It is said that pandemics are lived in advance, but only understood backwards.
At the end of a year in which Covid-19 claimed 1.7 million lives since it was first identified in the Chinese city of Wuhan last year, experts are now wondering if and when there was a turning point when the disease spread . has become unstoppable worldwide.
And about lessons for the future.
The stories they tell, sometimes conflicting, have one thing in common: a sudden realization early on in scientific circles that it was the long-predicted ‘big’ and how they encountered clay feet in policy circles that were primarily aimed at triggering a flu pandemic to respond, not a new coronavirus.
While some have argued that the spread of the epidemic was inherently exponential and unpredictable in its dynamics, others point to missed opportunities at various points shortly after the first appearance of Covid-19 in China when it began to invade elsewhere.
William Hanage, associate professor of epidemiology at Haran’s School of Public Health, recalls his personal ‘swallowing moment’ at the beginning of the year.
The first time I used the word pandemic was on January 28 in a message to a friend. The World Health Organization has just declared a public health emergency of international importance, and I remember thinking it was H1N1 [influenza] it would already be called a pandemic.
‘The word itself does not have much practical power, but it has a lot of power to train the public to take action. The delay was not helpful.
‘Even then we see evidence of transfer outside China. Several broadcasts. I knew when the first two cases were announced in Iran, followed by the news of deaths that we were for a rollercoaster ride.
“I was in a meeting. People talked about the seriousness. I talked about people coughing on planes. Someone finished my sentence … ‘then people fall dead’. ”
Hanage adds: “The first rule of good pandemic management is that you have to be straight with people. Tell it straight. These kinds of statements were necessary, but were almost ignored by public health officials who kept the risks until March. ‘
Looking back, Hanage is most surprised at the lack of concrete efforts in many countries, including the US and the UK, to deal more effectively with the initial spread of infections at the earliest stage, at a time when the efforts possibly had the most practical impact.
For Hanage, however, the biggest missed opportunity was how other countries reacted to the outbreak in northern Italy that took off quickly, the first serious outbreak in Europe.
“The breaking point as far as I can see was the failure of other countries to pay attention to what is happening in Italy.”
Hanage still detects the same cognitive dissonance in policy circles and among individuals.
Not much has changed. It seems like people are still finding reasons why it does not apply to them, why their country is different or that they are different when they go home thanks to Thanksgiving and spend a lot of time with people. ”
If one thing is clear, it is that, even though experts remain divided over the details of the early broadcasts – a topic that has become the source of sometimes heated debate – scientists agree that the chances are missed.
In an article published in October by Michael Worobey and colleagues in Science, the evolution of the virus is followed, unlike in some narratives, early attempts in Europe and the US could “extinguish” the first emerging clusters much more effectively than which is understood there. the time.
“Our results,” the newspaper said, “indicate that rapid early intervention could have successfully prevented early introduction of the virus in Germany and the United States. Other, later launches of the virus [fresh undetected infections coming in] from China to Italy and the state of Washington, the United States, established the earliest continuous European and North American transmission networks. ”
Among the later introductions – which led to its early success – Worobey points to a number of major travel events, including the Trump administration’s decision to repatriate some 40,000 U.S. residents from China, although it has banned Chinese entry into the country. US in February.
This, according to Worobey, led to one of the “serial, multiple introductions [of the virus that] causing the major outbreaks in the United States and Europe that still keep us in control ”.
In other words, public health officials have drawn the wrong lessons about what is possible to counter the disease as they have been blinded by new infections entering their countries.
While Peter Forster, of the University of Cambridge, who has done his own analysis of the spread of the virus through the history of mutation, disagrees with Worobey’s specific timeline and suggests another way for infections, the conclusions he make the same.
Like Hanage and Worobey, he believes that much more effective action, especially detection at the earliest stage, might make a difference.
‘I sent a message to Chris Whitty to introduce it very early. But did not get an answer. A few weeks later it was everywhere.
‘What made me believe it was serious in mid-January was to look at the relationship between deaths and recovery in China. Now we know that there was an underreporting of asymptomatic cases, but that should have been a warning. ‘
What has become clear to everyone is that the monitoring of respiratory diseases and a broader mindset that has focused for too long on a flu outbreak as the most likely source of ‘the next pandemic’ needs to change.
“My expertise is in watching viruses develop,” says Forster. “I would say you need to monitor very often how the virus mutates.”
Worobey and his colleagues came to a similar conclusion. “Our findings highlight the potential value of establishing intensive, community-level architectural viral surveillance architectures, such as the Seattle influenza study, during a pre-pandemic period.
“The value of detecting cases, before they have blossomed into an outbreak, cannot be overstated in a pandemic situation.”
For Hanage, the lesson is still broader. “People make mistakes,” he says, describing the mistakes early in the answer. “It’s not unforgivable to learn from them.”