The new strain of coronavirus that has spread across Asia is causing concern ahead of China's Lunar New Year.
- A new strain of the coronavirus — similar to SARS — is spreading across China and to nearby countries, including the U.S..
- Although it's relatively early on, the virus appears to be fairly infectious and capable of human-to-human transmission, a serious concern given the many travelers expected to visit China for the upcoming Lunar New Year.
- The World Health Organization intends to convene an emergency committee in the near future to determine whether the outbreak should be considered a public health emergency of international concern.
Chinese officials recently confirmed that a new SARS-like virus is capable of human-to-human infection. The virus has killed at least six people so far and has left nearly 300 more sick.
Wuhan, where the virus was first detected, has canceled its upcoming Lunar New Year celebration over concerns about the hundreds of thousands of visitors that would visit the city and potentially spread the virus to other parts of the world.
The virus has already begun to spread — the respiratory illness has been detected in Beijing, Shanghai, and Shenzen, as well as in Japan, Thailand, South Korea, and Taiwan. Recently, the Centers for Disease Control and Prevention (CDC) confirmed that the virus has appeared in the U.S. as well. A male traveler in Snohomish County, Washington state, reached out to local health facilities after he began presented pneumonia-like symptoms on January 15th.
The spread has also been encouraged by the less-than-rapid response from the Chinese government, which only began checking travelers' temperatures on January 14th despite learning of the virus in mid-December. Furthermore, millions of visitors are expected to travel to China for the Lunar New Year, presenting an opportunity for the virus to spread even further.
A new coronavirus
A photo of the closed Huanan Seafood Wholesale Market in Wuhan, which has been linked to several cases of the coronavirus.
The virus resembles SARS (severe acute respiratory syndrome), which killed 774 people in 2002 and 2003 across several Asian countries. Like SARS, the new virus is a coronavirus, so-named because of the bulbous projections encircling the viroid that resemble a royal crown or a solar corona. The Wuhan coronavirus, dubbed 2019-nCoV, appears to be an entirely novel strain that has not been detected in humans before. Scientists believe that the virus's primary source was an animal, but it is clear now that the virus is capable of spreading between humans, causing fever, shortness of breath, a cough, and other respiratory issues.
There is evidence to suggest that the disease could be highly infectious as well; one patient is believed to have infected 14 medical professionals in the hospital where they were being treated.
China's and the WHO's response
Handout photo from the Centers for Disease Control and Prevention (CDC) shows a microscopic view of the coronavirus. According to the CDC.
(Photo by CDC/Getty Images)
Although some have criticized the Chinese response as being sluggish, it has acted far more quickly than it did during the 2002 SARS outbreak. After the SARS virus first appeared, the Communist Party of China discouraged state media from reporting on the virus and delayed in reporting information to the World Health Organization (WHO) for months.
That being said, there is some concern that the Chinese government is underreporting the figures associated with the disease. In an interview with CNN, researcher Neil Ferguson claimed that the number of cases outside of China suggest that more individuals are infected than is being reported. "We calculate," he said, "based on flight and population data, that there is only a 1 in 574 chance that a person infected in Wuhan would travel overseas before they sought medical care. This implies there might have been over 1,700 cases in Wuhan so far."
"There are many unknowns," continued Ferguson, "meaning the uncertainty range around this estimate goes from 190 cases to over 4,000. But the magnitude of these numbers suggests that substantial human-to-human transmission cannot be ruled out. Heightened surveillance, prompt information sharing and enhanced preparedness are recommended."
The WHO plans to convene an emergency committee on January 22nd to determine whether the outbreak can be considered a public health emergency of international concern, or PHEIC, which is defined as "an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response." A similar determination was made regarding the 2002 SARS outbreak.
Under international health regulations, the declaration of a PHEIC requires states to respond quickly to the emergency. While it is characterized as a last resort, declaring a PHEIC in and of itself offers the WHO few powers beyond the ability to form an advisory emergency committee on the crisis.
Given that Wuhan is a city of 11 million people and that the virus has already spread beyond China's borders, such a declaration seems merited. With a PHEIC in place, hopefully the WHO will be able to work with the Chinese government to minimize the spread of the disease prior to the upcoming Lunar New Year.
A notice for passengers from Wuhan, China is displayed near a quarantine station at Narita airport in Japan. Japan's Ministry of Health, Labour and Welfare recently confirmed its first case of pneumonia infected with a new coronavirus from Wuhan City, China.
Photo: Tomohiro Ohsumi/Getty Images
Quarantines are worth the trouble to keep the next pandemic at bay but they need to be applied intelligently.
- A new essay argues that quarantines are often needed, but require strict guidelines on when they can be used.
- Pandemics are inevitable, and actions that can save lives must be planned now.
- The arguments in this essay will undoubtedly be of use during the next outbreak.
