FST BLOG

X marks the Pandemic

• 6 April 2020
• General
• Alana Cullen

Covid-19 first emerged as an infectious disease in late December 2019. By April 2020 it virtually has the entire world on lockdown. Perhaps the most interesting thing is, we knew it was coming.

In 2018 the World Health Organisation declared that they were on the lookout for Disease X. Part of their research and development blueprint, Disease X represented a “serious international epidemic... caused by a pathogen currently unknown to cause human disease”. Sound familiar? It was also predicted that this mysterious disease would emerge as a zoonotic infection (from an animal reservoir). Since all things appear in threes, the third, final and perhaps eeriest clue that associates Covid-19 with Disease X is that it was “estimated to be a respiratory virus similar to the flu” which could “reach all major global capitals within 60 days”.

It would appear someone over at the World Health Organisation had a crystal ball, because they just predicted the future, our present nightmare.

Less fortune telling, more a team of outstanding scientists whose role it is to seek research and development preparedness techniques early on, so that Disease X could be tackled swiftly, when it did eventually rear its head - this time, in the form of Covid-19.

So, epidemiologists knew of X’s imminent arrival, but nothing more than the why was known of the who, what, where, how and why classic detective story. This “invisible enemy” (a term coined by many governments in mounting a response against Covid-19) was shrouded in a cloak of mystery until it came knocking on our hospital steps.  

First let us reiterate what we already knew pre-outbreak of Disease X, the question of why had this pandemic arisen now? With an increase in global travel and goods transport, increasing herds of livestock that can act as a disease reservoir and climate change, pandemics are estimated to increase with a large one that will cause mass disruption on average every 13 years. New diseases are also easier to identify now with improved genome sequencing technologies. All these factors combined means that “no country is immune to an infectious disease” no matter the amount of biomodelling or government plans in place.

The plans in place for containment of disease worked as well as they could have against an unknown agent. The World Health Organisation has 160 countries who have completed their “Pandemic Preparedness Plan”, with there being two broad responses in place - a pharmaceutical route and a non- pharmaceutical route. Richer countries fall into the former, being declared to have a “gold standard” pandemic plan, whereas lower economically developed countries fall into the latter. These plans have proven successful during other potential pandemics such as Ebola, Middle East Respiratory Syndrome and most relevant to the UK, the 2009 Swine Flu epidemic. The UK had a policy success with this epidemic as the mortality was far lower than the projected figures. The National Health Service was going to reach full capacity and be stretched no matter how much planning was done. How can you truly prepare for a worst-case scenario against a virus you know little about?

A story reversed; we knew our villains’ ‘motive’, why they would appear way before we knew any other details. Let us work our way back through what we know now to fill the chapters.

Scientists have identified what the disease is. Covid- 19 is a strain of virus from the family of coronavirus. Other coronaviruses include Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome; some coronaviruses even cause the common cold. The question of how it causes disease has been answered through deciphering its structure. SARS- CoV-2 virus particles are spherical and have proteins (spikes) on their surface. After being transmitted through droplet infection and inhaled into the lungs, these spikey proteins attach to human cells, fuse with the cell membrane and then the viral genes enter the host cell and replicate. It is the replication of viral particles in the airways that causes the coughing and respiratory symptoms. The question of where Covid-19 originated is in Wuhan, China. Although the exact animal source is not yet identified, it is presumed to come from a live animal market in the city.

The question of who is changing every day. Originally thought to only be a severe threat to ‘vulnerable’ people - those over the age of 65, immunosuppressed, pregnant, or with a pre-existing health condition. Yet we are seeing increasing news stories that the virus shows no mercy. In one case it has caused the death of a perfectly healthy 21 year old in the UK. This demonstrates that we cannot treat this as a trivial infection, and that it is a collective effort to stay indoors to help prevent its spread and preventable deaths. It is also important to recognise the impact that Covid-19 has on our mental health, a discussion about guarding mental health during the pandemic can be found here. 

The story does not end there. The cases continue to rise, and lockdown has become the new norm. And we can be sure of more twists and turns in the plot ahead.

Luckily, the identification of Disease X as an unknown pathogen which we always keep an eye out for, means that provisions to intercept through the appropriate health care interventions are already in place. Look at the race for a vaccine against Covid- 19. Within 14 days of getting the genome sequence from China, Imperial College London developed a candidate vaccine, with reports that we could have one on the market by early 2021. Another 35 institutions are also testing potential vaccine candidates with a similar timeline. This is an unprecedented speed for vaccine development, usually it takes 5- 10 years for anything to be certified as a viable vaccine. Thanks to these scientific advancements, there is a light at the end of the long tunnel.

Although we can collectively ‘fight’ Disease X this time, we must use this historic event as our waking call.

Disease X is not a one off, this pandemic is not a singular event we will all recall 50 years down the line. With increased globalisation, intense agricultural practices and humans encroaching further and further onto animal habitats, this is only the first book in a long Disease X series. Now is the time to reflect and revaluate our practices and build stronger health systems worldwide. This will help to combat the emergence of future Disease Xs at source of the outbreak. Let us not forget the ramifications that our first encounter with Disease X has had on the world, because it is sure not to be the last.

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