Currently, there are no confirmed cases of 2019-nCoV in Africa, but multiple people suspected of infection, based on their travel history and symptoms, have been identified at the borders of a growing number of African countries. If the cases start to occur within the borders of these countries—and without obvious links to known sources of infection—properly diagnosing those infected will be extraordinarily difficult.
If the 2019-nCoV epidemic spreads around the world, rich countries may decide to test incoming travelers who display compatible symptoms. In poor communities, identifying those carrying the virus will be even harder. To test routinely for the large number of patients expected from the most pessimistic predictions about the 2019-nCoV epidemic, a herculean burden will need to be placed on national laboratories. Most important, a large-scale testing policy will require health-care workers to treat patients, collect all these individual samples, and ship them to central laboratories because no bedside rapid diagnostic tests are currently available for 2019-nCoV virus. In the face of competing needs from diseases with much higher mortality rates, how realistic is such a proposal?
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The 2019-nCoV acute respiratory disease may manifest profoundly differently in poor regions of the world. Currently, older patients and those with chronic ailments seem to get more severely ill from coronavirus and are at higher risk of death. In the developing world, 2019-nCoV could conceivably yield more severe disease and higher mortality rates because of underlying malnutrition and other concurrent infections (as we see with tuberculosis and influenza). These concerns are relevant in the United States too. A patient’s history of smoking could make novel coronavirus infection worse. The indoor and outdoor pollution to which many poor communities are exposed might have an effect, too. As scientific discovery moves forward, will rich countries spend the resources needed to answer the questions important to poor communities all around the world?
If a greater number of sicker patients require hospitalization for 2019-nCoV acute respiratory disease, patients admitted with other conditions suffer as well, as space becomes scarce and health-care workers are pulled in all directions. Many hospitals operating in rich countries faced shortages of intensive-care beds during prior pandemics like H1N1 and SARS. They had to work together and improvise ways of caring for a large number of critically ill patients. Such planning will be even more crucial in low-resource areas.
Nearly 90 previously unknown human pathogens have been discovered since 1980. Emergent diseases sometimes bring new attention and new resources; the Bill and Melinda Gates Foundation, for instance, recently made a major contribution to help tackle the novel coronavirus. Still, the central lessons of 2019-nCoV and Ebola are the same: Temporary support in the aftermath of an epidemic is not a substitute for much greater investment by the international community in health care in the most vulnerable countries all around the globe. The advent of 2019-nCoV should push us to look beyond specific diseases and toward how we can improve health care more generally—and contain the next pandemic before it starts.