A coronavirus.
A new deadlycoronavirus2019-nCoV, related toSARSandMERSand apparently originating in live animal markets in Wuhan, China, is starting to spread worldwide.
Chinese authorities havereported5974 cases nationwide, 1000 of them severe. With infections in nearly every province, authoritieswarned2019-nCoV appears to be spreading fast out of its epicenter.
The characterization appears supported byinitial modeling.
The virussbasic reproduction number, a measure of the number of new cases per infection given no cap on available susceptibles, is clocking in at a healthy 3.11. That means in the face of such momentum, a control campaign must stop up to 75% of new infections to reverse the outbreak. The modeling team estimates there are presently over 21,000 cases, reported or not, in Wuhan alone.
Full-genome sequences of the virus meanwhileshowfew differences between the samples isolated across China. Slower spread for such a fast-evolvingRNA viruswould be marked by mutations accumulating place-to-place.
The coronavirus is starting to open up theaters overseas. Travelers with 2019-nCoV havebeen treatedin Australia, France, Hong Kong, Japan, Malaysia, Nepal, Vietnam, Singapore, South Korea, Taiwan, Thailand, and the United States. Local outbreaks are nowstarting upwithin sink countries.
As the infection is characterized by human-to-human transmission and an apparent two-week incubation period before the sickness hits, the infection will likely continue to spread across the globe. Whether itll be Wuhan everywhere remains an open question.
The viruss finalpenetranceworldwide will depend on the difference between the rate of infection and the rate of removing infections by recovery or death. If the infection rate far exceeds removal, then the total population infected may approach the whole of humanity. That outcome, however, would likely be marked by large geographic variation brought about by a combination of dead chance and the differences in how countries responded to their outbreak.
Pandemic skeptics arent so sure of such a scenario.Far fewerpatients have been infected and killed by 2019-nCoV than even the typical seasonal influenza. But the mistake here is in confusing a moment early in an outbreak for a viruss essentialist nature.
Outbreaks are dynamic. Yes, some burn out, including, maybe, 2019-nCoV. It takes the right evolutionary draw and a little luck to beat out chance extirpation. Sometimes enough hosts dont line up to keep transmission going. Other outbreaks explode. Those that make it on the world stage can be game changers, even if they eventually die out. They upend the everyday routines of even a world already intumultor atwar.
The deadliness of any potential pandemic strain is the meat of the matter, of course.
Should the virus prove less infectious or deadly than initially thought, civilization goes on, however many people are killed. The H1N1 (2009) influenza outbreak that worried so many a decade-plus ago proved less virulent than it first seemed. But even that strain penetrated the global population, and quietly killed patients, at magnitudes far beyond these first follow-up dismissals. H1N1 (2009)killedas many as 579,000 people its first year, producing complications in fifteen times more cases than initially projected from lab tests alone.
The danger here is found in humanitysunprecedented connectivity. H1N1 (2009) crossed the Pacific Ocean in nine days, superseding predictions by the most sophisticated models of the global travel network by months. Airline data show atenfoldincrease in travel in China just since the SARS epidemic.
Under such widespread percolation, low mortality for a large number of infections can still cause a large number of deaths. If four billion people are infected at a mortality rate of only 2%, a death rate less than half that of the 1918 influenza pandemic, eighty million people are killed. And unlike for seasonal influenza, we have neitherherd immunity, nor a vaccine to slow it down. Even speeded-up development will at best takethree monthsto produce a vaccine for 2019-nCoV, assuming it even works. Scientists successfully produced a vaccine for the H5N2 avian influenza onlyafterthe U.S. outbreak ended.
A critical epidemiological parameter will be the relationship between infectivity and when those infected express symptoms. SARS and MERSprovedinfectious only upon symptoms. If this bears out for 2019-nCoV, we may be in relatively good shape, all things considered. Even without a vaccine or tailored antivirals, we can immediately quarantine the suddenly sick, breaking chains of transmission with nineteenth-century public health.
