While the World Health Organization has said the risk of COVID-19 spreading worldwide is now “very high”, officials have suggested that efforts to combat the coronavirus are still in the containment phase.
But some medical experts believe that the containment stage has long since passed, that the spread of the COVID-19 is inevitable, and that living with the coronavirus could become a reality. COVID-19 is the respiratory illness caused by the new coronavirus.
“This will not be contained, this has not been contained,” said Isaac Bogoch, an infectious disease physician at Toronto General Hospital.
Massive public health efforts have been helpful in slowing down the spread of the infection and reducing the pace and frequency of exported cases from China to the rest of the world, but containment has not worked, Bogoch said.
‘Will continue to spread’
“This is spreading throughout the world and it will continue to spread throughout the world,” he said.
On Friday, WHO director-general Tedros Adhanom Ghebreyesus told a news conference that the Geneva-based health agency has “increased our assessment of the risk of spread and the risk of impact of COVID-19 to very high at a global level.”
China has seen more than 80,000 confirmed cases and almost 3,000 deaths. Outside China, there have been more than 7,000 cases in 60 countries, with more than 100 deaths.
Michael Ryan, executive director of the WHO Health Emergencies Program, explained public health authorities speak of containment and of mitigation strategies when dealing with disease. Containment, he said, includes the measures taken to break the chain of transmission of the coronavirus.
Mitigation is accepting that the virus cannot be prevented from spreading and from causing COVID-19, but health officials do what they can to mitigate its impact through treatment.
“What we’ve been saying clearly is that containing the virus and interrupting transmission gives us an opportunity to stop the virus,” Ryan said.
“To accept that mitigation is the only option is to accept that the virus cannot be stopped.”
But Bogoch said if WHO officials are defining containment as the possibility that the coronavirus will not spread beyond a certain border, that they can still prevent different countries in different regions from seeing this infection, “I don’t think that’s very realistic.”
“We’re seeing global transmission of this infection.”
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The different strategies that have been taken — closing borders, reducing travel, stopping travel, halting trade — all of that slowed down the progression of the infection, he said. The initiatives in China certainly bought the world several weeks to prepare for exported cases, the WHO found.
“It does not halt it and it will not halt it,” he said. “It might buy you a week. It might buy you a few weeks.”
Containment may have been possible had there been very early detection of the novel coronavirus and had China imposed massive control initiatives when the scale of the epidemic was much smaller, he said.
“Then and only then could this virus have been contained. And I would say some people would even argue with me on that front as well.”
The challenge, said Amesh Adalja, an infectious disease physician and a senior scholar at the Johns Hopkins Center for Health Security, is that coronavirus spreads efficiently from human to human, much differently than SARS or MERS.
Symptoms of SARS more severe
Unlike SARS, where the symptoms were much more severe, a large proportion of individuals that are infected with coronavirus aren’t sick enough to come to medical care, a significant factor in containing the virus.
“It’s not something that we can prevent from happening in the absence of a vaccine. It’s not containable in the way that those viruses were,” Adalja said. “So this will become endemic.”
And it’s going to be much more of a challenge to change the thinking, from a public policy standpoint, from containment to one of mitigation, he said.
“I think that could have been avoided if people would have realized in the beginning that because of this virus’s characteristics, that it wasn’t going to be something amenable to containment,” Adalja said.
Jason Kindrachuk, an assistant professor and Canada Research Chair in emerging viruses at the University of Manitoba, said the most recent situation reports and trends suggest a picture where the coronavirus will continue to spread globally.
“We’re in a position of fighting essentially a multiple front war against this virus,” he said. “How do you now start to contain something that is moving rapidly and transmitting rapidly across a number of regions, especially when we’re dealing with a global population that is used to travelling and moving as well.”
Ian Mackay, a virologist and associate professor at the University of Queenland’s UQ Child Health Research Centre, said determining whether the virus has been contained may play out country by country.
“Somewhere like South Korea, for example, is still tracking hard, but they must be looking down the barrel of having to switch from trying to contain this to trying to mitigate the damage it can cause.”
“I guess every country is going to look at containment versus mitigation with their own circumstances and if they even have the ability to contain at all.”
So what does mitigation of the coronavirus and COVID-19 mean in the near future?
Some have suggested the virus will run its course throughout the world and burn itself out, while others believe that the novel coronavirus will integrate itself into the seasonal viruses that come around every winter, causing clusters of COVID-19.
“This is going to become like some of the other coronaviruses that we have. There are four of them that cause disease every year. This is likely to become the fifth coronavirus at that capacity,” Adalja said.
“This isn’t unprecedented. And the vast majority of cases are going to be mild,” he said. “This isn’t something that’s going to be cataclysmic.”
“But it is something that’s manageable if we prepare appropriately and don’t panic.”
However, Kindrachuk questioned how vulnerable populations will cope with yet another virus, if it becomes endemic.
“Every addition of a new pathogen or a new infectious disease increases the public health care toll in those [vulnerable] regions … and ultimately has a much larger global impact in terms of both public health, as well as economic tolls.
“If this thing does become endemic, how do we now actually reposition ourselves to be able to compensate for this virus being a part of our lives?” he said.