When I googled how many films Hollywood actor Kevin Bacon has been in, the answer “at least 61” popped up. The figure is as high as it is vague, and is the basis of the parlour game “six degrees of Kevin Bacon”. For those that don’t know, the game involves challenging yourself to find the shortest path between a chosen actor and Kevin Bacon based on who they have acted alongside. It is built on the idea that, in this day and age, two people on Earth are six or fewer acquaintance links apart – the concept of “six degrees of separation”.
The world is interconnected to a degree never previously seen, allowing local crazes to spread quickly across the globe. The South Korean pop song Gangnam Style reached 3 billion views on Youtube in 2017 – just one example amongst others that include the ice bucket challenge, Furbies and David Beckham hairstyles.
That’s all well and good when what spreads is (arguably) something positive. When it comes to disease, our global closeness becomes more of an issue. By now, the novel coronavirus first isolated in the city of Wuhan in China has become international news and, as of last week, a full blown pandemic. Pandemic originates from the Greek words “Pan” meaning “all” and “Demos” meaning “people”. According to the World Health Organisation, a pandemic occurs when there is a worldwide spread of a new disease.
At the time of writing, there are 596 official cases reported in the UK.
Globally, that figure is currently at 132,500, the majority of which are still from China. In all, around 10 deaths so far have been reported in the UK and 5,000 deaths globally. Although there is a lot of emerging information still being analysed amidst a lot of conjecture and misinformation, this outbreak is turning out to be quite a shock to us all. One positive to emerge amongst the chaos is the high level of international communication and co-operation means that something like this has far less impact than it might have done in the past. There are obvious exceptions here (Trump) but nothing’s perfect.
Historically, true pandemics were far more devastating. The most recent example, the Spanish flu of 1918 is estimated to have killed around 100 million people and is thought to have infected around 27% of the world’s population. Perhaps the most famous of them all is the bubonic plague or “Black Death”. The most widely known outbreak of this decimated the populations of Europe throughout the 14th Century, killing around 75 million people. The culprit, a bacteria known as Yersinia pestis, is still around today and between 2010 and 2015, accounted for 3,248 cases of plague worldwide. Nowadays, it can be treated with antibiotics, but in the 14th Century, people still believed in such things as the four humours, conceived in part by the Roman physician Galen, who also apparently coined the term ‘plague’. In the belief that the plague was a punishment from God, some practised self-flagellation to repent for their sins. It didn’t do much good.
A similar outbreak, known as the plague of Justinian, broke out across the Byzantine Empire in AD 541 and it is thought that this was also due to a form of Yersinia pestis. This affected between 13 and 26% of the world’s population at the time. Both forms of plague were so transmissible and virulent in large part because of the fleas on the back of rats that were transported along the Silk Road and across the oceans on ships.
The association with animals is quite a common feature in disease outbreaks and epidemics. There are many viruses for example, carried by animals that do not infect humans. However, all it takes is a genetic mutation in this virus to enable it to cross the species barrier. The resulting pathogen is one to which populations have no innate immunity, hence the tendency for them to spread more rapidly. That is what is thought to have happened in the case of this novel coronavirus. Coronaviruses are widespread in our population already, many of which are responsible for a simple cold. However, various forms can cause more severe illnesses – for example the Severe Acute Respiratory Syndrome (SARS) from 2003. This was a coronavirus. The current outbreak was thought to have originated from a seafood market in Wuhan and the transfer from animal to human is known as zoonotic. SARS was thought to have been caught from civet cats and the coronavirus that caused the MERS (Middle Eastern Respiratory Syndrome) in 2012 originated from dromedary camels. It should be easy to guess where the H1N1 influenza virus that caused the swine flu outbreak in 2009 came from.
With so many different names, things can get a bit confusing. The WHO takes responsibility for naming the disease itself (now christened as COVID-19) but the International Committee on Taxonomy of Viruses is responsible for naming the virus based on its genetic makeup. They have labelled it as SARS – CoV – 2. In an attempt to prevent unnecessary fear in the regions that suffered most from the SARS outbreak in 2003, and perhaps taking a leaf out of Prince’s notebook, the WHO are referring to it as “the virus responsible for COVID-19”.
In the modern age, notwithstanding the risk to human life, there is potential for huge economic impact during outbreaks such as this through restriction of human movement so vital to industries such as tourism and shipping. This aspect is beginning to emerge in levels the current infrastructure has never experienced before and how it affects us all is perhaps an even bigger uncertainty than the virus itself. Some estimates of a 25% reduction in the global tourism industry have even been suggested. With markets and livelihoods at risk, tremendous efforts to look for solutions are underway. Much of this builds on successful work carried out in the past.
Smallpox is the flagship example of the success of vaccination. Caused by the variola virus, smallpox was responsible for around 300-500 million deaths throughout the 20th Century but was officially eradicated through vaccination in 1979. Only one other disease has been wiped out in the same way, though it is less well known. Rinderpest was a virus that affected cattle and buffalo and, again through vaccination, was declared formally eradicated in 2011. Interestingly it is thought that the modern measles virus may have branched off from the rinderpest virus (making it zoonotic) around the 11th Century.
The Ebola virus that affected West Africa between 2012 and 2016 did not reach pandemic proportions although it caused 11,310 deaths in the affected regions. (Ebola was also zoonotic, coming from apes, bats and deer). Following the development of a vaccine, the outbreak was halted. This was largely due to the rapid co-operation between drug regulators, pharmaceutical firms, and charities across the world who, along with the WHO, collaborated more closely than they normally would have done.
The Coalition for Epidemic Preparedness Innovation (CEPI) was set up following the Ebola outbreak and aims to forearm experts all around the world against future outbreaks of disease. As a result, techniques and templates for faster vaccination development have been outlined and experts are using new technology in gene sequencing more and more. The genetic sequence of SARs-CoV-2 was published by Chinese scientists in January and work is underway already to find a vaccine.
Seasonal flu jabs are an important part of our disease prevention techniques already. In the USA between 2017 and 2018 around 60,000 people died from influenza and so this is no time to become complacent considering that early mortality rates (and one must be cautious considering there may be mild cases that are not making their way into the stats) seem to indicate a higher percentage for Covid-19. Neither though is it time for panic as around 81% of COVID-19 is mild and self-limiting. It may be difficult not to do just that in light of the unprecedented measures the government are now advising.
The latest update is that, if you are in the UK, one should self-isolate if one has a new cough and fever. I will admit, some of the projected figures look alarming and it may be that this goes on for some time, eventually inducting this current coronavirus into the seasonal epidemics in the coming years alongside flu. Had this happened in 1918, who knows how bad it would have been? Then again, we didn’t have the force (destructive or not depending on how you look at it) that is social media back then. It would seem this is becoming more of a social experiment of how well we can all pull together and co-operate as much as anything else. Hopefully we don’t embarrass ourselves.
Common sense is our biggest ally here. If you think you might have it, take the necessary precautions but don’t panic. Don’t call your GP if you just have the sniffles (most likely a normal cold anyway) but do contact help if you are struggling with your breathing or concerned that you are deteriorating. Look at the NHS and government websites for the latest guidance, not Twitter or Facebook. Don’t panic buy. There are elderly people who are vulnerable and rely on certain supplies alongside others with genuine medical conditions or who are in pain who need things like paracetamol to control pain. It does no good at all if it’s stored up in Steve Jobsworth’s bomb shelter.
As far as I know, there is no current advice on what to do if you come into contact with Kevin Bacon.