“The chances of a global pandemic are growing and we are all dangerously underprepared.” — World Health Organization in a September 18, 2019 statement mere months before the COVID-19 outbreak.

“There’s a glaring hole in President Trump’s budget proposal for 2019, global health researchers say. A U.S. program to help other countries beef up their ability to detect pathogens around the world will lose a significant portion of its funding.” — From a 2018 NPR news report. 

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During recent years the world has swelled with new and re-emerging infectious illnesses. Ebola, HIV, and SARS were among the worst. And many were accelerated, worsened or enabled through various harmful interactions with the living world to include deforestation, the bush meat trade and the climate crisis. But these illnesses were not the only ones. Between 2011 and 2018, the World Health Organization had tracked 1,483 epidemics worldwide including SARS and Ebola. These illnesses had forced human migration, lost jobs, increased mortality, and major disruption to the regions impacted. In total 53 billion dollars in epidemic related damages were reported.

Comparison of lungs of a Wuhan patient who survived COVID-19 — image A-C — to those of a patient who suffered death from the illness — image D-F. Both image sets show the tell-tale ground glass like opacities of COVID-19 in lungs. Image source: Association of Radiologic Findings.

By late 2019, before the present pandemic, a sense of unease had appeared to settle upon the global health, threat analysis, and infectious disease response community. The Global Preparedness Monitoring Board (GPMB) convened a joint World Bank and WHO meeting during September. The meeting brought with it a kind of air of dread. At the time, various climate change related crises were raging around the world and the general sense was that the human system had become far more fragile in the face of an increasingly perturbed natural world. At the conference, members spoke uneasily about past major disease outbreaks like the 1918 influenza pandemic that killed 50 million people. About how we were vulnerable to that kind of potential outbreak in the present day.

“While disease has always been part of the human experience, a combination of global trends, including insecurity and extreme weather, has heightened the risk… The world is not prepared,” GPMB members warned. “For too long, we have allowed a cycle of panic and neglect when it comes to pandemics: we ramp up efforts when there is a serious threat, then quickly forget about them when the threat subsides. It is well past time to act.”

And they had reason to be uneasy, for even as global illnesses were on the rise in the larger setting of a world wracked by rising climate crisis, reactionary political forces in key nations such as the United States had rolled back disease monitoring and response capabilities. It basically amounted to a withdrawal from the field of battle against illness at a time when those particular threats were rising and multiplying. And the responding statements of increasingly loud concern coming from health experts and scientists, ignored or even muzzled by the brutally reactionary Trump Administration, would end up being devastatingly prophetic.

Live Animal Markets Again Suspect

“We do not know the exact source of the current outbreak of coronavirus disease 2019 (COVID-19). The first infections were linked to a live animal market, but the virus is now primarily spreading from person to person.” — CDC.

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If the story of how SARS first broke out in 2002-2003 is not fully understood, then we know even less today about how the second strain of SARS (SARS-CoV-2 or COVID-19) made its way into the human population. What we do know is that the disease is closely associated to a coronavirus found in bats, that the disease transferred from bats or animals ecologically associated with bats and the virus (such as pangolins or civets) to humans through some vector, and that live animal markets remain high on the suspect list.  According to recent scientific reports, an intermediate host such as a pangolin, a civet, a ferret, or some other animal like the ones sold in wet markets probably played a role. Chinese health experts also identified a seafood and wildlife market in Wuhan as the original source of the new illness in January.

Regardless of its zoonotic genesis, COVID-19 made its leap into the human population sometime during late November or early December of 2019 in Wuhan, China where it began to spread. At first the spread was relatively slow. Or it seemed slow, due to the fact that the initial source of the infection was small — possibly just one person. But viral spread operates on an exponentiation expansion function. And like its cousin SARS-CoV, COVID-19 was quite transmissible — generating about 2.2 persons infected for each additional new illness.

Wuhan Suffers First Outbreak

At the time, no-one really knew how rapidly the illness spread. Some early reports of the disease seemed to indicate that it was easy to contain. That it wasn’t very transmissible. These accounts would prove dramatically wrong in later weeks. But this early confusion  about the risk posed by COVID-19 did hint at its nasty, sneaky, back and forth nature. About how it lulled the unprepared and the overconfident into a sense of false security early on. It also would later show that slower responses to the illness in its ramp-up phase would prove devastating.

