As the coronavirus becomes the all-consuming news story of the moment, the Financial Times decided to invite an extremely apropos guest for this weekend's "Lunch with the FT". That guest is: Belgian scientist Peter Piot, the "Mick Jagger of Microbes", best known for discovering the Ebola virus.
Obviously well-qualified, how does Piot feel about COVID-19? He didn't mince words: "This is serious."
"I’m not the scaremongering type," he says. "But I think this is serious in the sense that we can’t afford not to consider it as a serious threat."
"It could be that, indeed, it’s going to be over in a few months," he continues, crunching into a tempura-covered sage leaf. "But just take the counterfactual. We say, ‘OK, it’s fine and we don’t do anything.’ I bet that we would already have had far more cases in Singapore, the UK, Germany. Let’s not forget, we are already well over 1,000 deaths. That’s not a detail."
The interview took place on Feb. 13, which means that since Piot made these comments, 1,500 more people have died, and serious outbreaks have emerged in Iran, South Korea and Italy. Saudi Arabia has halted pilgrimages to Mecca, and Japanese PM Shinzo Abe has asked all schools in the country to close.
As the discussion delved deeper into the subject of the outbreak, Piot pointed out that although this "certainly isn't SARS" it spreads much more easily because it resides in the tissues of the throat, allowing it to be spread through the air more easily.
With all this in mind, the "big question", as Piot sees it, is how many will ultimately be infected.
"Now, let’s say, the mortality rate is 1 per cent. So, the big question is, how many people will get infected? Are we talking about hundreds of thousands or millions? Now 1 per cent of one million is 10,000; that’s 10,000 people who will die," he says.
"It’s clearly not Sars," he continues, referring to severe acute respiratory syndrome, which killed nearly one in 10 who contracted it 17 years ago. "That’s the good news. But the bad news is, it spreads much faster. The Sars virus sits deep in your lungs. With this virus, it seems that it’s in your throat and that’s why it’s far more contagious."
But since there is no vaccine, Piot pointed out that if it things do get bad, we're screwed, since we only have "medieval" methods of containment at our disposal.
"Secondly, we have no vaccine. All we have is medieval ways of containment: isolation, quarantine, contact tracing."
Piot then offered an interesting comparison to the AIDS outbreak. He recalls that, back in 1981, when the first AIDS cases were discovered among six or seven gay men in California, nobody expected it to go on to infect 75 million people.
In situations like this, he adds, it's always better to overreact than to dismiss the threat.
Piot remembers hearing about the first cases of a mysterious virus in Los Angeles in 1981. "The first report of HIV was six or seven gay men in California. Cumulatively, now we have, like, 75m people who have been infected. Who would have thought that then? Nobody. I’d rather be accused of overreacting than of not doing my job."
After exchanging some comments about the food, the epidemiologist explained to his FT interlocutor why he doesn't begrudge the WHO for 'going easy' on China.
He praises the role of the World Health Organization, which he says is nimbler under Tedros Adhanom Ghebreyesus, an Ethiopian and its first African director. Dr Tedros has been criticised for going easy on China, which suppressed information in the early stages of the outbreak. "The dilemma is he could have his five minutes of fame by bashing China. But what happens afterwards? You need to work with them,” he says, scooping up some juicy borlotti beans.
As for what will happen with the outbreak in China? Piot suspects the situation will get "much worse" before it gets better.
What’s the worst-case scenario with coronavirus, I ask. "That we’ll have a pandemic," he replies. "I think it will get much worse in China. And here we will see more and more transmission. That’s my gut feeling. But how big it’s going to be, I honestly don’t know."
He actually has some experience in this department: When he was battling the spread of AIDS in 2002 as the head of UNAids, the United Nations-backed NGO dedicated to fighting the global outbreak, he made the mistake of publicly criticizing China about the number of AIDS cases going unreported.
"It’s a fine line. I learnt this the hard way," he says, referring to 2002 when UNAids, the organisation he ran from 1995 to 2008, issued the so-called "Titanic Peril" report, which argued that China had many more cases of HIV than it was admitting. "It’s the only time that my then boss, Kofi Annan, called me on a Sunday afternoon. He said, 'Peter, you’re a brave man, but nobody has ever won against the People’s Republic of China.'"
Though he also eventually convinced the CCP to make some progressive policy changes to contain an AIDS outbreak.
"Wen asked me, 'What’s the situation, what should we do?' And I thought, you have 10 seconds to think. Am I going to be diplomatic or am I going to say the truth? He must have seen it. He said, 'Forget who I am. Forget that we’re the Communist party. Tell me what you think and I’ll see what I can do.' Piot advised Beijing to be more open about the problem and to work with people who were vulnerable, including drug addicts and sex workers, rather than jailing them. China’s policy changed decisively after that encounter.
Overall, in Piot's estimation, the world has done a decent job of recognizing the threat posed by pandemics. Still, there's still plenty of room for improvement, as the epidemic is showing the world, particularly now that the issue of mask shortages is becoming a problem in the US after playing a major role in exacerbating the outbreak in China.
Piot thinks differently. "If we do nothing, then that’s the case," he says, particularly since new viruses - as coronavirus appears to have done - can always jump from animal to human. But these days far more people die of non-communicable diseases than of infectious ones, he says.
"Collectively, we’ve done quite a good job. That’s why we need, how to say it, a fire brigade," he says, of a stronger and better-prepared global health system. "You don’t set up a fire brigade when your house is already on fire."
That's a catchy line. Hopefully, once the dust settles, the global community will remember that this wasn't the first global pandemic, and it likely won't be the last.