Coronavirus: time to panic?

The world is starting to panic over the 2019 coronavirus outbreak. Are we over-reacting?

Here are 3 reasons why we should panic, followed by 4 reasons why we shouldn't.

1. The virus, 2019-nCoV, is completely new to humans, and we don't know exactly how bad it will get. As of 29 February, it has already killed nearly 3,000 people, over 2,700 of them in China. 
2. It appears to be very infectious. Cases are now appearing in people who didn't travel to China, and who didn't have any contact with known cases. Coronavirus illness (newl named COVID-19) has now been reported in over 60 countries, on every continent except Antarctica. No matter where you are, it is probably coming your way.
3. The mortality rate has been reported to be as high as 2%.  The Johns Hopkins University tracking site makes it appear even higher, with 2,933 deaths out of 85,688 cases, which is over 3%. By comparison, the 1918 Influenza pandemic had a mortality rate of around 2-3%, and in that epidemic, the worst in modern history, 30–50 million people died, which was 1.7% of the world's population at the time.  Extrapolating to today's population of 7.7 billion people, a virus that deadly would kill 130 million people.

This seems really bad. So perhaps we are not overreacting.

On the other hand, there are several very good reasons why we should stay calm.

1. The mortality rate is probably much, much less than 2%. The rapid spread of COVID-19 suggests that many more people are infected than those who have confirmed cases. The number of people who have no symptoms or very mild symptoms is likely to be ten times as high as the number of reported cases. (This is only a guess.) That would mean the mortality rate might be only 0.2%, or even lower. We still don't know. (The cruise ship that was quarantined in the Japan had just over 700 cases, and 6 people have died, suggesting a mortality rate of 1%.)
2. The reported mortality rate is dramatically lower in young people. If you are under 30, you can probably relax a bit. However, if you are over 70, the mortality rate is frighteningly high, 8-15%. 
3. 2,933 deaths is a tragedy, but it's a tiny number compared to the annual deaths from the influenza virus, which we have learned to live with. In the U.S. alone, the CDC estimates that 12,000–61,000 people die each year from the flu (the number varies a lot because the virus itself changes from year to year), and 9-45 million people get sick. The worldwide totals are far higher. So in terms of numbers, the world is definitely over-reacting to the new coronavirus.
4. Infectious viruses tended to become milder over time. At least 4 other coronaviruses already circulate among humans, causing little more than mild cold symptoms. It is quite possible that the virus causing COVID-19, nCoV-19, may mutate to become a milder disease as well. RNA viruses mutate extremely rapidly, and from an evolutionary perspective, viruses adapt to their hosts by becoming milder. (My perspective is based in part on my past research on the influenza virus.) From the virus's point of view, it can't spread itself around if the host is too sick.

What can we do? A few things:

1. Panic isn't helpful. Don't panic.
2. In the short term, the best response will be to develop a vaccine. (Dr. Peter Hotez and colleagues at Baylor College of Medicine are already working on one.) We need to dramatically increase government investment in vaccine development. It seems that the U.S. is doing that, although not quickly enough.
3. If you feel sick, stay home.
4. It's probably best to avoid travel to a location where COVID-19 is known to be circulating widely. Right now this list includes China and Iran, but it could grow in the coming weeks.
5. In the longer term, we need to increase rather than cut biomedical research funding. Even if we get a vaccine, we still need actual treatments, not only for COVID-19 but for other viruses. (Most viruses are incurable with current technology.) The recent proposal out of the White House aims to cut NIH funding by 7% and CDC funding by 16%. As anyone following the coronavirus news now realizes, the CDC is responsible for tracking the virus in the U.S. and for coordinating our public health measures to respond to the outbreak.

Finally, I should add a note of caution about the bogus treatments already being hawked by peddlers of pseudoscience. There are multiple websites and Facebook pages, including some anti-vaccine sites, already claiming they know how to treat coronavirus illness. (I won't link to any of them, as I don't want to give them the traffic.) These are complete scams. No one has any treatment that will prevent or cure COVID-19, but if we make the investment, we'll get a treatment one day.

(Note: the WHO has renamed the virus SARS-CoV-2, but The Lancet article that first described its genome calls it nCoV-19.)

Would you trust your kids with this man? No? I didn't think so.

Today I want to shine a bit of light on the conspiracy theorist behind the film "Vaxxed" and its recent sequel, "Vaxxed II." I'm not going to provide any links to the movie, or to describe it, except to say that it's a slickly-produced conspiracy theory masquerading as a documentary. Don't watch it.

