The year of the rat is off to an ominous start.
“We just stay home and don’t go out,” says Mr. Dong. The 33-year-old researcher, who provided only one name, has no other options. He, his wife and their 3-month-old daughter live in Wuhan, the epicenter of an unfolding global health crisis. They’re treating the forced time at home as a holiday, though he says, “this is different than any of them before.” Families like his huddle in their homes, fearful that if they venture out, they will get sick. Since the first cases of a previously unknown pneumonia-like illness emerged in December, Wuhan, the capital of Hubei province, has frozen in place. Ten-lane thoroughfares lie empty after a ban on personal cars, and buses and subways sit silent. Lunar New Year 2020 was stripped of its traditional fireworks, boisterous gatherings around overflowing tables of food and drink, and happy reunions with family and friends.
As researchers and public-health officials scramble to learn as much as they can about the new virus—how easily it transmits among people, and how deadly it is—fears swamp this city of 11 million. The disease responsible is caused by a coronavirus that’s never infected people before. Conflicting advice about how infectious the virus might be are swirling through the Internet, along with misinformation about exactly where the virus, dubbed 2019-nCoV, came from. Hospitals in Wuhan are besieged by the sick, and only a handful of clinics are able to test for the disease.
Coronaviruses make up a family of viruses that live mainly in animals (bats are a favorite) but also includes strains that contribute to the common cold in people. Only recently have they become more threatening, causing two deadly global pandemics in the past two decades—severe acute respiratory syndrome (SARS) in 2002 and 2003, and Middle East respiratory syndrome (MERS) in 2012. Each new outbreak adds a fresh urgency to the question of whether public-health officials could be doing more to confront the threat from emerging infections in general, and coronaviruses in particular.
The numbers will have climbed by the time you read this, but as of Jan. 29, the new virus had claimed at least 133 lives and sickened more than 6,000 people across 18 countries, including at least five cases in the U.S.
On Jan. 30, the World Health Organization (WHO) declared this a “public-health emergency of international concern”—which entails more stringent monitoring and containment of infected people—and China’s President Xi Jinping is certainly treating it as a national emergency. He ordered an unprecedented quarantine of Wuhan, banning travel in and out of the city on Jan. 22; a few days later, he extended the quarantine to a dozen cities in Hubei province. Xi also took the unusual step of extending the official Lunar New Year holiday to discourage millions from traveling back to work and further seeding new infections around China.
Faster than the virus itself, fear has spread around the globe. In the U.S., designated airports quickly instituted screening programs to identify passengers on Wuhan-originating flights with signs of fever, cough or difficulty breathing, and to immediately direct them to hospital isolation wards. Numerous airlines canceled flights to and from China. Asian stock markets that weren’t closed for the Lunar New Year plummeted. In the U.S., Europe and Asia, shortages of surgical face masks were reported.
The emergence of a powerful new infectious virus for which there is (as yet) no vaccine should scare us, of course. But at the same time, humans are better equipped to fight these kinds of outbreaks than ever before. New technologies, specifically ones that make possible the sequencing of any living thing’s genetic blueprint, are finally giving us a meaningful advantage over microbes. We can map the genome of a virus, for example, which provides valuable clues about how it spreads and helps us figure out how our immune systems can best battle it. The finest scientific minds are doing just that with coronaviruses in the hope that epidemics do not have a chance to mushroom into pandemics.
The question now is how quickly we can transmit that knowledge to every corner of the world, especially to China, where in some places the flow of information is tightly controlled by a paranoid state. Researchers in London and Hong Kong have already warned that Beijing has dramatically underestimated the number of cases in Wuhan. “For any disease outbreak, the best strategy is transparency,” says Yanzhong Huang, senior fellow for global health at the New York City—based Council on Foreign Relations. “Even taking into account the potential for panic, you need people to be prepared.” With a government as opaque as China’s, can we be sure that we are?
Coronaviruses are not rare. In fact, you might have one right now. Depending on the year, anywhere from 10% to 30% of the annual burden of colds can be blamed on one of four coronaviruses. That’s why, until the early 2000s, the scientific community treated coronaviruses primarily as nuisances and paid relatively little attention to them. “Twenty years ago, people weren’t thinking in terms of coronaviruses being potential causes of pandemics or respiratory disease,” says Dr. Ian Lipkin, director of the center for infection and immunity at Columbia University Mailman School of Public Health.