Sunday, however, Chinas health minister Ma Xiaoweistunnedthe world announcing that 2019-nCoV had expressed infectivitybeforesymptoms. Its such a turnabout that infuriated U.S. epidemiologists are demanding access to the data showing the new infectivity. The shock implies researchers stateside expect the virus couldnt possibly be able to evolve outside what they appear to imagine as some public health archetype. If the new infection life history holds true, health authorities arent going to be able to use symptoms to identify newly active cases.
These unknownsthe exact source, infectivity, penetrance, and possible treatmentstogether explain why epidemiologists and public health officials are worried about 2019-nCoV. Unlike the seasonal influenzas cited by pandemic skeptics, the uncertainty rattles practitioners.
It is the nature of the job, to worry, yes. Worry is built into the very probabilities and systemic errors embodied more broadly in the trade. The damage in failing to prepare for an outbreak that proves deadlyfar exceedsthat from the embarrassment of preparing for an outbreak that fails to live up to the hype. But in an era celebrating austerity, few jurisdictions wish to pay for a disaster that is no guarantee, whatever the collateral benefits of precaution or, on the other end of outcomes, the devastating losses associated with a bad gamble.
The choice how to respond is often entirely out of epidemiologist hands anyway. The national authorities who will make these decisions juggle multiple and often contrary agendas. Stopping even a deadly outbreak isnt always treated as the most important objective.
While authorities stumble about figuring out what to do, the scale of impact can suddenlyengagein escape velocity. As 2019-nCoV itself demonstrated moving from a single food market to the world stage in a month, the numbers can ramp up so far and fast that an epidemiologists best effort, theirraison dtre, is dealt a lethal blow by facts on the ground.
My own visceral reactions this disease round have skipped across worry, disappointment, and impatience.
Im an evolutionary biologist and public health phylogeographer who has worked on various aspects of these new pandemics for twenty-five years, much of my adult life. As Ivewrittenelsewhere, with the help of many others, I have tried parlaying a growing understanding of these pathogens, from thegenetic sequencesof my initial studies up through economic geographies of land use, the political economy of global agriculture, and the epistemology of science.
Clarity can sour a soul. As my social media chimed with queries about 2019-nCoV, my immediate response bordered on pique and exhaustion. What, pray, do you wish me to say? What do you want me to do about this?
In dispensing advice personal and professional to legitimately worried friends and colleagues, I made some wrong calls. To one farmer friends query about traveling abroad, I advised a surgeons mask, washing hands before all meals, and stop fucking livestock, bro. Darkly ribald humor gets me through stress, but his earnest reply, Stop fucking livestock? showed I had missed my mark. Not a good look on my part at all. I apologized. He laughed about it later.
Its an occupational hazard. There is the danger of an existential dread that arises from the political inertia epidemiologists must square off with in preparing the world for a nigh-on irresistible pandemic their constituencies pretend is no bother until its too late.
If 2019-nCoV is indeed the Big Bug, and it is not clear yet if thats the case, there is almost nothing to be done at this point. All we can do is batten down the public health hatches and hope the virus kills only a small part of the worlds population instead of 90%.
Clearly humanity shouldntstartreacting to a pandemic when its already underway. Its a total dereliction of any notion of forward-thinking theory or practice. And leaders and their learned supporters worldwide identify themselves asPrometheans!
As Iwroteseven years ago:
I expect it will be a long time before I address an outbreak of human influenza again other than in passing. While an understandable visceral reaction, getting worried at this point in the process is a bit bass-ackwards. The bug, whatever its point of origin, has long left the barn, quite literally.
This century weve already trainspotted novel strains of African swine fever,Campylobacter,Cryptosporidium,Cyclospora, Ebola, E. coli O157:H7, foot-and-mouth disease, hepatitis E,Listeria, Nipah virus, Q fever,Salmonella,Vibrio,Yersinia, Zika, and a variety of novel inuenza A variants, including H1N1 (2009), H1N2v, H3N2v, H5N1, H5N2, H5Nx, H6N1, H7N1, H7N3, H7N7,H7N9, and H9N2.
And near-nothingrealwas done about any of them. Authorities spent a sigh of relief upon eachs reversal and immediately took the next roll of the epidemiological dice, risking snake eyes of maximum virulence and transmissibility.
