During emerging epidemics, we should be quicker to name and slower to sensationalise, urges Salil Patel
The collective threat that is covid-19 was nameless until a few weeks ago. At the start of the year, the term “coronavirus” was one that many people would not have heard of, but its search popularity on Google increased by an order of 100 between 19 and 28 of January. This novel coronavirus we’re facing is circumnavigating the globe, with Italy, Iran, and South Korea the latest countries to be heavily affected. The entirety of Italy is now in lockdown and intensive care units are bearing the strain. Cities are striving to contain the virus, but many are failing.
By the time the World Health Organization (WHO) named the disease caused by this new virus covid-19 on 11 February, it was a month since China had reported its first death, 12 days since the WHO had declared a global health emergency, and the day the thousandth person had died in China. At this point, the number of people who had died in China alone surpassed the total number of people who had died from severe acute respiratory syndrome (SARS) during the SARS-CoV epidemic in 2003. The International Committee on Taxonomy of Viruses designated this new coronavirus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Yet it seems we are facing a very different battle to 2003.
Coronaviruses are a family of viruses that cause a constellation of similar symptoms and resulting diseases. Symptoms include fevers, coughs, myalgia, and breathing difficulties. This can result in a mild cold-like course or, at the more extreme end, severe pneumonia, acute respiratory distress syndrome, multiorgan failure, and—as we can be reminded in real time—death. Coronaviruses are zoonotic in nature (jumping from animal to human). The 2003 SARS-CoV outbreak resulted in an epidemic affecting 26 countries. While another recent coronavirus, Middle East respiratory syndrome coronavirus (MERS-CoV), was first identified in 2012, and since then 27 countries have reported cases. The common cold—that which we refer to after a week of runny noses, sore throats, and irritating coughs—can also be caused by coronaviruses.
Why is a name important? All the diseases caused by the viruses mentioned above have an overlapping constellation of symptoms and can vary dramatically in severity. Mortality rates range, with SARS killing an estimated 9.6% of those infected, MERS killing 34.4%, and covid-19 killing (an estimated) 3.4%. It is important to note that this number is currently very fluid as it is calculated from confirmed cases only, and we need to be aware of how statistics may be affected by undertesting. Mortality rates are also not the sole metric to judge an epidemic by. After all, covid-19 has killed more people than the SARS and MERS outbreaks combined because far more people have been infected.
While developing a vaccine, making policy changes that are based on the latest evidence, and finding effective antiviral treatments will be critical in this epidemic, language is also very much at the centre of all our public health endeavours. This is even truer in global emergencies.
The WHO, when announcing covid-19, stated that officially naming a disease is important to “prevent the use of other names that can be inaccurate or stigmatizing.” How often, for example, have we seen media reports refer to covid-19 as the “Chinese coronavirus”? Names that include regions can lead to stigmatising reporting, which ranges from subtler misconstructions to racist headline exclamations. In some parts of the world, racially motivated attacks against Asian people are spreading, just as surely as the virus itself. Language matters. With the luxury of hindsight, we can see that perhaps the medical community may not have been quick enough to name this outbreak.
Already, in this epidemic we’ve faced a lot of misinformation in the guise of advice and inaccuracy in reporting. In times of global health emergencies, people are prone to feeling fear and anger, emotions that are often receptive to overblown rhetoric. At a time when hashtags can shape the narrative as much as official guidance, perception can outpace reality. We have access to reliable sources and need to make the most of these: the NHS, WHO, and CDC are good places to start for up to date information. And there are also expert voices leveraging the power of social media to inform, rather than embellish; for example, Adam Kucharski is doing marvellous work modelling viral spread and Marc Lipsitch is brilliantly poking holes in media misinformation.
The art of conveying the complexity of epidemics in order to educate and convince is deft. It requires a balance between teaching and horrifying, and its recommendations can range from reducing transmission through simple hygiene measures, to potentially grinding schools, hospitals, and cites to a halt. We might not yet have full control of the spread of this virus, or learnt all that we can about future mutations, but we can control the rhetoric. Creditable, responsible, and open communication can save lives during an epidemic. Let us be quicker to name and slower to sensationalise.
Salil Patel is an academic foundation doctor in London and research fellow at the Nuffield Department of Clinical Neurosciences, University of Oxford. Twitter @SalilPatel
Competing interests: None declared.