The use of isolation and quarantine has a history of success going back to the black plague. The practice of isolating sick people form healthy ones intuitively strikes many of us as useful, and many of us do it on our own accord when we fall ill. It seems like a simple step up from that to the idea of quarantining people who are sick or have been exposed to deadly diseases to stop them from spreading.
However, the impositions on individuals that quarantine requires, such as isolation from friends, family, and activity is a rather steep price to pay. Besides, the use of force to limit people's freedoms for the greater good is always a moral minefield. Deciding exactly when, where, and how to implement a quarantine is a tricky business.
A paper by Alberto Giubilini, Hannah Maslen, Tom Douglas, and Julian Savulescu of the Oxford Uehiro Centre for Practical Ethics might have a solution. By taking a moral approach to the problem, one that seeks the most robust possible foundation for intervention, the authors hope to provide sound guidelines to people considering the question of when to intervene and when to take no action.
What is a quarantine exactly?
Health workers are seen with a young patient under quarantine at the Nongo Ebola treatment unit in Conakry, Guinea on August 21, 2015. The World Health Organization WHO has lost track of 45 people under surveillance, who had been in contact with a patient who contracted Ebola, in Guinea. (CELLOU BINANI/AFP/Getty Images)
For the purposes of this paper, isolation and quarantine had two different meanings. As the authors define them: "Isolation separates sick people with a contagious disease from people who are not sick. Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick."
Why would quarantine be a good idea? After all, they aren't sick yet!
"Typhoid" Mary Mallon, far left, in quarantine. Her refusal to wash her hands while carrying typhoid fever bacteria may have killed fifty people. She was forced into quarantine for the safety of the public.
The first argument that the authors make is the obvious one, society benefits a great deal from quarantining a person who might be carrying a deadly disease at a relatively low cost to that society and a moderate cost to the person quarantined. A person who is exposed to Ebola might contract the disease and start spreading it before they are aware of their illness. Quarantines try to prevent this by hiding away anybody who might have been exposed to a disease, even if they are asymptomatic.
This consequentialist stance is the one typically invoked by governments and state agencies when quarantines are introduced, but the authors don't think it is the best ethical foundation. After all, it might be for everybody's benefit to lock away anybody exposed to the common cold for a week to keep infection rates down. This seems excessive, suggesting that the final answer lies elsewhere.
The authors then argue that, in many cases, the individual exposed to a potentially deadly disease will have a moral duty to quarantine themselves; making what the authorities do merely the enforcement of what a person ought to do anyway.
They use the example of Peter Singer's drowning child. Singer famously asked if we had a moral obligation to save a drowning child if the act of saving them was at a low cost to us. He concluded that we do, and many people agree with him. The authors call this the duty of "easy rescue" and argue that it applies in many quarantine cases since the cost of a person hiding in their room until they know they won't make others sick is typically low while the payoff could include saving lives.
The authors then suggest that, "when the cost to us of engaging in some activity is small, and the harm to others which is prevented is great, the state may permissibly compel us to engage in that activity." They place this inside of certain parameters, however.
Most of us would agree that we must keep other people from getting sick when we are ill. However, the suggestion here is that in severe cases, like when the illness in question is deadly, that the state has legitimate power to make sure we stay home. This is more limited than just comparing costs and benefits and doing whatever gives the best payoff, but still allows for interventions during the worst outbreaks.
But what about the freedom of the individual?
The authors don't suggest that the authorities should always start with quarantines and use them whenever the mood strikes. They make it clear at the beginning of their paper that, "we will argue that authorities ought to implement quarantine and coercion in such a manner that they have the strongest justification possible for those measures."
They also point out that any rational use of quarantines would be limited to severe cases. As they note, while it might be a social net-positive to quarantine people with the stomach flu, the lack of threat it poses makes the action unthinkable. Ebola, on the other hand, is enough of a threat to people that quarantines would be justified.
At some point though, the freedom of a person to do what they like would be infringed on for the sake of the public health. Many people are put off by this. The question is determining when an individual poses enough of a threat to the people around them that forcing them into quarantine is justified. The authors are of the mind that this is permissible when a person might have a very deadly disease.
In some cases, quarantine laws are overused and not based on a cost-benefit analysis, such as when New Jersey introduced a quarantine of people who had been in certain African countries during the 2014 Ebola outbreak. The poorly thought out law was changed after a lawsuit was brought against the state. This case should be a warning against over-application of quarantines, but not against their use when they are correctly implemented.
The idea of using force to lock people in their rooms to assure that others don't get sick is a tricky one. It makes perfect sense when we're healthy, but seems like a potential use of excessive force when we might be on the sick bed. Nevertheless, the ethics surrounding this issue are far from settled though. Given that we're already preparing for the next pandemic, we may be ruminating more moral questions sooner than we think.