Why Weren’t We Ready for the Coronavirus? – The New Yorker

But, toward the end of his tenure with the C.D.C., as a high-level bureaucrat, he was responsible for orchestrating, not investigating; science was a small slice of the job. Now its almost all science, he said. Virology, epidemiology, ecology, and other aspects of disease science provide the substance of his mission, educating the next generation of public-health practitioners.

The eclectic dcor of his current office includes electron micrographs of various pathogens hung like portraits in a rogues gallery, two sculptures of mosquitoes as big as crows, a Star Wars clock, a Big Hero 6 toy robot, cards sent from children all over the world, mementos and gifts from his travelsa Congolese incense burner, the Saudi beheading swordand a whiteboard on which he records what he calls my metrics. His precious metrics: measures of progress toward academic goals for his school, scientific goals, philanthropic goals to support the work. Im evidence-based and evidence-driven, he said.

I asked Khan about COVID-19. What went so disastrously wrong? Where was the public-health preparedness that he had overseen at the C.D.C.? Why were most countriesand especially the U.S.so unready? Was it a lack of scientific information, or a lack of money?

This is about lack of imagination, he said.

There were warnings. One of them was Khans favorite disease, SARS. In late 2002, an atypical pneumonia of unknown origin began spreading in and near the city of Guangzhou, in southern Chinaone of the largest urban agglomerations on the planet. In January, 2003, in the body of a portly seafood merchant suffering a respiratory crisis, the virus reached a Guangzhou hospital. In that hospital, and then at a respiratory facility to which he was transferred, the man coughed, gasped, spewed, and sputtered during his intubation, infecting dozens of health-care workers. He became known among Guangzhou medical staff as the Poison King. In retrospect, disease scientists have applied a different label, calling him a super-spreader.

One infected physician, a nephrologist at the hospital, experienced flu-like symptoms but then, feeling better, took a three-hour bus ride to Hong Kong for his nephews wedding. Staying in Room911 of the Metropole Hotel, the doctor became sick again, spreading the disease along the ninth-floor corridor. In the days that followed, other guests on the ninth floor flew home to Singapore and Toronto, taking the disease with them. Several weeks later, the World Health Organization called it SARS. (The Metropole, having become notorious, was later renamed.) By March15th, the W.H.O. was reporting a hundred and fifty new SARS cases worldwide.

Two mysteries loomed, one urgent and one haunting: What was the causea new virus, and if so what kind?and from what sort of animal had it come? The first mystery was soon solved by a team led by Malik Peiris, a Sri Lankan doctor who got a degree in microbiology at Oxford before going to the University of Hong Kong. Peiris specialized in influenza, and he suspected that H5N1, a flu virus that is troublesome in birds and often lethal in people but not infectious person-to-person, might have evolved into a form transmissible among humans. His team managed to isolate a new virus from two patients. It was a coronavirus, not a flu bugthat is, it was from a different virus family, with different familial traits. But the mere presence of this new virus in two SARS patients did not mean that it was the cause of the disease. Then Peiriss team showed with antibody testing that it might indeed be the SARS agent, and further work proved that they were right. Although earlier tradition tended toward naming new viruses by geographical associationEbola was a river, Marburg a city in Germany, Nipah a Malaysian village, Hendra an Australian suburbgreater sensitivity about stigmatization prevailed. The pathogen became known as SARS-CoV. Recently, the name has been revised to SARS-CoV-1, so that the agent of COVID-19 can be called not Wuhan virus but SARS-CoV-2.

SARS reached Toronto on February23, 2003, carried by a seventy-eight-year-old woman, who, with her husband, had spent several nights of a two-week trip to Hong Kong on the ninth floor of the Metropole Hotel. The woman sickened, then died at home on March 5th, attended by family, including one of her sons, who soon showed symptoms himself. After a week of breathing difficulties, he went to an emergency room and there, without isolation, was given medication through a nebulizer, which turns liquid into mist, pushing it down a patients throat. It helps open up your airways, Khan told mea useful and safe tool to prevent,say, an asthma attack. But, with a highly infectious virus, unwise. When you breathe that back out, essentially youre taking all the virus in your lungs and youre breathing it back out into the airin the E.R. where youre being treated. Two other patients in the E.R. were infected, one of whom soon went to a coronary-care unit with a heart attack. There he eventually infected eight nurses, one doctor, three other patients, two clerks, his own wife, and two technicians, among others. You could call him a super-spreader. One E.R. visit led to a hundred and twenty-eight cases among people associated with the hospital. Seventeen of them died.

In Singapore, the first SARS case was a young woman who had also stayed at the Metropole, and had, on March 1st, sought help for fever, cough, and pneumonia at Tan Tock Seng Hospital, one of Singapores largest facilities. She had visitors, and, when several of them returned as patients, doctors suspected something contagious. Then four nurses from the young womans ward called in sick on one day, an abnormality noticed by Brenda Ang, a physician who was in charge of infection control at the hospital. That was the defining moment for me, Ang, a tiny, forthright woman, said, when I visited her at the hospital. Everything was accelerating. It was Thursday, March 12, 2003, the day that the W.H.O. issued a global alert about this atypical pneumonia.

At about that time, Ali Khan arrived in Singapore, serving as a W.H.O. consultant (seconded from the C.D.C.) to help organize an investigation and a response. He met daily with Suok-Kai Chew, the chief epidemiologist at the Ministry of Health, and along with others they developed strategy and tactics, getting governmental coperation through a SARS task force. The public-health strategy was isolation and quarantine. Before this outbreak, quarantine and isolation were not often evoked for infectious-disease outbreaks, Khan told meat least, not in the recent past. During the medieval plagues in Europe, infected unfortunates were sometimes sent outside city walls, to die or recover; the Mediterranean seaport Ragusa (now Dubrovnik) established a trentino, a thirty-day quarantine for travellers arriving from plague zones. In late-nineteenth- and early-twentieth-century America, during smallpox outbreaks, victims showing pox (especially if they were poor people or people of color) could be confined in quarantine camps, surrounded by high fences of barbed wire, or in nightmarish pesthousesnot so much to be treated but for the safety of the general populace. That was a concept that had sort of gone out of vogue, Khan told me dryly. He and Chew and their colleagues revived it in a more humane version.

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Why Weren't We Ready for the Coronavirus? - The New Yorker