By December through mid-January, Wuhan was dealing with an uptick in pneumonia-like infections. Having experienced SARS illness before, the region was put on alert after getting days of indicators that all was not right. These response efforts have been criticized as slow. How it happened is also opaque. One reason is that China was rather close-lipped about the outbreak’s rise on its soil at first. But another reason (an arguably much greater one) for this lack of clarity is due to the fact that many U.S. disease monitors charged with providing reports about the infectious disease situation on the ground in China and various other countries were removed by the Trump Administration in the years and months leading up to the outbreak.

Despite not providing a clear early picture of the outbreak, China did start to rapidly and effectively respond during December and January. In December, researchers received samples of the disease which they identified as a new coronavirus infection — naming it SARS-CoV-2. Once samples were available, both China and the World Health Organization (WHO) swiftly and dutifully produced tests to detect the illness. As of late January of 2020, China had 5 tests for COVID-19. At the same time, WHO began deploying tests to countries and by February the global health agency had shipped easily produce-able tests to 57 countries. This early availability of testing capability provided by WHO would prove crucial to the effective infectious disease responses of many countries in the follow-on to China’s disease outbreak.

Viral Glass Like Nodules in Lungs

Back in Wuhan and in larger China, it was becoming apparent both how deadly and how transmissible the new SARS was. From mid January 23 through February 18 — over a mere 26 days — the number of reported cases rocketed from around a hundred to more than 75,000. About ten times the total cases of the first SARS outbreak in 2002-2003. This even as China shut down large regions of the country, putting the whole Wuhan region on lock-down, and setting up dedicated COVID-19 testing and treatment centers. Notably, the new SARS-CoV-2 had become not only a serious threat to China. It was now a significant threat to the globe — one unprecedented in the past 100 years. A threat on a scale that disease experts had warned of during late 2019. One that if it broke out fully was more than capable of mimicking the 1918 flu pandemic’s impact and death tally.

After rapid growth in COVID-19 cases in China, a strong national response has limited the first wave of outbreak in that highly populous country to just over 80,000. Image source: WorldoMeters.

The disease, which had first been seen by some as mild and easy to contain, had taken hold to great and grim effect. It produced direct and serious damage to people’s lungs. China’s dedicated mass testing centers quickly adapted to look for the tell-tale and devastating signature of COVID-19’s progress in the human body. A kind of viral glass like set of nodules that appeared plainly in scans of victims lungs.

As devastating as the disease was to individual bodies, it hit community bodies hard as well, producing mass casualties as about 15 percent of all people infected ended up in the hospital. A large number of these hospitalized cases required intensive care support (ICU) with ventilators and intubation to assist breathing. This put healthcare workers at great risk of infection themselves — because as with SARS — COVID-19 was not containable in the hospital setting without protective gear and masks (PPE). Early indications were that the lethality rate in China was around 2-3 percent or 20 to 30 times worse than the seasonal flu. Present closed reported case mortality for China now stands at 4 percent with 3,333 souls lost.

The progress of COVID-19 in an infected person was itself rather terrifying. Its ‘milder’ expression resulting in severe flu and pneumonia like symptoms with a number of other bodily responses to include serious spikes in blood pressure along with a manic variance in symptom severity. In hospital cases, victims often struggled to breathe to the point that they required oxygen. If the disease progressed, it produced serious inflammation — filling up lungs with fluid requiring support with machines for breathing. Late stage COVID-19 also attacked the body’s organs with inflammation, resulting in a need for multi-organ support in the worst cases.

Massive Outbreak of a Terrifying Illness

It was a nasty, terrible thing. It brought China to its knees — despite what ended up being a strong overall response by the country. At present, China is still recovering, still going slow with certain sectors of its economy despite limiting new cases to less than 100 per day.

The first outbreak in China was extraordinary in number of persons infected. So large as to be extremely difficult to contain through a well managed global response. But the response from key nations like the U.S. was not well managed. So through various contacts and travel vectors within the human system, this serious illness made its way out to the rest of the world. For the diligent contacts tracing and isolation, the early detection and response by international disease experts that had contained Ebola and the first SARS outbreak had been both hobbled and overwhelmed.

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