Are we ready for the next pandemic?

0
476

According to one estimate Earth may have about two million viruses. Virologists estimate that anywhere between six-eight lakhs of those could potentially infect the humans

Nandkumar M Kamat

The COVID-19 global infection tally will soon reach 30 million and the total deaths one million. There are signs that the pandemic will not be over till summer next year or April 2021. Many countries are expecting a third wave with the onset of winter soon. Some vaccines would be in the market by February- 2021 but mass vaccination won’t be possible till October-December 2021. Scientists are genuinely worried about another outbreak in the meantime.

Are we ready for the next pandemic within the next one-five years? This is the right question everyone involved in containing morbidity and mortality due to COVID-19 needs to ask.

A pandemic is a global calamity. It could be microbial or viral. A pandemic generally begins with a small local outbreak. When the outbreak is not contained then it becomes endemic. When the endemic goes out of control and spreads to larger areas then it becomes a
pandemic.

But to declare an endemic as a pandemic is not so easy. The present pandemic began as a cluster of pneumonia cases in Wuhan, Hubei province of China. But it was only on March 11, that the World Health Organisation (WHO) declared COVID-19 as a pandemic. WHO came under heavy criticism for this delay.

Last Monday, the WHO director general, Tedros Adhanom Ghebreyesus warned that the world must be better prepared for the next pandemic. He said at the WHO headquarters in Geneva that this will not be the last pandemic. He said: “History teaches us that outbreaks and pandemics are a fact of life. But when the next pandemic comes, the world must be ready – more ready than it was this time.”

How big is the challenge to predict the threat from the viruses? According to one estimate Earth may have about two million viruses. Virologists estimate that anywhere between six-eight lakhs of those could potentially infect the humans. But our present global knowledge of the infectious strains is limited to about 300 viruses. This means we don’t know anything about the rest of the 99 percent and more infectious viruses. This is a frightening scenario.

Countries like India are totally unequipped in the area of virological research. In April 2020, the ICMR team had reported the presence of bat coronavirus (BtCoV) — in two bat species from Kerala, Himachal Pradesh, Puducherry, and Tamil Nadu. These are not known to infect humans but nobody can say anything about the future when these bats come into contact with the humans and transmit the virus which then mutates and becomes infectious. Despite the huge diversity and population of bats in the country the research on coronaviruses is very limited. So the next outbreak could take place even from India without much warning.

Till 1957, nobody had heard of Kyasnur Forest Disease Virus- KFDV. It was detected and reported in 1957 from sick and dead monkeys in forests of Shimoga district, Karnataka. It spread to several south Indian states but none showed any interest in a joint co-ordinated study to find the origin and source of transmission to far flung places.  Fortunately, KFDV is not a respiratory virus like COVID-19 but no lessons were learned.

The present major global disease burden would give us an idea of what to anticipate. Here are the details of ten major diseases identified by WHO. The most dangerous air-borne viral disease is Ebola. In 2014, West Africa had 28,616 Ebola cases and 11,310 deaths. In DRC (Democratic Republic of Congo) there had been 3,481 cases and 2,299 deaths. DRC had the world’s second largest Ebola outbreak on record. Thanks to international efforts it was declared over on June 25, 2020.  In 2017, the Marburg virus disease created an outbreak in Uganda, where there were three cases, all of whom died. In 2005 the same disease in Angola resulted in over 200 infections with 90 percent fatalities.

Another dreaded outbreak was the Lassa fever which causes between 100,000 and 300,000 infections annually, with around 5,000 deaths. Then we have MERS-CoV (Middle East respiratory syndrome coronavirus) which was first identified in 2012 in Saudi Arabia. Since then sporadic outbreaks have caused 2,519 cases and 866 deaths.

Another disease-SARS (Severe Acute Respiratory Syndrome) virus caused 8,273 cases and 775 deaths from the end of 2002 to July 2003. Spread by the fruit bats the Nipah virus caused an outbreak in Kerala in 2018 resulting in 23 cases and 17 deaths.  The mosquito borne Zika outbreak in 2015 and 2016 saw 500,000 cases and 18 deaths, and 3,700 babies born with birth defects. The lesser known Crimean-Congo haemorrhagic fever first emerged in 2018 in Afghanistan, which had 483 cases and 59 deaths and cases are still growing. Then the Rift Valley fever outbreak in 2010 and 2011 in South Africa infected 250 people and caused 25 deaths.

Smallpox may be eradicated from Earth but the closely related monkeypox emerged in Nigeria. In the outbreak between 2017 and 2019, there were 300 cases of monkeypox, and about 18 people died. In the Congo region this is still causing infections.

We have seen how the Goa government had premature jubilation over ‘Green Zone”, after the central government declared both districts COVID-19 free on May 1 without having any systematic short term or long-term plan ahead to contain the COVID-19 spread. So, it may be premature and futile to ask the state government – are we ready for the next pandemic? Hopefully the state government would strengthen public health infrastructure.