That changed in 2002, when SARS first emerged from China. Of the 8,000 people ultimately confirmed to have the respiratory disease, up to 10% died, waking public-health experts to the dangers of a virus that had jumped from bats to cats and dogs, and then to people. In Wuhan, officials believe 2019-nCoV made such a leap inside the city’s Huanan market. Rows of blue stalls housed countless purveyors of exotic, wild animals for consumption. “I saw live hedgehogs, porcupines, that kind of thing,” says Alan Laine, 57, a physics teacher from the U.K. who has lived in Wuhan since 2002. “It wasn’t exactly hidden.” The market has been shuttered since Jan. 1, though officials in white hazmat suits continued to sift through evidence when TIME visited on Jan. 22.
Movement across species is what makes virus experts nervous. Because of their sloppy genetic copying, viruses mutate all the time. By chance, the new aberrations sometimes make a strain more adept at living in a new host—and in some cases, those changes make it more virulent as well.
In some respects, the outbreak in Wuhan might have been inevitable. Ralph Baric, professor of epidemiology at University of North Carolina at Chapel Hill and an expert on the genetic sequences of coronaviruses, has worked with Chinese researchers since 2002 to better understand this family of microbes and how its members infect human cells to cause major respiratory symptoms.
From bats, Baric and his team extracted a series of coronaviruses that varied genetically from SARS by anywhere from 2% to 12%. Those differences hinted that some were primed to jump from bats to people, and cause serious disease. His findings should have rung alarm bells, he says. “We made strong predictions that these coronaviruses were poised for re-emergence in human populations.” In December, that prediction came true, when a mysterious pneumonia-like illness began spreading in the city of Wuhan.
It’s not a mystery how authorities should respond to a new infectious disease; by and large, it’s been the same for thousands of years. Since typhoid fever struck Athens in 430 B.C.—among the first recorded outbreaks—to the black plague in Europe during the 1300s, and the more contemporary 1918 influenza pandemic, isolation and quarantine have been the most effective ways to contain a highly contagious infectious agent and prevent it from decimating an entire population of people.
Yet in China, those lessons weren’t always followed, despite the recent legacy of SARS. Although scientists in China quickly identified the new coronavirus, public-health officials were slow to advise people about how best to protect themselves. It took President Xi nearly a month after the first cases emerged in Wuhan to finally address the health crisis publicly, and local health officials say that delay tied their hands. As Wuhan Mayor Zhou Xianwang explained on CCTV on Jan. 27, “As a local official, I could only disclose information after being authorized [by the central government]. A lot of people don’t understand this.” Indeed, the wife of a doctor in a Wuhan hospital told TIME that her husband had been instructed not to discuss the coronavirus situation and the government’s response with anyone.
The top-down leadership structure of Xi’s government leaves local health departments with little authority to issue alerts or take any action, snarling public health and politics at the expense of human lives. Train conductors were reportedly initially told not to wear masks to avoid generating more panic among passengers, just days before the entire rail system was shut down. “People didn’t realize the severity of the situation,” says a graphic designer from Wuhan who provided only her last name, Tao. “They thought the virus was controllable and not contagious. The government did not publish the facts in time, and they failed to control the epidemic.”
The swing from downplaying the initial cases to the extreme policies now in place fueled outbursts on the social-media network Weibo: “The common people are suffering. We don’t really have democracy here, and we are deprived of the right of telling the truth,” wrote one Weibo user on Jan. 28. Another, on the same day, went further, seeing the outbreak as a harbinger of the future of the Chinese state. “The virus outbreak exposes the truth. It is a wake-up call: our country is not as strong as we expected, our system is not as superior as TV describes.”
Xi’s government has done at least one indisputably effective thing to help battle the virus. On Jan. 10, it posted online a scientific paper containing the genetic blueprint of 2019-nCoV. The prompt release of the sequence won Xi plaudits in the global health community, since it allowed teams around the world to begin breaking down the ingredients of the infection and figuring out how to fight it.
When SARS hit, the sequencing of the human genome was costly and cumbersome; in part because of that, in 2002, it took the Beijing government five months to release what it did in just a few days in 2020. Today, the technology is cheap and routine and is already speeding detection of new cases. When the first potential case of 2019-nCoV appeared in the U.S., the Centers for Disease Control and Prevention (CDC) was able to confirm the fingerprint of the new coronavirus overnight, from the patient’s sample sent to the agency. The CDC also plans to ship testing kits to health departments, both in the U.S. and abroad, to enable them to quickly confirm coronavirus infections and distinguish them from the current seasonal flu.
