China outbreak shows the need for a pandemic warning system

WHEN the news broke last week that thousands of children in Northern China had crowded into hospitals with pneumonia, it was hard not to worry that this might represent the early stages of some new, more virulent Covid variant or even a new pandemic entirely. 

This episode and all the worry it’s generated illustrate how much the world needs an organised early warning system for infectious illnesses. Such a system would be able to flag trouble early without getting triggered by every surge in ordinary respiratory diseases. 

Last week, the World Health Organisation (WHO) asked China for more information on the outbreak, and Chinese authorities responded by saying they were seeing a surge in pneumonia caused by ordinary respiratory viruses. The authorities told WHO that they figured this out by deploying a test capable of detecting 13 known viruses to determine that this was not the start of a new pandemic. 

There’s an element of trust involved, though, and some people don’t trust the Chinese government after it proved slow to warn the world about the dangers of Covid-19 and destroyed evidence that could have shown how the virus jumped to humans.

A systematic, scientific, globally agreed-upon procedure for disease surveillance would preclude the need for that kind of trust. There would be a uniform standard for gathering and reporting data. 

In mid-November, a group of pandemic preparedness experts and disease detectives gathered at Boston University (BU) to hash out a way to use screening and testing technology to gain the upper hand on viruses — not only for early detection but for early vaccine and drug development, sorting the hundreds of viruses into categories and developing prototype vaccines that work across them.

They considered deploying testing not only during outbreaks but routinely, sampling occasional patients with flu-like symptoms and wastewater for bacteria and viruses. Existing screening technology can identify more than 250 viruses, as well as fragments of DNA or RNA from as-yet-unknown pathogens. 

One major challenge to a global pandemic early warning system would be avoiding false alarms. The best way to separate real signals from noise is to have independent lines of evidence, said Nancy Sullivan, co-host of the November meeting and director of the 

National Emerging Infectious Diseases Laboratories at BU. 

Such a system could combine sampling from wastewater and people seeking medical care with continued global monitoring for outbreaks. If just one of those shows a bump, it might be noise, but if two or three simultaneously show a bump, then it’s more likely to amount to an illness of concern. 

At the BU meeting, Sullivan moderated the panel on such a system and told me that it was followed by a working lunch on how they would begin. Sullivan said they discussed a pilot programme that would start with four international locations. Patients whose samples were taken would have to be treated like volunteers in a clinical trial since their samples would be used for something other than direct diagnosis. 

Today, she said, pandemic preparedness plans are coming forward from the National Institute of Allergy and Infectious Diseases, WHO and a charitable group called the Coalition for Epidemic Preparedness Innovations. 

What they hope to get is a centralised system that pulls them all together. 

David Sanders, a virologist at Purdue University, said that right now, there’s no uniform set of rules guiding what each state must report to the Centres for Disease Control and Prevention. “It’s not systematic surveillance — it’s anecdotal rather than scientific.” 

For states or countries contributing to a centralised database, there should be other health benefits beyond flagging potential new pandemics, including an improved understanding of the ebb and flow of existing viruses. The current situation in China may not be the start of the next Omicron-like Covid wave or a new pandemic, but for those sick kids and their families, it’s no false alarm. — Bloomberg

  • This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners. 

  • This article first appeared in The Malaysian Reserve weekly print edition