How does one begin to write about an event with no clear beginning? Who can say whether the pandemic’s first spark—index case in epidemiological parlance—was in December 2019 or January 2020 or some earlier date? We may never truly know the exact minute when the world’s first human was infected with the novel SARS-CoV-2 virus—the causative agent of COVID-19.
Since starting to shelter in place in mid-March, I have been thinking about what it is I really want to say about this public health crisis. There are so many moving parts and so many people adding to the conversation. I could write about the biology and epidemiology of an infectious disease and how we might #flattenthecurve or practice #socialdistancing, or about the politics of division, denial and, fear. I could write about the add-on costs of unemployment, school closures, slowing of travel and trade, and the cessation of inter-country collaborations and partnerships that if in place may have helped overcome our shared pandemic challenge. However, as an epidemiologist and someone who has spent a career asking the how, what, where, why, and who of disease events, I ended with two questions. How did we get here? Where do we go from here? Before exploring these questions, it makes sense to consider what we do know about COVID-19.
What we know about COVID-19
We know:
(1) As of June 23, 2020, there are 9,158,912 confirmed cases and 474,241 deaths (https://coronavirus.jhu.edu/map.html) due to this emerging viral zoonotic pathogen—a disease-causing infectious agent that may be transmitted between non-human and human animals. Each of these numbers is, or was, a person; and if we lose sight of this one truth it would be a second tragedy. We also must remember that although humans often worry about zoonotic disease events when the pathogen is transmitted from animals to humans, and rightly so as is evident with the current pandemic, we must remember that transmission may occur in both directions, and may cause death of human and non-human animals alike.
(2) The pandemic has shut down cities, created mass unemployment and economic hardships, and angered a growing number of citizens in many countries helping to fuel protests and unrest.
(3) That we are living through the biggest public health crisis of the last 100 years. In fact, the last time humans were faced with a pandemic of this magnitude was in 1918-1919 with the Spanish Flu, when an estimated 50-100 million people died. (My great, great grandfather was one of the Spanish Flu’s victims in 1920 and during the fourth wave in the US.)
(4) We must find a new normal post-COVID-19 world if we are to minimize the impacts from this pandemic and to mitigate the chance of future zoonotic pandemics.
How did we get here?
I saw a roadside sign in April that said, “Whoever said that one person can’t change the world never ate an undercooked bat.” Although not quite that simple, the fact is that our relationship with food is at the core of the pandemic. The sign is correct in that the pandemic started with a virus in a bat that spilled over to an intermediate host; as the most trafficked mammal on the planet, pangolins are top on this list of a possible intermediate host. It is there that the virus may have mixed with the pangolin’s coronavirus, resulting in a novel virus. A brand new virus ready to spillover to the human population. Unfortunately, this novel virus (SARS-CoV-2) is highly human adapted and really likes to infect our cells and is easily transmitted human to human.
A bat and a pangolin, or a turtle or snake or civet cat or name your favorite possible intermediate host….probably met at a wet-market which at the time the two hosts met may have housed 1000s of live and dead animals together under unhygienic conditions. If you aren’t familiar with wet-markets, they are markets where people buy all types of animals and animal products to take home for the dinner table. Animals are often butchered on the spot near live animals so that blood and intestines and microbes may mix together between the dead and live animals. During my years of working in Africa, Asia, and the Americas I have seen many of these markets, or places I like to call “zoonotic cesspools.” In addition to being an animal welfare nightmare, they may serve as ground zero for infectious agents (pathogens) to move effortlessly from one species to the next. As is obvious today, this then may lead to devastating health, social, and economic outcomes for humans around the world as the current COVID-19 pandemic has proven.
We should not be at all surprised that the cause of this pandemic is a coronavirus. In fact, we have been witness to two other coronavirus epidemics in the 2000s, with sudden acute respiratory syndrome (SARS) in 2003 linked to civet cats at a wet-market, and Middle Eastern Respiratory Syndrome (MERS) first seen in 2012 and linked to the growing use of dromedary camels as a food source throughout the world. We were lucky when SARS disappeared almost as quickly as it surfaced and that MERS has yet to become a pandemic. With a 30% mortality rate (the number of people infected that will die), it is really good that MERS virus is not as contagious as SARS-CoV-2.
Had the spillover event that started COVID remained confined to a single wet market in a single town, we would not currently be witness to a pandemic. However, in the 21st century with the movement of people and products around the globe at an unprecedented rate, we see just how easy it is for a pathogen to circle the globe within hours. Humans and animals may serve as “pathogen packages.” Where each of us travels so too travels all the microbes and pathogens that call our bodies their home.
Where do we go from here?
Should we just agree to welcome this pandemic as the new normal along with the other global challenges of today; climate change, plastic pollution, and biodiversity loss? Or might it be better to re-imagine a new normal post-pandemic world? One in which our human actions work to minimize spillover events and the many other greatest threats to planetary health.
With great challenge comes great opportunity. This is the opportunity of our lifetimes. This is an opportunity to create a new normal in which human actions do not drive other species to extinction or devastate the ecosystems that sustain all life. We must work to change food systems and slow the trade in wildlife, to ensure there are places on Earth where land and water remain free of the growing human footprint so it may be available for other species, to lower consumption of things in developed countries, and to ensure human well-being and livelihoods in developing countries.
Only if we confront the wicked challenges of the 21st century and work together to slow climate change, biodiversity loss, emerging infectious disease events, and other human created threats will we have a chance for a healthy tomorrow. We can and will get through this pandemic. Humanity has done it before. If we come together as individuals and communities and countries and accept that we are all in this together, we may actually come out stronger in a post-COVID world. And, once we move beyond our current situation, we must work to prevent the next pandemic from surfacing or the next continent-wide wildfires from burning, or the next species from going extinct.
Abraham Lincoln is credited with saying, “the best way to predict the future is to create it.” Now is the time. Now is our time to make strategic choices about the future. We must open our eyes to how the current pandemic is changing and will continue to change our world. How we choose to respond will determine the final outcome. The choices we make now will not only determine how this pandemic ends, but also how soon the next pandemic occurs. The 3 trillion dollar, and counting, question before us is whether we believe in the old adage that prevention is cheaper than the cure. I hope the “new normal” takes us on a path toward One Health in which we work for a holistic and preventive approach for environmental, animal, and human health. The survival of our species may very well depend on it.