Nine months ago, a global enterprise I work with used its substantial resources to simulate the widespread outbreak of an infectious illness. Using our knowledge and experience, as well as publicly available research, we modeled a fictional disease whose behavior turned out to be eerily similar to that of COVID-19.
I’m pleased to say that when the coronavirus pandemic struck, that enterprise was far better prepared than most, as it had established policies around notifying employees, working from home and more. What’s not at all pleasing, however, is how few businesses, nations and other entities were similarly prepared.
Along with my medical colleagues, security experts and the intelligence community, I’ve been concerned about a COVID-19-style pandemic for the better part of a decade. Unfortunately, the coronavirus will not be the last of its ilk. With the world focused on infectious disease, now is the time to raise awareness of (and prepare for) what’s to come, notably the following:
Multi-drug resistant tuberculosis (MDR-TB). Like drug-susceptible TB, drug-resistant forms of the bacterial disease are spread through the air. Person A, already infected, coughs, sneezes or speaks, infecting Person B. Because many anti-TB drugs have long been in widespread use, the global population is inevitably developing immunities to them. The result: MDR-TB, which, as its name implies, does not respond to the most common anti-TB drugs. Even worse is extensively drug resistant TB (XDR-TB), which puts up a fight against additional drugs. According to the World Health Organization (WHO), only 55% of MDR-TB patients and 34% of XDR-TB patients are treated successfully. I fear that mismanagement of TB cases will continue to allow these drug-resistant variants of the disease to propagate. The impact will be disproportionately felt in disadvantaged communities (as is happening today with COVID-19 in the U.S.) and developing nations in which there are significant gaps in quality healthcare. There is some good news on the preparedness front: Both the WHO and the Centers for Disease Control and Prevention (CDC) have robust anti-MDR-TB strategic plans in place. But having a strategy and executing one are two very different things.
Malaria has been a killer of millions in subtropical and tropical climates for centuries. The common strains of this disease have shown a great propensity to become resistant to anti-malarial medications, resulting in a constant battle between effective treatment and resistance. Added to this is the recent development of another malaria strain (Plasmodium knowlesi) that has jumped from macaque monkeys to humans via mosquitoes, originating in Southeast Asia. This, of course, makes P. knowlesia zoonotic disease. Zoonotic diseases are caused by bacteria, viruses, fungi or parasites that spread from animals to humans, and they have become more common in recent years. Ebola, bird flu, H1N1, MERS, SARS and now the current coronavirus SARS-CoV-2 (COVID-19) are all examples. COVID-19’s presumed origins in China’s “wet markets” has alerted the world to the dangers posed by this type of infection. As the world’s population grows and trends toward urbanization, and as climate change compels animal species to migrate or lose their habitat, humankind will surely interact with animals in new, often unhealthy, ways.
New forms of the flu. Before the coronavirus spread widely in the U.S., many sought to downplay its risks by noting the effects of seasonal flu. While such comparisons now appear to be an underestimation of this coronavirus impact, it is absolutely worth noting that in 2018-2019, more than 34,000 Americans died of the flu (according to the CDC), and that the figure topped 61,000 the year before. Globally, by the WHO’s estimate, up to 650,000 people die every year of the flu. (As you read this, more than 100,000 people have died of the coronavirus, with the number rising each day.) And that’s merely the seasonal flu, for which the medical and scientific communities do have a strategy with vaccination, especially in developed nations. What truly worries me is the next pandemic flu, like H1N1 (swine flu), the 2009 novel influenza, first detected in the U.S., that the CDC believes killed as many as 575,000 worldwide.
Vigilance: The Rx For the Next Pandemic
If the death toll from the swine flu, just over a decade ago, surprises you, you’re not alone — and that’s my point. More than ever, we live in the world of the now. COVID-19 is the only story in the news, and I hear and read universal agreement that once we get a handle on this crisis (and we will), everything will be different. The world will have changed. Lessons will have been learned.
I hope that’s true, but I’ve seen the opposite too many times. The crisis passes. Urgency fades. A fresh emergency arises. Resources that once seemed essential are redistributed.
I hope and pray that’s not the case this time. Let the coronavirus be the wakeup call that compels us to prepare for, while also striving to prevent, the next pandemic.
This blog is part of our special report on the future of infectious disease. Stay tuned for more blogs on this topic.