COVID-19: A revelation - A reply to Ian Mitroff.

This is a rejoinder of Dr. Ian Mitroff's perspective titled "Corona Virus: A Prime Example of A Wicked Mess". While I agree with Dr. Mitroff on the complexity of the COVID-19 outbreak and the urgency to address it, I disagree with him on points related to the role of wet market in this specific outbreak and whether China had acknowledged the existence of the outbreak. I also consider key highlights of the outbreak are the importance of collaboration across national and state borders and a balance between privacy and public health under such situations.

I read with great interest the perspective “Corona Virus: A Prime Example of A Wicked Mess” by Dr. Ian Mitroff (2020). The elegantly written piece exudes passion. I cannot agree more with him on the complexity of the COVID-19 outbreak and the urgency to address it. I, however, do have disagreements with the respected author.

Dr. Mitroff griped over the failure of the Chinese government to curb the practice of selling the “infected” meat of animals in close contact with human. We might have to note that “wet market” exists in many places around the globe, particularly in developing countries. While I agree in principle that such markets should be more regularly inspected and regulated, the livelihood of those relying on the practice needs to be balanced. In addition, research has pointed to the possibility that the virus might have been transmitting, mutating, and adapting amongst humans before it reached the Huanan wet market (Andersen et al., 2020).

On whether China had acknowledged the existence of an outbreak of respiratory illness, it is important to note that Dr. Redfield, Director of the US Centers for Disease Control and Prevention (CDC), received a call from his counterpart in China on January 3, 2020 about the outbreak (Shear et al., 2020). What ensued in both countries is puzzling indeed. I share the disappointment and anger against delayed responses to a dire situation. Meanwhile, the US CDC did start to screen travelers from Wuhan on January 17 and the US imposed on January 31 an temporary suspend entry, additional screening, or possible quarantine for individuals that have visited mainland China in the past 14 days (Patel, Jernigan, and 2019-nCoV CDC Response Team, 2020). A recent study suggests that early cases of COVID-19 in New York City are primarily from European and US sources (The Mount Sinai Health, 2020).

I drew a slightly different conclusion from Dr. Mitroff's. COVID-19 has features that befuddled the world's best virologists and epidemiologists, including the existence of asymptomatic or pre-symptomatic patients who may be contagious (Chen et al., 2020), an incubation period ranging from two to 14 days (Bai et al., 2020), and an estimated case fatality rate of 1–3% and an R 0 of approximately 2.2 (Li et al., 2020; Xu et al., 2020). With these features, COVID-10 triumphs over any border, be it between nations, between states, or even across the Pacific and the Atlantic which had been considered the insurmountable borders of the US.

I dare to make two suggestions. First, globalization will continue but will require collaboration between nations. Unless we want to transition the countries into fiefdoms, we will need trade and human mobility, and in turn, close collaboration to battle the next pandemic. Second, the US Constitution has given the states sovereignty over public health but dealing with pathogens like SARS-COV-2 (the virus causes COVID-19) would require effective coordination across states. It would necessitate constitutional law scholars to sit down with the federal and state governments and have a long and hopefully productive conversation.

My final thought is on privacy and ethics. The Health Insurance Portability and Accountability Act (HIPAA) has imposed strong privacy requirements on public health and healthcare practitioners. Tools and practices used by China and Korea cannot be employed in the US effectively – for example, contact tracing in the US has not been at all successful. Balancing the mission to control a pandemic, technology, and privacy concerns would be an excellent topic of future research for a team of ethicists, informaticians, and legal scholars.