That approach suffers more than a failure of foresight or nerve. However necessary, emergency interventions cleaning up each of these messes can make mattersworse.
You see, sources of intervention compete. And, as my colleagues and I argue, emergency criteria are deployed as impositions inGramscian hegemonyto keep us from talking about structural interventions around power and production. Because, dont you know, were warned,ITSANEMERGENCYRIGHTNOW!
Atop this game of keep away, the failure to address structural problems can render these very emergency interventions ineffectual. TheAllee thresholdthat prophylaxes and quarantine aim to push pathogen populations belowso that infections may burn out on their own unable to find new susceptiblesissetby structural causes.
As our teamwroteabout the Ebola outbreak in West Africa:
Commoditizing the forest may have lowered the regions ecosystemic threshold to such a point that no emergency intervention can drive the Ebola outbreak low enough to burn out. Novel spillovers suddenly express larger forces of infection. On the other end of the epicurve, a mature outbreak continues to circulate, with the potential to intermittently rebound.
In short, neoliberalisms structural shifts are no mere background on which the emergency of Ebola takes place. The shiftsarethe emergency as much as the virus itself Deforestation and intensive agriculture may strip out traditional agroforestrys stochastic friction, which typically keeps the virus from lining up enough transmission.
Despite now with both an effectivevaccineandantivirals, Ebola is presently undergoing its longest recorded outbreak in the Democratic Republic of Congo. What got lost along the way? Where is our biomedical God now? Blaming the Congolese to cover up this failure is an exercise incolonial displacement, washing imperialisms hands of decades of structural adjustment and regime change in the global Norths favor.
Saying theres nothing we can do isnt quite right either, however, even as the complaint about reacting only upon a new diseases attack still stands.
Within any one locale, thereisa left program for an outbreak, including organizing neighborhood brigades in mutual aid, demanding any vaccine and antivirals developed be made available at no cost to everyone here and abroad, pirating antivirals and medical supplies, and securing unemployment and healthcare coverage as the economy tanks during the outbreak.
But that way of thinking and organizing, an integral part of thelefts legacy, appears to have left the building for more performative (and discursive) configurations online.
The reactionary bent to disease control left and right has since pivoted me to assisting efforts at anti-capitalist agricultures and conservation. Lets stop the outbreaks we cant handle from emerging in the first place. At this point in my career, with the structural pacing the emergencies, I generally write about infectious diseases in only tangential terms.
Structural causes of disease are themselves a source of debate. For one, questions remain as to 2019-nCoVs origins.
Muchinitial attentionhas been placed on a particular exotic food market in Wuhan, with an orientalist preoccupation with strange and unsavory diets, representing both the end of biodiversity the West itself is destroying and a revolting source of dangerous disease:
The typical market in China has fruits and vegetables, butchered beef, pork and lamb, whole plucked chickens with heads and beaks attached and live crabs and fish, spewing water out of churning tanks. Some sell more unusual fare, including live snakes, turtles and cicadas, guinea pigs, bamboo rats, badgers, hedgehogs, otters, palm civets, even wolf cubs.
Said snakes are brandished as both signifier and signified, aliteral sourceof 2019-nCoV that also harkens to a paradise lost and original sin from a serpents maw.
There is epidemiological evidence in the hypothesiss favor. Thirty-three of 585 samples at the Wuhan market werefoundpositive for 2019-nCoV, with 31 at the west end of the market where wildlife trading was concentrated.
On the other hand, only 41% of these positive samples werefoundin market streets where the wildlife were housed. A quarter of the original infecteesnever visitedthe Wuhan market or appeared directly exposed. The earliest case wasidentifiedbefore the market was hit. Other infected marketers trafficked in hog alone, a livestock species that expresses a common vulnerable molecular receptor, leading one team tohypothesizehog as the putative source for the new coronavirus.
AtopAfrican swine fever, which has killed as many ashalfof Chinas hog this past year, the latter possibility would represent quite the clusterfuck. Such disease convergences are not unheard of, even folding into an intimatereciprocal activation, wherein proteins of each pathogen catalyze each other, facilitating new clinical courses and transmission dynamics for both diseases.
