Dr. David McKeown served as Torontos Medical Officer of Health from 2004 to 2016.
Information about the outbreak of a new coronavirus circulating in the populous Chinese city of Wuhan has emerged so quickly that its been hard to keep track of it all. In China, there have been more than 500 confirmed cases of the virus, which is officially known as the 2019-nCoV virus and causes pneumonia-like symptoms; at least 17 people have died. Beijing has imposed a transportation lockdown in Wuhan, which is believed to be the viruss epicentre. Meanwhile, the U.S. Centers for Disease Control and Prevention confirmed Americas first case on Tuesday, as public-health authorities in Canada stand on alert ahead of the busy travel season around the coming Lunar New Year.
So now is the time for a useful caution: an epidemic of a communicable disease can be both a biological and a sociological event.
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The Severe Acute Respiratory Syndrome (SARS) epidemic, which struck Toronto in 2003, was caused by a novel coronavirus that was first identified in southern China and ultimately spread to several urban areas around the globe. In Ontario, it infected 375 people mostly patients and workers in the health-care system and while 44 people died, there was limited spread in the larger community.
China locks down the central city to try to contain the virus which has killed at least 17 and infected nearly 600.Reuters
Nevertheless, it was accompanied by its own twin event: an irrational fear of people from the part of the world where the virus originated. People who looked Asian reported being shunned on public transportation and having trouble hailing cabs. As the medical officer of health in the Peel Region at the height of the SARS epidemic, I even held a press conference at a once-bustling Chinese restaurant in Mississauga, in an effort to reassure anxious people that it was entirely safe to eat at such businesses.
We saw the same kind of panic happen in the early days of the HIV pandemic in the 1980s. Back then, it was common for public health professionals to talk about how they were actually fighting two epidemics at once an epidemic of a challenging new virus which caused serious illness and death, and an epidemic of fear. The first one constituted a global health crisis, which continues to this day. The second epidemic did significant damage on its own by stoking discrimination against the most affected communities and impeding efforts to implement control measures for disease transmission.
In a time of panic, sober reality can become a rare resource. But the fact is this: Formerly deadly communicable diseases have been largely banished from the top ranks of causes of death in wealthy countries by better sanitation and living standards, antibiotics and vaccines, and it is now very uncommon for a healthy person to die of an infection transmitted by another person, even during an outbreak. The diseases that usually kill us now heart disease, lung disease, diabetes or cancer are largely diseases of how we live rather than who we meet on the subway. So what is it about communicable-disease epidemics that retain the power to spark levels of fear and anxiety that are wildly out of proportion to actual risk?
Researchers who have studied how people perceive health risks have found that some of these risks are consistently overrated, particularly those that are poorly understood and over which people feel they have less control. Those are often features of epidemics caused by new or unfamiliar microorganisms.
Furthermore, a fundamental quality of most communicable diseases that they can be passed from one person to another sets the stage for a persons fear for their own health to be misdirected at other people, rather than the disease itself. The person on the street, on the bus or in the restaurant is seen as the threat particularly when that person is a member of a visible and identifiable group who is believed, correctly or not, to be more likely to be infected. Fear directed in this way can exaggerate divisions within communities, magnify the social and economic impact of an epidemic, and create lasting fissures, while also complicating and distracting from the epidemic-control measures that are needed to tackle the problem.
The first step in combating the other epidemic is to anticipate and address it directly. The best prescription is frank and accurate information from credible sources and lots of it. Community leaders can also help by modelling appropriate social relationships with communities targeted by discrimination and fear.
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Early champions of the fight against HIV often say that education is the best vaccine we have. That remains true in the fight against new and modern epidemics and its a truth we must hold fast to right now.
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