Anti-vax activists often use conspiracy theory tactics, which work like this: they simply make up a claim, out of thin air, that a secret cabal of doctors (or government scientists, or pharma companies) is out to harm patients by giving them vaccines, and is hiding the "truth" about the risks of vaccination. Never mind how irrational this is, and never mind that there's not a shred of evidence behind it: if you try to argue with the anti-vaxxer, you're part of the conspiracy.

So rather than try to disprove something that was never proven in the first place, let's look instead at the source of the anti-vax propaganda film, "Vaxxed." The source is one man: Andrew Wakefield. Who is this guy, and why is he so obsessed with vaccines?

Wakefield was once a doctor, before he had his license revoked a decade ago. In his former life, he was a gastroenterologist, with no special training in vaccines or infectious diseases. He first gained fame–a lot of fame–for a 1998 paper in a medical journal, The Lancet, in which he claimed to have discovered a link between the MMR vaccine (that's the one that covers measles, mumps, and rubella) and autism.

Here are some things you need to know about Wakefield before watching his movie:

1. Wakefield's 1998 paper, it eventually turned out, was "an elaborate fraud." Wakefield defrauded the public, his patients, and even his own co-authors on the paper, most of whom were unaware of his elaborate conflicts of interests.
2. Before he published his 1998 study, Wakefield was hired by a lawyer, Richard Barr, who was trying to build a lawsuit against vaccine makers. Barr paid Wakefield £435,000 (equal to $750,000 US dollars at the time) to help him build his case. Wakefield's co-authors were unaware of this contract.
3. The study claimed that 8 out of 12 children had been diagnosed with autism soon after getting the MMR vaccine. It described these children as "a consecutive series" of admissions to the hospital where Wakefield worked. That was a lie. It turned out, as investigative journalist Brian Deer revealed, that all 12 children and their parents were referred to Wakefield by Barr–the lawyer who was paying Wakefield to conduct the study, and who was trying to sue vaccine makers.
4. Wakefield also falsified data on all 12 of the children in his original study.
5. Wakefield conducted "invasive and distressing procedures" on the children without approval from his hospital's ethics board.
6. After learning some of the back story, 10 of his 12 co-authors tried to retract the paper in 2004. Wakefield refused to join them, so they published a partial retraction, signed by the 10 co-authors. The Lancet itself later fully retracted the paper (over Wakefield's objections), but it took until 2010 for them to act. By then, the anti-vax movement had spread widely.
7. Prior to publishing his paper, Wakefield filed a patent claim for a "safer" vaccine for measles, one that would have profited him greatly once he discredited the (perfectly safe) MMR vaccine.
8. After losing his license in the UK, Wakefield moved to Austin, Texas where he ran an organization called Thoughtful House, through which he paid himself a salary of $280,000. (Perhaps coincidentally, Austin is now a hotbed of anti-vaccination activism.)

For more than 20 years, Andrew Wakefield has made money off false claims that vaccines cause autism, first put forth in his discredited 1998 paper. He gives talks, writes books, conducts seminars, and now makes movies, of which make him money. Since the publication of his paper, dozens of studies involving literally millions of children have shown, time and again, that vaccines do not cause autism. Wakefield has denied every one of those studies, and continues to push his bogus claims.

(Why, you might ask, have scientists conducted studies looking for a link between autism and vaccines, if there was never any evidence for such a link? The answer is simple: anti-vaxxers have been so successful at scaring people about a nonexistent threat that scientists and public health experts felt it necessary to conduct those studies, in order to reassure people. Literally millions of dollars have been spent to prove something we already knew.)

Meanwhile, measles outbreaks have appeared with increasing frequency in the U.S., the UK, other European countries, and around the world, including the deadly outbreak in Samoa late last year, which caused 5,700 infections and 83 deaths in a population of just 200,000. Wakefield's new movie was released in the middle of that outbreak.

So to anyone who watched the movie Vaxxed and is now having doubts about vaccines, I ask: would you trust your children with this man? I wouldn't.

Are you "vaccine hesitant"? You may be in a cult

Edward Jenner, who pioneered vaccination, and two colleagues
 (right) seeing off three anti-vaccination opponents, with the dead
lying at their feet (1808). I Cruikshank/Wellcome Images/Wikimedia
Commons, CC BY-SA

The World Health Organization recently declared that "vaccine hesitancy," as they called it, was one of the top 10 threats to global health. That's right: it was up there with air pollution, climate change, influenza, Ebola, and other threats.