At the same time, Western Sinophobiadoesnt absolveChinese public health. Certainly the anger and disappointment the Chinese public hasdirected atlocal and federal authorities for their slow reaction to 2019-nCoV cant be spun as weaponized xenophobia. And in our wise efforts to keep our foot out of that trap, we may also be missing a critical agroecological symmetry.
Setting aside the culture war,wet marketsandexotic foodarestaples in China, as is now industrial production, juxtaposed alongside each othersince economic liberalizationpost-Mao. Indeed, the two food modes may be integrated by way of land use.
Expanding industrial productionmay push increasingly capitalized wild foodsdeeperinto the last of the primary landscape,dredging outa wider variety of potentially protopandemic pathogens. Peri-urban loops of growing extent and population density mayincreasethe interface (and spillover) between wild nonhuman populations and newly urbanized rurality.
Worldwide, even the wildest subsistence species are being roped into ag value chains: among themostriches,porcupine,crocodiles,fruit bats, and thepalm civet, whose partially digested berries now supply the worlds most expensive coffee bean. Some wild species are making it onto forks before they are even scientifically identified, including one new short-nosed dogfishfoundin a Taiwanese market.
All are increasingly treated as food commodities. As nature is stripped place-by-place, species-by-species, whats left overbecomesthat much more valuable.
Weberian anthropologist Lyle Fearnleypointed outthat farmers in China repeatedly manipulate the distinction between wildness and domesticity as an economic signifier, producing new meanings and values attached to their animals, including in response to the very epidemiological alerts issued around their trade. A Marxist mightpush backthat these signifiers emerge out of a context that extends well beyond smallholder control and out onto global circuits of capital.
So while the distinction between factory farms and wet markets isnt unimportant, we may miss their similarities (and dialectical relationships).
The distinctions bleed together by a number of other mechanisms. Many a smallholder worldwide, including inChina, is in actuality acontractor, growing out day-old poultry, for instance, for industrial processing. So on a contractors smallholding along the forest edge, a food animal may catch a pathogen before being shipped back to a processing plant on the outer ring of a major city.
Spreading factory farms meanwhile may force increasingly corporatized wild foods companies to trawl deeper into the forest, increasing the likelihood of picking up a new pathogen, while reducing the kind of environmental complexity with which the forest disrupts transmission chains.
Capital weaponizes the resulting disease investigations.Blaming smallholdersis now a standard agribusiness crisis management practice, but clearly diseases are a matter ofsystemsof productionover time and space and mode, notjustspecific actors between whom we can juggle blame.
As a class, the coronaviruses appear to straddle these distinctions. While SARS and 2019-nCoV appeared to have emerged out of wet marketspossible pigs asideMERS, the other deadly coronavirus, emerged straight out of anindustrializing camel sectorin the Middle East. Its a path to virulence largely left out of broader scientific discussion about these viruses.
It should change how we think about them. I would recommend we err on the side of viewingdisease causalityand intervention beyond the biomedical or even ecohealth object and out into the field of ecosocial relationships.
Other ethoses see a different way out. Some researchersrecommendwe genetically engineer poultry and livestock to be resistant to these diseases. They leave out whether that would still allow these strains to circulate among what would now be asymptomatic food animals before spilling over into decidedly unengineered humans.
Again turning back the clock, a source of my pique, nine years ago Iwroteabout what efforts at genetically engineering out pathogens miss as matters of first principle:
Beyond the issue of the affordability of the new frankenchicken, especially for the poorest countries, influenzas success arises in part from its capacity to outwit and outlast such silver bullets. Hypotheses tied to a lucrative model of biology are routinely mistaken for expectations about material reality, expectations are mistaken for projections, and projections for predictions.
One source of vexation is the dimensionality of the problem. There is even among mainstream scholars a dawning realization influenza is more than mere virion or infection; that it respects little of disciplinary boundaries (and business plans) in both their form and content. Pathogens regularly use processes accumulating at one level of biocultural organization to solve problems they face at other levels, including the molecular.Agribusiness ever turns us toward a techno-utopian future to keep us in a past bounded by capitalist relations. We are spun round and round the very commodity tracks selecting for new diseases in the first place.
