Map of life expectancy at birth from Global Education Project.

Wednesday, February 05, 2020

The real cost, and longer term implications, of the Wuhan coronavirus

It's too soon to know for sure how the tale of the novel coronavirus will play out, but at this point we have a pretty good idea. A stipulation in both of the scenarios at the linked essay is that yeah, it gets loose into the wild and eventually can show up anywhere in the world. I think that's pretty much definitely going to happen if it hasn't already.

Scenario number 1, and most likely, in my view, it will just be one more virus that causes what amounts to a common cold and in a few people who are otherwise debilitated goes on to be complicated by pneumonia. In that case, for a year or two it will circulate as a novel virus to which no-one is immune and there will be a fairly high incidence -- although most people who are exposed will have no symptoms, or very mild symptoms. Then things will settle down and it will hardly be noticeable. One more common cold virus won't make a big difference, there are already dozens of them. Note that the most likely evolutionary trajectory for any endemic virus is that it becomes less virulent over time, because people who are lying on their couch all day aren't likely to transmit it.

Scenario number 2 is that it's a bit more virulent, like influenza, and also tends to recur seasonally. having one more influenza virus to contend with is definitely not better than a poke in the eye with a sharp stick, however since this class of virus, unlike influenza, has a very low mutation rate, it should be possible to make an effective vaccine that's good year after year, so that situation will be controllable.

Ergo, the main cost of this episode is going to be the economic cost of the quarantines and travel bans, which is already quite substantial, and which are unlikely to do any good in the long run.

That said, the last implication in the world I would want you to take away is that we should be complacent about emerging infections. In the battle between humanity and pathogens, we've won a few since we figured out what they actually are (viruses and micro-organisms, not miasma) and come up with antibiotics and vaccines. The eradication of smallpox was a major contributor to the dramatically increased life expectancies of the modern era and believe me, it's made our lives a whole lot happier. Smallpox was a major bummer. Poliomyelitis was actually an emerging infection of the mid-20th Century, but we have nearly eradicated that one and have indeed eradicated it in most of the world. Vaccines against measles, mumps, rubella and many other pathogens have made a huge difference in most of the world although those diseases have no been eradicated. (They could be.) And antibiotics not only have conquered the most common causes of early death, they have made all sorts of surgery possible that otherwise would be too dangerous.

But there are two items of bad news. The first is that as the recent emergence of three different fairly virulent coronaviruses in China shows, along with other novel infections such as HIV, Ebola and Zika, we're going to be confronting new pathogens regularly. Some of them we'll get a handle on relatively quickly, others we won't, but with such a huge, interconnected human population there will be more and more all the time. At some point the overall burden will grow faster than we can beat it back, and the possibility of a major catastrophe always lurks.

The second piece of bad news is that we are running out of antibiotics, as pathogens evolve to beat them. Given that the incentives to invest huge sums in new antibiotics just aren't there -- they are taken for a relatively brief course unlike highly profitable drugs that people take for years or a lifetime -- the bugs are getting ahead of us. That also creates the possibility of catastrophe.

So while I wouldn't lose any sleep over this particular episode, or at least not much, I would say that it draws attention to the big picture, which is one we should worry about.

I would also say that we need to limit the population the less painful way, by having fewer babies, rather than wait for it to happen the hard way. But that is going to be tough because it will mean an aging population with a smaller proportion of working age people. That discussion is for a bit later.

1 comment:

Don Quixote said...

When I see in videos or read in books that the world's human population is expected to "level out" at about 10 billion, I always wonder, "What will limit it?"

Now that I've read today's blog, I assume there's a way to calculate that that is probably the maximum number of people the Earth can support, and there will then be attrition either through illness or some other means. But I still wonder about this projection and the precise mechanisms that will limit/lower the population of Homo sapiens.