Can a fragmented world stop COVID-19 pandemic?

Shashank Bengali and Victoria Kim, Tribune News Service

China locks down tens of millions in their homes to slow the march of a deadly virus — but furnishes scant information about the mercurial spread of a disease that has spooked the world.

South Korea and Singapore opt to track patients’ movements in granular detail, favouring radical transparency over privacy. In Italy and Iran, politicians trade blame over rapidly growing outbreaks that are seeping across unstable regions, making a global pandemic seemingly inevitable. Infections appear in Mexico. Then Nigeria.

As the world unites in resolve to battle the deadly virus that causes COVID-19, it is doing so with as many as 195 separate playbooks, each country calibrating its emergency measures to suit domestic and international politics, local capacity, cultural norms and other considerations that have little to do with public health.

The result is a global response that can appear uneven, inchoate and at times dangerous, with neighbouring countries adopting different strategies to similar threats across a closely connected planet.

“Unfortunately we are only as prepared as our weakest link,” said Lawrence O. Gostin, a global health professor at Georgetown Law School. “We are seeing that clusters of cases in one country can quickly move regionally and globally. No one is safe unless we are all safe.”

Responses to recent outbreaks have been hindered, Gostin said, by a range of factors: weak health systems, insufficient testing equipment and medical professionals, authoritarian leaders who restrict the flow of information, political instability and violence, and the limitations of the World Health Organisation, which is loath to criticise the very governments it relies upon for funding.

In years past, countries like the US might have played a leading role in spearheading a global response. But President Donald Trump for weeks has minimised the threat of the virus and has been focused largely on the impact on markets, even as the virus began transmitting on US soil in the middle of a divisive election year.

The strengths and shortcomings of governments and institutions have been on full display in recent days, as the number of coronavirus infections soared past 80,000 in more than 50 countries. Nearly 3,000 have died, the vast majority in China.

New cases were reported this week in Brazil and Nigeria, increasingly signaling that the virus will reach all corners of the world and that the effort to stay ahead of it will be prolonged, with no end in sight. The novel virus sends shudders daily across the planet, cancelling concerts and sporting events, and raising questions over sealed borders, quarantines, the viability of face masks and test kits, the long-term consequences on financial markets and what happens if the disease reaches deeper into Africa.

“My biggest concern is while this is being artificially held back, are countries taking advantage of this time?” said Dale Fisher, a Singapore-based physician and chairman of the WHO’s Global Outbreak Alert and Response Network. “China can’t stay closed forever, and this outbreak, it already has brought cities to their knees, brought countries to social and commercial standstill.”

From being slow to disclose the severity of the virus when it first emerged in December in the animal markets of the central city of Wuhan, China is now winning praise for locking down 100 million people in Hubei province — an unprecedented cordon sanitaire that appears to have slowed the spread of the virus domestically.

For the first time last week, the number of infections reported in a single day was greater outside China than inside.

A WHO mission to China last week lavished praise on the government’s measures. That same organisation credited Beijing’s response even as the nation’s leaders were not forthcoming about the extent of the disease two months ago. Questions continue to linger about China’s transparency over the infections it records.

Chinese officials have disclosed only limited information about infections among front-line health care workers, when infected people first began to show symptoms and the total number of people it has tested — all of which could help determine how the disease spreads.

“The lack of that information makes it harder for China and the world to do everything possible to limit the impact of the virus,” Frieden said. There is also the question of whether the draconian measures taken by Chinese authorities can be replicated elsewhere in the world — especially in liberal democracies.

Governments in two new epicenters, Iran and Italy, were scrambling to get a handle on outbreaks that started with travelers arriving from China.

Iran’s theocracy at first downplayed the threat, perhaps to curry favour with China — an important trading partner — and to avoid startling a population already beaten down by years of fiscal mismanagement and US economic sanctions.  Iran has now reported 245 cases — including the infection of its deputy health minister — and 26 deaths. The unusually high ratio of deaths to known cases has led experts to extrapolate the country may have thousands of undetected infections. Iran is believed to be the source for infections in a half-dozen regional countries, including Lebanon, Iraq and Afghanistan, a prospect that has the virus colliding with conflict zones.

Italy was quick to quarantine two Chinese tourists with coronavirus in Rome last month, and was the first European country to stop direct flights from China, but has nevertheless been hit by the biggest outbreak in Europe.

Elsewhere in Asia, governments are facing questions over a lack of infections. Cambodia and Indonesia have reported one and zero cases infections respectively, despite having received large numbers of travellers from China in January. Indonesia had daily direct flights from Wuhan, the epicenter, until authorities suspended the flights Jan. 24.

To experts, the low figures suggest that the virus is spreading undetected.

Nigeria’s first case Friday marked COVID-19’s arrival in sub-Saharan Africa, where health systems already struggle to cope with existing diseases like malaria and yellow fever. The WHO is rushing test kits to the continent’s hospitals, some of which developed experience testing for infectious diseases during the Ebola outbreak. But the coronavirus presents a more difficult challenge, experts said, because it can be transmitted even by people who fail to show symptoms.

“If COVID-19 reaches sub-Saharan Africa” in large numbers, Gostin said, “it would be our worst nightmare.”