Diagnosing a disease is one thing, but treating it is another, and creating a vaccine or drug will take longer. To find out exactly which proteins the virus is using to wreak havoc requires making high-quality synthetic DNA from the viral genome, something only a few companies are able to do in a process that takes around 10 days. Then researchers need to make proteins from that DNA. Without those proteins from the viral genome, you can’t test which antibodies or drug compounds might counteract them. “The [genetic] code on a screen doesn’t get you things to work with on the bench,” says Karla Satchell, co-director of the center for structural genomics of infectious diseases at Northwestern University’s Feinberg School of Medicine.
Scientists shouldn’t be relying on private companies in this way, says Andrew Mesecar, a coronavirus researcher and head of biochemistry at Purdue University, who researches coronaviruses. He is currently working on a solution: he and his team have studied the proteins, or enzymes, that different strains of coronavirus use to replicate in human cells, and developed 50 compounds that can inhibit their activity, essentially blocking the virus from causing infection. “My idea is to have an [IBM] Watson of drug discovery,” he says. “As soon as we get the sequence information for a new disease-causing virus, I can feed the computer the information, and it will say you should try these compounds off the shelf to start. It’s not here yet, but it’s coming, and I hope this is realized in my lifetime.”
Yet even if researchers identify a potential drug for 2019-nCoV, testing its safety and efficacy will take months. To speed that process up, scientists are tapping some new technologies. For example, stem cells can be coaxed to churn out high volumes of human lung cells in order to study how a virus like 2019-nCoV interacts with them. And three-dimensional cell cultures, which mimic in a lab dish the physical and molecular environment in the human body, could substitute for some early human safety studies, making for a more affordable and efficient way to test how safe a treatment might be.
Advances like these make some in the field hopeful that the public-health response could be better this time around. “Twitter and everything was lighting up on Friday night [Jan. 10] that the genetic sequence of the virus was posted,” says Mesecar. “We analyzed the first one that Saturday morning. Within 20 minutes of having the sequence, I knew it was very close to SARS. That’s when I thought, ‘Uh-oh, this could be as virulent as SARS.’ That tells you right away that you had better act like this is SARS.”
There is still a lot about the Wuhan coronavirus that researchers don’t know, however. It’s not clear how easily the virus spreads from person to person or how long its incubation period is, and there are reports from Chinese health officials that it can be spread by someone who is infected but doesn’t have any symptoms of the illness. The CDC and other health agencies are trying to confirm that right now. Both U.S. and Chinese scientists are also working on developing a vaccine for 2019-nCoV, relying on some of the genetic knowledge they gathered from SARS.
All the science in the world still might not be a match for human nature, however, as personal fears often take precedence over the public good—especially during an unfolding outbreak when health officials don’t have all the answers. When Jacob Wilson, who runs a media company in Wuhan, first felt his throat get scratchy on Jan. 21, he wasn’t concerned. The 33-year-old from Alexandria, La., hadn’t visited the seafood market that was being targeted as the source of the outbreak, and health authorities in Wuhan said the new mysterious pneumonia-like illness wasn’t passed between humans. Reassured, Wilson continued going to work. “But for the next three days I had a fever and dry cough, which turned into an upper-respiratory infection, sneezing, runny nose and then muscle soreness, weakness and sharp pains throughout my chest,” he says. Unsure whether he was infected with 2019-nCoV or the flu, he decided to wait it out rather than brave a potentially infectious line of people at the hospital for several hours. “It just seemed absolutely terrifying and unsafe,” he says.
Even if he had gone to the hospital, he might not have learned if he had 2019-nCoV; only four medical centers in the entire city had kits to test for the virus at the time. He turned instead to his mother, a nurse in the U.S., who prescribed antiviral and asthma medications that improved his symptoms after about a week.
He and the roughly 50 million people stuck in Hubei province are still facing a quarantine period that looks likely to drag into weeks and possibly months, as the numbers of infections and deaths creep higher. With workplaces shuttered, and no way to earn money, locals are counting their meals—and trying to remain positive. “This break is peace and quiet,” says Dong. “People may feel bored, but I enjoy this holiday.” Until science offers a better remedy, the people of Wuhan must cling to those simplest of defenses: hope and hiding.
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Write to Charlie Campbell/Wuhan, China at firstname.lastname@example.org