From Gates to Osterholm: The coronavirus was actually expected

At a White House press conference last week, the president noted that the novel coronavirus had “snuck up on us.”

China might be the only country that could say it “snuck up” on them, since the virus was born there. And yet the SARS outbreak in 2003 was living proof of how the intimate mixing of wild and domesticated animals with humans in so-called “wet markets” was a pandemic virus incubator. But China ignored the warning and only briefly shut them down.

The truth is, the novel coronavirus snuck up on no one. And it wasn’t fringy conspiracy theory bloggers who were sounding the pandemic alarm. It was some of the best and brightest people on the planet, including Bill Gates. The self-described “super-optimist” said this in April 2018:

There is one area, though, where the world isn’t making much progress, and that’s pandemic preparedness. This should concern us all, because if history has taught us anything, it’s that there will be another deadly global pandemic.

We can’t predict when. But given the continual emergence of new pathogens, the increasing risk of a bioterror attack, and how connected our world is through air travel, there is a significant probability of a large and lethal, modern-day pandemic occurring in our lifetimes.

And he said this:

In the real world, though, the health infrastructure we have for normal times breaks down very rapidly during major infectious disease outbreaks. This is especially true in poor countries. But even in the U.S., our response to a pandemic or widespread bioterror attack would be insufficient.

‘More than likely … an unknown pathogen’

Then Gates said this:

However, the next threat may not be a flu at all. More than likely, it will be an unknown pathogen that we see for the first time during an outbreak, as was the case with SARS, MERS, and other recently-discovered infectious diseases. [SARS and MERS are both coronaviruses]

At the Munich Security Conference last year, I asked world leaders to imagine that somewhere in the world, there is a weapon that exists – or that could emerge – that is capable of killing millions of people, bringing economies to a standstill, and casting nations into chaos.

If you had listened to that April 2018 lecture and thought, “That Gates guy is a little bit of an alarmist,” then you might have also dismissed an October 2019 event hosted by the Johns Hopkins Center for Health Security as kind of a Star Trek convention for public and international health braniacs.

It was titled “Event 201” and began with the modeling of a fictional novel coronavirus they named Coronavirus Associated Pulmonary Syndrome (CAPS). Their fictional CAPS started in pigs in South America, but once it crossed over into humans it behaved like COVID in every other respect — quickly moving around the globe, overwhelming health care systems, tanking financial markets and businesses, causing unprecedented social upheaval, and paralyzing the business and government systems required to deal with the pandemic. (For the exercise, their model predicted 65 million deaths globally, and since COVID’s arrival Event 201 representatives have been busy pointing out that that number should not be extrapolated to COVID, as it used different inputs.)

Fifteen prominent, knowledgeable individuals from global business, government, and public health were part of a panel that spent the rest of the conference discussing private-public partnerships that might mitigate the worst outcomes of the projected pandemic. They came up with seven recommendations, put their crystal balls back in their briefcases, and went home. And the band played on.

Larry Brilliant’s 2006 TED Talk

Going back further, in 2006, epidemiologist Larry Brilliant won the TED Prize for his development of an early detection system that would crawl the web, global news, and social media to detect the earliest sign of an infectious outbreak. After beginning his TED talk by discussing global efforts to eradicate smallpox, he moved on to the likelihood of a bird flu. Having previously surveyed a number of the top epidemiologists in the world, he summarized their answers:

Ninety percent said they thought there’d be a pandemic within your children or your grandchildren’s lifetime. And they thought that if there was a pandemic, a billion people would get sick. As many as 165 million people would die. There would be a global recession and depression as our just-in-time inventory system and the tight rubber band of globalization broke, and the cost to our economy of one to three trillion dollars would be far worse for everyone than merely 100 million people dying, because so many more people would lose their job and their health care benefits, that the consequences are almost unthinkable. And it’s getting worse, because travel is getting so much better.

Fortunately, those predictions were much closer on COVID’s economic impact than on its mortality, but 14 years after Brilliant’s TED Talk, viruses continue to do their thing: replicate and mutate. You can think of an RNA virus like the coronavirus as the world’s tiniest slot machine, perpetually rolling over its genetic slots, hoping to hit a “winner” — a new mutation that creates a virus that is easily passed (infective) and unrecognized (‘novel’, so no one has immunity). From a virus’ standpoint, it just needs to replicate and move on to the next unwitting victim; it doesn’t need to kill anyone, but it will.

Within a few weeks of Event 201, one lucky coronavirus hit it big in China’s Hubei province, and it’s been following the script ever since. All of this was foretold. If this COVID virus “snuck up on us,” it was because we ignored the prophetic voices of some of our smartest advisers, including Dr. Michael Osterholm at the University of Minnesota’s Center for Infectious Disease Research and Policy. Osterholm is an international expert on influenza preparedness — and the lack thereof, even as our awareness and expectation of a coming pandemic rises. In a recent interview, he made his point with alliteration, noting we often “elect to neglect it.”

The lesson we learn from history is that we are often unable to learn from history.

Dr. Craig Bowron is a Twin Cities internist and writer.