Preparing against the risks of tomorrow requires us to use a bit of imagination. In this series, we present three experts with a fictional crisis that could occur in five to ten years. How can we avoid it? How can we prepare for it? How can we manage the potential fallout? The answers are in the Emerging Risks Room.
Baltimore, February 7, 2022. 10:12 am. Twenty-seven-year-old Katie made her way to work at the movie theater in Fells Point, where she had been employed for two years now, while pursuing her studies in literature. As usual, Katie took the bus that dropped her off a few blocks away.
Buried in a thick coat, hands thrust deeply into the pockets, and with a knit hat pulled over her ears, Katie mulled over the events of the past week as she walked the remaining distance to work. Only last Wednesday she had still been in Lima, finishing a semester of study abroad. That night, she had shared farewell drinks in a downtown bar with Jane and Marguerite, two friends from her school, as well as Nina, Pedro, Valeria and Gustavo, whom she had met in Peru. The next morning, after only a few hours of sleep, she was at the Jorge-Chávez airport boarding a plane to the US.
Friday, Katie had had a hard time waking up. The backlash from the trip and farewell party, she thought. She went to work anyway, but just before the end of her shift, she suddenly felt dizzy. The cash register swam before her, and the neon lights were blinding. Closing her eyes, she held on tightly to her chair. When she thought the spell had passed, she rose to get some fresh air. But just then, her knees buckled. Luckily, her coworker Mike caught her as she fainted briefly.
On Saturday, Katie was back at work. She wasn't feeling better. In fact, she was worse: feverish and alternating between occasional hot flashes and chills. She also had a slight cough. And she kept scratching her neck, where a mild rash had appeared, like an allergic skin reaction. When she got home that evening, Katie went straight to her room and collapsed into bed. Despite the cozy warmth of her quilt and the clothes she hadn’t bothered to remove, she couldn't stop shivering.
After that, Katie drifted through a continuous fog of varying thickness... She was constantly in autopilot mode. The fever didn’t go away, and the dizzy spells, although less serious than when she fainted, became more frequent.
Since Sunday was her day off, Katie went to the emergency department at Johns Hopkins Hospital. In the waiting room, she saw several South Americans who also seemed to be feverish and coughing. The doctor prescribed a blood test, aspirin, “and most importantly, a lot of rest” for Katie. “It's probably just temporary fatigue or a magnesium deficiency.” Unfortunately, there was no improvement. This morning, the coughing was twice as worse and Katie had even spat up some blood before leaving for work.
Tomorrow, her colleague Mike would call in sick. He would not greet her cheerfully with his typical “Hey Katie, how’re you doin’ today?”. Mike would be at home, unable to get out of bed. The day after tomorrow, it would be Clarence, the ticket collector, who would faint after getting home from work and not come back. Quang and Tatiana, who cleaned the theater in-between viewings, would be next.
By the middle of the following week, many of the movie theater’s customers would be showing the same symptoms. In Lima, the situation was worse, with the infection heavily impacting three entire districts, including the one where Katie lived. Ten days later, the first death would be reported. Five days after that, the provisional death toll would rise to 30, just within the capital. Outbreaks would be reported in Mexico, Chile, Venezuela, in the United States, and the first cases would appear in Europe and Asia.
To the consternation of doctors, existing drugs would prove useless in stopping or preventing the spread of the disease. Research teams in several laboratories around the world would seek alternatives – engaging costly and lengthy work of which the first concrete results would not be seen for several months.
In 20 days, the WHO would issue an epidemic alert. By then the disease will have killed over 100 people worldwide. Reported cases would reach the thousands. The story of what the media would soon dub “the American virus” had only begun.
Health care delivery and administration services direct all their focus to restraining the epidemic, neglecting their “traditional” activities. Some of the medical staff are affected.
Human activity significantly declines, due to fear of contagion (people stop going to work, avoid going out, consume less, etc.).
The circulation of goods and people slows radically, coming to a near halt in the most severely affected regions.
People in the most severely affected countries try to move to “safer” countries (slower spread of the virus, better health care).
<Why this can happen>
In 1918 and 1919, the Spanish flu claimed more lives than World War I. The culprit was the emergence of a new virus from avian wildlife, causing high levels of contagion (pandemic) and mortality. The lack of antibiotics to fight the disease was identified as a decisive factor of its worldwide spread.
deaths caused by the traditional seasonal flue, per year, worldwide
Our more recent history is punctuated by other epidemics, such as those caused by the avian flu virus (H5N1) in 2003, the severe acute respiratory syndrome-associated coronavirus (SARS-CoV) that killed almost 800 people between 2002 and 2003, the Middle East respiratory syndrome coronavirus (MERS-CoV) detected in 2012, which caused 670 deaths, and the Ebola virus, which took 11,000 lives between 2014 and 2016. More epidemics will occur in the future.
Today’s geopolitical climate, with the existence of an increasing number of failed states and the growing threat of terrorism and other types of conflict has only increased the risk factors and potential for a crisis, such as the intentional development and spread of a pandemic agent.
With a respiratory disease, the speed with which public services in both healthcare and administration detect the variation of a known virus, the emergence of a new virus or the reappearance of an old virus will determine how well a potential epidemic can be managed and contained. It will also determine the ability to deliver appropriate care.
This is why in 2016 the World Bank collaborated with the WHO and the private sector to set up the Pandemic Emergency Financing Facility, a mechanism enabling funds to be rapidly made available when an epidemic outbreak occurs.
Lastly, research is crucial, especially the fast development of diagnostic tests and potential vaccines for new viruses.
Enter the Emerging Risks Room
How I carried one of history’s worst viruses home in my suitcase
*Illustrations: Léonard Dupond