Today, the number of confirmed cases in Europe is more than four times as high as in China. It wasn’t an inevitable scenario. It is the result of complacency, inadequate preparedness and missed opportunities.
Today, the epicenter of the novel coronavirus outbreaks is in the United States and Europe. In effect, more than half of all cases worldwide are in Europe.
Furthermore, Europe has over four times more cases than China.
How did this happen? How could it happen?
The first missed opportunity
At the end of January, the World Health Organization (WHO) declared the ongoing virus outbreak a “public health emergency of international concern.” The WHO was concerned about the possible effects of the virus, if it would spread to countries with weaker healthcare systems.
On February 4, WHO chief Dr. Tedros dropped a news bomb by stating publicly that it was the countries outside China that had been slow in sharing information about cases. After a month of international crisis and a global alert, a stunning three of five member countries had failed to provide adequate case information to WHO. Those reports were vital to assess the international scope of the outbreak and to contain it.
Instead of mobilization, major European economies followed the virus crisis as if it was a “Chinese problem.”
The complacency was compounded by the concurrent media coverage, which was often sensational and misguided contributing to the “infodemic.” Still worse, instead of preparing against the virus, public debate began an odd battle against the WHO, its chief and some of his right-hand executives thereby compounding the inadequate preparedness (see my “The Strange War with WHO’s Battle Against COVID-19”, The World Financial Review, Feb 14, 2020).
As the timeline suggests, it was this missed first month that led to the confirmed cases soaring outside China after February 4 (Figure).
Yet, the writing was on the wall. In China, a “mystery pneumonia” of unknown etiology was first identified in Wuhan by the end of December. At the onset of January, the WHO had been informed about the new virus. And by January 10, scientists in China sequenced the virus’s genome and made it available. With SARS this work had taken months; now only a month.
After mid-January, Beijing initiated the draconian measures to contain the virus and the story was all over in international headlines.
In the United States, the first coronavirus case was identified on January 20. In Europe, the first cases were detected just days later, on January 24, in Bordeaux and Paris, along with a cluster of infections that was discovered in Haute-Savoie. In Germany, the first case was confirmed on January 27; in Italy, four days later; in Spain and the UK, on January 31.
And yet, thereafter, weeks of mobilization were missed as major European countries hoped for the best but didn’t prepare for the worst. That odd state of waiting prevailed until a dramatic escalation ensued in Italy on February 21, when a cluster of cases was confirmed cases in Lombardy, followed by another acceleration in Spain just three days later.
That’s how Inadequate preparedness ensured the virus a free ride, which resulted in an explosion of local transmissions in late February. By then, Italy had few alternatives but to adopt the Chinese strategy of shutting down cities and banning social activities, strictly isolating infected people. Only weeks before, many European leaders had criticized such measures as “autocratic” and “counter-productive.” Now they rushed to adopt them.
At the turn of April, confirmed cases worldwide exceeded 650,000, while those in Italy were approaching 100,000; in Spain, 75,000; Germany, 55,000; France, 40,000; and the UK 20,000. Combined, these five European countries alone had more than twice as many cases as the U.S.
Here’s the inconvenient truth about the first missed opportunity: When Dr Tedros delivered his news bomb on February 4, there were only 25 confirmed cases in Europe. When serious mobilization began around mid-March, the number of those cases had exploded more than 1000-fold to 28,000 in the five major European economies, while the total had soared to about 35,000. Today, at the start of April, those cases have increased 10-fold in major European economies and the region as a whole – in the former case, to 270,000 and in the latter, to some 360,000.
Worse, another missed opportunity may loom ahead.
Toward a second missed opportunity?
As mobilization began belatedly, some European leaders tried to frame inadequate preparedness as a foresighted strategy. In the UK, Prime Minister Boris Johnson stated that “we can turn the tide within the next 12 weeks.” In mid-March, he added that schools would stay open. He advised people with symptoms to stay at home for a week and advised seniors over the age of 70 to avoid certain activities.
Relying on the advice of some epidemiologists, Johnson began to advocate “herd immunity” as the new strategy. Basically, the idea is that, within a certain group of people, the circulation of diseases can be stopped after enough are infected and gain immunity. If, say, two thirds of people in a group have immunity, the number of people a sick person can infect will plunge below one. And that will bring the disease under control.
The idea is presented as a “realistic” solution. Since tight control and isolation strategies may not work anymore, the virus is already spread all around the world.
It is not a new idea, however. It was first deployed in the 1920s and recognized as a recurring phenomenon in the 1930s when, after a significant number of children had become immune to measles, new infections temporarily decreased. Subsequently, mass vaccination to induce herd immunity became common.
Unfortunately, in the coronavirus crisis, the idea of the herd immunity may imply the kind of medication that has potential to worsen the crisis. After all, there is no vaccine yet and it may take a year or longer to develop. So, if resignation is disguised as a strategy, it is likely to condemn major risk groups – the elderly, those with chronic pulmonary conditions, hypertension, diabetes and asthma patients, and those without adequate access to affordable health care – into a premature death.
Worse, whatever happens in Europe will not stay in region. In a global, inter-connected economy, all countries are linked. And with pandemics, the weakest links determine the future of the whole, through flows of world trade, investment and particularly migration and tourism.
If major European countries opt for the herd immunity scenario, it would be naïve to expect the virus to disappear by early summer (that’s the current expectation). It could easily last into the fall and well into 2021. As a result, human costs would soar, while economic devastation would spread deeper and broader.
In that scenario, herd immunity would signal a second missed opportunity.
This is the first part of the commentary that was released by The European Financial Review on March 31, 2020