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Fighting the spread of disease with the spread of information

The fallout from inadequate information management extends beyond the scope of hospitals and clinics to the wider society.

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A police officer standing guard outside Huanan Seafood Wholesale market in Wuhan on Jan 24. The death toll in China's viral outbreak has risen to 25, with the number of confirmed cases leaping to 830, the national health commission said.

AMID tepid optimism following the preliminary China-US Phase One trade deal, concern in the region has now shifted to the novel coronavirus outbreak originating in Wuhan. The rapid spread of the disease domestically and internationally has prompted health officials to take expedient precautions to curtail its spread. Singapore's Ministry of Health has initiated a screening campaign to capture and isolate imported cases.

At the crux of the current outbreak's response efficacy lies the issue of information management. The public health system must remain wary of past precedents and barriers that may hinder a complete response, failing which the socio-economic cost of this outbreak may spread throughout the Asia-Pacific.

In the past, local government officials in China have often obscured the full picture from both the public and central government, even whilst publicly toeing the central government line. For example, the 2008 Sanlu melamine-tainted milk scandal was marked by an attempted cover-up by the Shijiazhuang municipal government in Hebei province. Sanlu was the city's largest taxpayer. The scandal progressed despite multiple previous health scandals and subsequent central government focus on the issue, which led to the execution of then-head of the State Food and Drug Administration, Zheng Xiaoyu, in late 2007.

Central government diktat in China is not widely and immediately enforceable. There is a need to take with a pinch of salt Vice-Premier Sun Chunlan's recent call for authorities to be open about the spread of the virus, especially when juxtaposed against the negative socio-economic and reputational cost that this would incur to local authorities.

The opacity of illness detection and outbreak assessment is further compounded by an incomplete understanding of the pathogen and associated disease. Coronavirus refers to a ubiquitous family of viruses capable of infecting a variety of hosts, from birds to bats. The possibility of multiple reservoirs obscures the origin of the strain. Though officials have preliminarily triangulated the first cases to a seafood market, the concurrent sale of poultry, rabbits, and other livestock complicates the virus' origin story, hindering eradication efforts.

In addition, multiple strains are known to infect humans, including those causing severe acute respiratory syndrome (Sars) and Middle East respiratory syndrome (Mers).

Different virus strains can present distinctively. Infection with some strains can result largely in common cold-like symptoms, whereas more dangerous strains can result in severe pneumonia and significant mortality. Public health officials have yet to characterise the relative severity of the Wuhan outbreak. Given the wide, multi-dimensional spectrum of disease that the coronavirus can effect, authorities must elucidate crucial information empirically. As such, the efficient communication of pertinent information within and across borders is crucial to stemming and treating the latest outbreak.

Because of the above factors, the spread of both virus and scale of the socio-economic fallout - on Singapore and the world - are potentially equally severe. Similarities have been drawn between the current Wuhan-derived outbreak and the SARS outbreak of 2002. The Guangdong-based epidemic involved over 8,000 cases, and in addition to the tragic human toll, the pathogen cost the world economy a World Bank-estimated US$54 billion. Singapore hosted over 230 cases. Schools and some offices were closed for a period.

Economic malaise

Sars was an unusually destructive affliction, and we do not necessarily predict the Wuhan-derived outbreak to prove equally destructive. However, the stakes from inadequate information management extend beyond the scope of hospitals and clinics to the wider society.

The world has changed rapidly since 2002. Socially, the expansion and ubiquity of social media today means that government and public health authorities must better engage the public stakeholders. For example, there has been rapid expansion of "human flesh search engines" - a form of vigilantism to identify and expose individuals to public humiliation - in China since the mid-2000s. As such, local governments are exposed to greater scrutiny in their handling of this outbreak.

Scientifically, the speed at which developments can occur has accelerated dramatically. Researchers' ability to sequence this coronavirus, designate it as a new strain, and quickly collect data on clinical features has become massively more powerful. Whereas SARS took approximately six months to sequence, scientists sequenced the novel strain two weeks after reporting it to international officials. Such progress is clearly a blessing for responders. It also adds strain to information management infrastructure. Adequate care must be taken to prevent gaps and delays in reporting.

Ultimately, this outbreak has great potential to exacerbate regional economic malaise, despite cautious optimism following the recent China-US trade deal. Despite fast growing public interest in the public health response, meaningful barriers have the potential to stymie good intentions. Prompt and effective information management, marked by accountability and transparency, are necessary to stem the human and socioeconomic costs of this coronavirus.

While much of this novel illness remains a mystery, the youth of its genesis and a rapid global response thus far have allowed public health responders to act expediently and diligently. As such, we have reason to remain optimistic that this developing challenge will be met.

  • Both writers have a BA in Public Health from Johns Hopkins University. Jia Yao completed an MA Regional Studies East Asia at Harvard University; Keerthi is completing an MD at New York University.