An American friend, long employed in China, sent his family home – and soon thereafter followed. His taciturn assessment, “no idea where this is headed.” The “novel” coronavirus is stirring fears of a global pandemic, headlines declaring it “more deadly” than SARS, the 2002-2003 “Severe Acute Respiratory Syndrome” outbreak. Perspective may be overdue.
Perspective is the first casualty in health crises, and reaction to the spreading coronavirus is no exception. Needed is an objective understanding of “first-order” concerns – numbers afflicted, mortality, and effectiveness of containment – but also likely “second” and “third-order” events.
For starters, headlines are largely accurate – as far as they go. China has undoubtedly underreported cases, as well as mortality.
This is a product of Chinese habits, fears, Communist control over information, an ingrained default to misinformation, and medical uncertainty on the virus.
Similarly, the headline that coronavirus has now killed “more people than SARS” is accurate – but misleading. As of January 9, an estimated 37,198 coronavirus cases produced 811 deaths, a fatality rate of 2.1 percent.
The SARS pandemic killed 774, so “more have died” from coronavirus – but that is out of context.
Between late 2002 and mid-2003, “6,903 SARS cases” were reported in “29 countries, including the United States.” Those cases resulted in “495 deaths,” a fatality proportion of 7.2 percent. That was the start.
Eventually, 8,098 total SARs cases resulted in 774 deaths in 17 countries, reflecting a 9.6 percent fatality rate. But perspective on “first-order” concerns is key. While transmission of coronavirus is common in China, symptoms are mostly mild.
Containment efforts, including travel restrictions inside China and suspension of international air travel, have been unprecedented.
In context, the likely spread of the coronavirus, symptoms, mortality, and projected health impact seems to be on a different order from SARS – or MERS – viruses. This is not to say the virus is not dangerous, but to put numbers behind headlines. Moreover, February 9 reports show the first drop in new infections since February 1, and most are at the “epicenter” of Hubei province.
By comparison, other well-known viruses produce mortality rates, some more significant than recognized. Common flu is estimated by the Centers for Disease Control (CDC) – through February 1, 2020 – to have affected between 22 and 31 million Americans, produced up to 15 million medical visits, and 370,000 hospitalizations, with between 12 and 30 thousand deaths. Point: Perspective, even on “first-order” outcomes – cases and deaths – is always important.
Notably, few observers are yet discussing “second” and “third-order” effects of the coronavirus, initial and prolonged reactions to it, which may be more lasting than relatively low mortality.
First, this virus – although less fatal – has triggered more global reaction, from urban containment, evacuation and military base quarantines to suspension of trade and travel, than most prior health scares.
Ironically, if this global reaction – fanned by the media – proves to have been an overreaction, global health and policy leaders could learn a poor lesson. They could do a retrospective, or lessons learned analysis, and conclude that this was an overreaction.
That could, in turn, reduce preparedness and reaction protocol for the next deadly virus. In short, conditioning global leaders to fear all viruses equally may create a tendency not to distinguish the relatively mild from the swift and deadly coronavirus from Spanish Influenza.
Second, international reaction to coronavirus will have a measurable impact on the global economy, radiating outward from China to layers of trading partners. The extended economic ripple may prove to have been an overreaction. Even if not, it may endure, not easily reversed.
China is more integrated into the global economy than during SARS, in 2002-03. The result is, while precautions are necessary, the economic impact of a screeching halt in trade with China may produce near-term and longer, hard-to-reverse effects – at least across 2020. Until confidence is high that the coronavirus is moribund, trade restoration will be slow. How this will affect trading partners of trading partners of trading partners with China remains to be seen.
Third, the long-term effect of deliberate underreporting by China – will elevate mistrust of China across a wide range of issues beyond the virus. While many knew Communist China was untrustworthy, recent events underscore the point.
Societies that hide lie and distort do not limit that practice to one sector.
Long term, this will underscore systemic fears, suspicions, and doubts about China, reinforcing general distrust. Reduced global confidence in China may alter multilateral and bilateral relationships. In the midterm, this may affect thinking in Hong Kong, and tied to China’s “belt and road” initiative. It may also reinforce doubts about China’s 5-G ambitions.
Finally, inside China, reduced faith in public reporting, institutions, transparency, and basic government concern for people may undermine the Communist government’s legitimacy. While totalitarian control suggests popular reactions will be suppressed, along with information, long-term impacts of reduced legitimacy are hard to gauge. When government actions lead to panic, reduced economic wellbeing, adverse health impacts, people begin to care.
Net-net, the coronavirus is not over, not to be taken lightly and represents a near-term concern. That said, perspective is essential – and that comes with a dispassionate review of numbers. Moreover, second and third-order effects of this virus and how governments responded – perhaps overreacting globally and underreacting within China – could prove enduring.