The secret thrill (and open terror) epidemiologists feel in an outbreak is nothing more than defeat disguised as heroism.
Almost the entirety of the profession is presently organized around post-hoc duties, much like a stable boy with a shovel following behind the elephants at a circus. Under the neoliberal program, epidemiologists and public health units are funded toclean upthe systems mess, while rationalizing even the worst practices that lead to many a deadly pandemics emergence.
In acommentaryon the new coronavirus, one Simon Reid, a professor of communicable disease control at the University of Queensland, instantiates the resulting incoherence.
Reid pings from topic to topic, failing to weave a whole out of his technicist observations. Such folly isnt necessarily a matter of incompetence or malicious intent upon Reids part. It is more a matter of the contradictory obligations of the neoliberal university.
U.S. leftists recently joined swords over the existence of theprofessional-managerial class.Jacobinsocial democratsrailat the capitalist PMC they angle to join in a Sanders administration, while tankies claim managers are proletarian too. Ill sidestep the metaphysical debatehow many PMC can dance on an epipen?only to observe that whether the PMCtheoreticallyexists in epidemiology, Ivemetits members in the flesh. They live!
Reid and other institutional epidemiologists are on the hook for cleaning up diseases of neoliberal originsyes, including out of Chinawhile meting out comforting platitudes that the system that pays them works. Its a double bind many practitioners choose to live with, nay, prosper from, even should the resulting epidemiologies threaten millions.
Reid here kinda gets the food system and conservation parts of the explanation for 2019-nCoV (and many of its celebrity forerunners out of the series of epidemiological reality shows run this century so far). But in introducing this protopandemic, he propositions, to paraphrase, that This utter horror has a saving gracehooray! And it is that China has been a source of repeated outbreaks, but it, and a WHO nowowned byphilanthrocapitalism, conducts exemplary biocontrol.
We can reject Sinophobia, offer material support, and still well remember Chinacovered upthe SARS outbreak in 2003. Beijing suppressed media and public health reports, allowing that coronavirus to splatter across its own country. Medical authorities one province over from an outbreak didnt know what their patients were suddenly showing up with at the ER. SARS eventually spread across multiple countries as far as Canada and was barely driven to extirpation.
The new century has meanwhile been marked by Chinas failure or refusal to unpack its near-perfect storm of rice, duck, and industrial poultry and hog production driving multiple novel strains of influenza. It is treated as a price for prosperity.
This is no Chinese exceptionalism, however. The U.S. and Europe have served as ground zeros for new influenzas as well, recentlyH5N2andH5Nx, and their multinationals and neocolonial proxies drove the emergence ofEbolain West Africa andZikain Brazil. U.S. public health officials covered for agribusiness during theH1N1 (2009) andH5N2outbreaks.
Perhaps then we should refrain from choosing between one of two cycles of capital accumulation: the end of the American cycle or the start of the Chinese one (or, as Reid appears to do, both). At the risk of accusations ofthird campism, choosing neither is another option.
If we must partake in the Great Game, lets choose an ecosocialism that mends themetabolic riftbetween ecology and economy, and between the urban and the rural and wilderness, keeping the worst of these pathogens from emerging in the first place. Lets choose international solidarity with everyday people the world over.
Lets realize a creaturely communism far from the Soviet model. Lets braid together a new world-system, indigenous liberation, farmer autonomy, strategic rewilding, and place-specific agroecologies that, redefining biosecurity, reintroduce immune firebreaks of widely diverse varieties in livestock, poultry, and crops.
Letsreintroducenatural selection as an ecosystem service and let our livestock and crops reproduce on-site, whereby they can pass along their outbreak-tested immunogenetics to the next generation.
Consider the options otherwise.
Maybe Ive been unfair to the Reids of the world, who as a matter of professional obligation must believe their own contradictions. But, as five hundred years of war and pestilence demonstrate, the sources of capital that many epidemiologists now serve are more than willing to scale mountains made of body bags.
Rob Wallace is the author ofBig Farms Make Big Flu.
A version of this article originally appeared on Monthly Review.
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