For the WHO, "vaccine hesitancy" is a polite phrase designed to engage the public and highlight how serious the problem is, without angering those who are guilty of it. I'm not going to be quite so polite here: "vaccine hesitant" means anti-vax. The anti-vax movement, which aggressively spreads fear and misinformation about vaccines, has become a major, worldwide threat.

It also resembles a cult, as I'll explain.

The most recent anti-vax nonsense centers on the new coronavirus that originated in China, and that has led the Chinese government to impose a massive quarantine affecting millions of people. This is a genuine public health crisis, and it has nothing to do with vaccines. Nonetheless, some anti-vaxxers are claiming, without evidence, that the new virus originated from a failed effort to create a coronavirus vaccine. I don't have time to get into that here, but Orac has a lengthy, detailed takedown of that bogus claim.

"Vaccine hesitancy" sometimes refers to parents who are just learning about vaccines for the first time, and who rely on the Internet to search for information. Unfortunately, these new parents are likely to be flooded with anti-vax messages, especially on Facebook. (In recent years, Google has taken steps to lower the priority of anti-vax sites, which has improved things considerably. Sites such as healthychildren.org now appear near the top of searches for "vaccine safety.") It's entirely reasonable to ask your doctor about the benefits and risks of vaccines.

But the answers that parents hear should be clear: vaccines work. As physician ZDoggMD (a pseudonym, obviously) explains in this video:

"Anti-vaccine sentiment is a poisonous scourge.... There's no debate about vaccines. Let's get over that nonsense that the media and celebrities have created, okay? There is nobody in the medical community of any actual reputation who believes that there are two sides to this."

The problem is that anti-vaxxers are continuously creating new websites, Facebook groups, and even movies to spread misinformation about vaccines, particularly the long-debunked claim that vaccines cause autism.

Why do I suggest that anti-vaxxers resemble a cult? Because they have several of the key features of cults, such as:

1. Members of the cult have special insights that outsiders cannot comprehend. With anti-vaxxers, this means they are completely convinced that they know that vaccines cause harm, despite mountains of evidence to the contrary.
2. The group and its leaders are the exclusive means of knowing "truth" or receiving validation, and no other process of discovery is credible. The anti-vax movement has had several prominent leaders, whose followers flock to their speeches and events. These include Andrew Wakefield, the disgraced former doctor who lost his medical license after it was revealed that he had committed fraud. His followers, though, either don't know or ignore his fraudulent past, and regard him as a hero. He makes a living from his books, a movie, and speaking fees, all based on spreading fear about vaccines. An even more prominent anti-vax leader is Robert Kennedy, Jr., who also sells books and gives speeches proclaiming the harms of vaccines. Thanks to his famous name, and despite the fact that he has no medical or scientific training, some people believe him.
3. Unreasonable fear about the outside world, such as impending catastrophe, evil conspiracies and persecutions. Conspiracy theories are the core of many anti-vax arguments. The most common version holds that the "medical establishment" (whoever that is) are hiding the dangers of vaccines so that they can make money. This is utter nonsense. All of doctors I know in the infectious disease community are motivated by a wish to cure disease. In any case, most doctors make little or no money from the vaccines they administer.
4. No meaningful financial disclosure regarding budget or expenses. Some anti-vaxxers profit handsomely by selling bogus, ineffective supplements as alternatives to vaccines. (I'm looking at you, Joe Mercola.) Because supplements are largely unregulated, they get away with it. They'd prefer you to think they're "just in it for the children."

I've no doubt that anti-vaxxers like Wakefield, Kennedy, and others would deny that they are conspiracy theorists, because that's how conspiracy theorists operate. If you question them (they argue), you must be part of the conspiracy. By their own reasoning, they can never be wrong.

So if you encounter someone, either on the sidelines at your kid's soccer game, on Facebook, or elsewhere, who is spreading claims that vaccines are harmful, pause for a minute and ask: what is the source of this information? Is it coming from someone who is profiting from this fear-mongering? There's a good chance the answer is yes.

It's ironic that when the world is faced with a true health emergency, such as the Ebola virus or the Wuhan coronavirus, the first thing that public health experts start to work on is a new vaccine. That's because vaccines provide our best protection against infections. We now have effective vaccines for 16 diseases that used to harm and even kill children in large numbers around the world. We've eliminated smallpox worldwide, and we've nearly eliminated polio, thanks to vaccines. Their very effectiveness is what has allowed the anti-vax message to take hold: many people are no longer frightened of dying from infectious diseases.

We're still a long way from conquering infections, but there's no reason for the world to slip back in time to an era when large numbers of people died from preventable infections. Vaccines work, if we'll let them.