientists in Wuhan, epicenter of the outbreak, have been aware of dangers for years.

In November 2015, the respected scientific magazine Nature published a report titled “A Sars-like cluster of circulating bat coronaviruses shows potential for human emergence”.

It talked of the work of an expert group, including the highly respected Dr Shi Zhengli of the Wuhan Institute of Virology, and went on to say: “Our work suggests a potential risk of Sars-CoV re-emergence from viruses currently circulating in bat populations.”

Ironically, we still do not know enough of the disease. Last Saturday, the China Daily reported that confirmed transmission routes of the coronavirus include direct transmission, contact transmission and aerosol transmission.

“Aerosol transmission refers to the mixing of the virus with droplets in the air to form aerosols, which causes infection after inhalation, according to medical experts,” Mr Zeng Qun, deputy head of the Shanghai Civil Affairs Bureau, told a media briefing. “As such, we have called on the public to raise their awareness of the prevention and control of the disease caused by family gatherings.”

The next day, a medical expert from China’s Centre for Disease Control and Prevention seemed to reverse that position, saying there is no definitive answer to whether the virus can be spread through aerosol form. In Singapore, the director of medical services at the Ministry of Health, Associate Professor Kenneth Mak, seems to tilt the same way, saying the virus is spread by droplets with no evidence that it is airborne.

China has been blamed – fairly or unfairly – for hiding the extent of the outbreak. However, deaths are harder to conceal than disease. In a perverse way, therefore, if the disease is much wider than thought, but the mortality figures more accurate, it could imply the bug is not as virulent as currently thought.

BEST AND WORST

“Outbreaks can bring out the best, and worst, in people,” WHO’s Dr Tedros said recently – and he is right.

One of the memorable shots following the Great Sendai earthquake and tsunami of 2011 was the sight of the patience and consideration that Japanese showed fellow sufferers who were short of food and petrol as they queued for supplies. Some survivors who had been left with only two bottles of water surrendered one to the needy. With public utilities stricken, many homes voluntarily cut electricity use so there was enough power to go round.

The run on Singapore supermarket shelves after the outbreak alert level was raised to orange on Feb 7 suggests that this country, which today exceeds Japan in average life expectancy and income levels, has a way to go to reach those standards of public behavior.

Neither is Britain, Singapore’s former colonial master, too different. The government announcement of an imminent health emergency touched off a wave of panic buying of masks and hoarding of canned foods and instant noodles. In the land of the British bulldog and stiff upper lip, many switched from public transport to their own cars, cycling, or just walking.

Virus outbreaks are class-neutral, of course, but how societies react can depend on their individual circumstances. Fully a third of Japan’s 30 million tourists are Chinese, and Tokyo has assiduously wooed them in recent years for both economic and strategic reasons. Last week, Japan, which along with the Philippines and Hong Kong is among the three foreign territories where there have been coronavirus-related deaths, was bracing for an epidemic with two taxi drivers and a doctor among the victims.

Eyes now turn to Africa, which has yet to report a confirmed coronavirus case. The continent has the weakest health systems and is only just managing to contain a hugely debilitating Ebola outbreak. In the Congo, for instance, Ebola deaths have come down from the hundreds to dozens and could spread again if attention is diverted to another disease. Nigeria, Ethiopia, Angola, Tanzania, Ghana and Kenya figure in the list of 14 African nations that the WHO has identified as at increased risk from the coronavirus because they either have direct air connections to China or receive a lot of Chinese visitors.

Meanwhile, Asean, where the quality of public health services can vary from Singapore and Thailand at the top, to some Indochinese states which could use substantial improvement, is gathering its own response.

During the Sars outbreak in 2003, whose peak impact was a five-month period from February to July, ministers of affected Asean states met to discuss a coordinated response. This time around, with the outbreak likely to persist for longer, Asean chair Vietnam is coordinating a response.

“We need to exchange information and cooperate with one another to avoid working at cross purposes,” Prime Minister Lee Hsien Loong said while touring Changi Airport’s Terminal 3 on Friday. “We did that in Sars, the ministers met. This time, I think we should do something similar. If the region has a problem, it’s going to be very, very difficult for Singapore to isolate ourselves and to keep the problem outside of our boundaries.”