2020 - The COVID-19 pandemic

LONDON: In his new-year message on Jan. 2, 2020, the director-general of the World Health Organization urged the world to “take a moment to thank all the brave health workers around the world.”

Within a few weeks, the words of Dr. Tedros Adhanom Ghebreyesus would begin to take on an unexpectedly urgent meaning. It quickly became clear the modern world was about to be engulfed in a fight for its life with a microscopic organism capable of a virulence not seen since the flu pandemic of 1918-19.

It also swiftly became apparent that for all the advances in medicine and technology in the intervening century, still we remained at the mercy of wayward nature, thanks in part to the inability of the world’s governments to act as one even in the face of a deadly global crisis.

On Jan. 26, 2020, I wrote an op-ed article, syndicated throughout the region, urging Gulf and other states to, at the very least, screen incoming passengers from China, where the virus emerged.

“The only correct reaction at this stage,” I wrote, “is prudent overreaction.”

On Feb. 17, I hardened the message: The single most effective defense our interconnected world had against the new virus was to ground every aircraft.

At the time, I was a medical journalist, writing investigative articles for the British Medical Journal and other publications. But in the case of the COVID-19 pandemic I was not blessed with any special insight. The tragedy of what would soon unfold was the fact that all the steps we could have taken to prevent it at the outset were simply common sense.

Yet at first, few outside of the central Chinese city of Wuhan seemed overly alarmed by the cluster of more than 40 mysterious, pneumonia-like cases reported by China to the World Health Organization’s local country office on the last day of 2019.

A week after Tedros’ speech, which made no mention of anything untoward brewing in China, Chinese authorities announced they had identified the cause of the outbreak: a novel form of coronavirus, a family of viruses common in animals and humans.

Where did it originate? For years, the theories have spread thick and fast. At first, the finger was pointed at pangolins, a scaly mammal prized in Chinese folk medicine for the supposed healing powers of its scales, and often traded illegally.

Conspiracy theorists suggested the origin of the virus was a Chinese lab, where it was deliberately engineered and then leaked out. This theory resurfaced as recently as January this year, when John Ratcliffe, US President Donald Trump’s newly appointed head of the CIA, revived a claim in which his own agency previously said it has “low confidence.”

The reality is we will almost certainly never know the true origins of the virus.

Most human coronavirus infections are mild but during the previous 20 years, two versions emerged that hinted at the family’s capacity to cause serious harm: severe acute respiratory syndrome coronavirus, or SARS-CoV, and Middle East respiratory syndrome coronavirus, or MERS-CoV. Together, they accounted for “only” 10,000 cases, with mortality rates of 10 percent and 37 percent respectively.

The new coronavirus that was emerging in early 2020 had far bigger, and more sinister, ambitions. On Jan. 11, China reported the first death caused by the virus, of a 61-year-old man with underlying health conditions who had been a customer at the market where, at first, the virus was thought to have jumped from animals to humans.

Over the coming days, and even weeks, the virus could still have been contained. But Chinese authorities were slow to introduce effective lockdown procedures. Aircraft continued to fly and, at first, the rest of the world looked on with a seemingly detached indifference that would soon prove fatal, to people and economies worldwide.

Even as the virus spread rapidly within China, the WHO played down the threat, declining to recommend the introduction of travel restrictions to the country or specific health precautions for travelers.

On Feb. 4, in fact, WHO chief Tedros even urged countries not to ban flights from Wuhan for fear of “increasing fear and stigma, with little public health benefit.”

Few public-health pronouncements have proved to be so ill-judged.

On Feb. 11, the organization gave the virus its official name: severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2. The disease it caused was also named: COVID-19.

But it would be March 11 before the WHO finally declared the outbreak to be a pandemic, a state of affairs that was already blindingly obvious to the 114 countries that by then were already in the grip of the virus.

Saudi Arabia recorded its first case on March 2. The patient was a man who had traveled from Iran via Bahrain over the King Fahd Causeway and, like the Kingdom’s second patient two days later, he failed to declare he had been in Iran, where cases of the disease were rocketing.

On March 25, just over three weeks after the first case in the Kingdom, COVID-19 claimed its first victim in Saudi Arabia, a 51-year-old Afghani who died in Madinah.

The genie was out of the bottle. Saudi authorities acted swiftly, forming a special action committee composed of representatives from 13 ministries, and introducing a broad range of measures including screening, quarantining all travelers when necessary, and fast-tracking production of essential medical supplies and equipment.

The Umrah pilgrimage was suspended, airports were closed, public gatherings were restricted and the Qatif region, where the Kingdom’s first cases had emerged, was swiftly locked down.

On March 25, the speed of the Kingdom’s response earned praise from Dr. Ahmed Al-Mandhari, the WHO’s regional director for the Eastern Mediterranean. Saudi Arabia, he said, had learned lessons from its experience a decade earlier with the MERS-CoV coronavirus, and the country was “also drawing from its unique expertise in managing mass gatherings and emergency preparedness during the annual Hajj pilgrimage.”

Around the world, however, few governments reacted as quickly. There was little cohesion in the responses; the already tardy WHO advice was often shunned until it was far too late, ineffective measures were introduced in piecemeal fashion, and there was a failure to coordinate responses internationally.

In the parlance of epidemiology, aircraft served as the fatally efficient vector for the virus, in the same way that the mosquito is the vector that spreads malaria. Yet for too long, governments around the world hesitated to take the extreme, but obviously necessary, action of suspending all commercial air travel.

Eventually, and in an uncoordinated, haphazard fashion, flights were grounded around the world but this came too late to prevent the virus traveling the globe. Ultimately, the delay caused far more global economic disruption than if air travel had been halted early on.

Even then, even after the virus had been allowed to make its way around the world, in many countries there was continued reluctance to act swiftly and shutter shops, offices, restaurants and transport systems, and to confine people to their homes. Lacking firm guidance from their governments, many people continued to mingle at work, on trains, in restaurants, in each other’s homes and on beaches.

And, increasingly, in hospitals.

As the virus spread inexorably around the globe, it exposed a lack of long-term health planning and preparedness in many countries where authorities, caught flat-footed, found themselves desperately short of bed space and competing ruthlessly with other nations for scarce supplies of the personal protective equipment required by front-line medical staff, all-important mechanical ventilators and, as hastily developed drugs were developed, limited supplies of vaccines.

Around the world, major international events, from Dubai’s Expo 2020 to the Tokyo Olympics, tumbled like dominoes as governments and organizers finally acknowledged that any gathering of people was a recipe for magnifying the disaster.

From the perspective of the history books, in terms of everything other than the virus and the savage toll it exacted in lost lives and devastated economies, 2020 had become the year that never was.

By the beginning of April, just three months after the first victims had been identified in Wuhan, the number of confirmed cases of COVID-19 had passed 1 million, more than 50,000 people had died, and much of the world was living in isolation and fear.

Faced with agonizingly difficult life-or-death decisions, health systems worldwide found themselves forced to adopt triage systems of a kind more typically seen on battlefields, allocating limited resources to those most likely to survive.

Horror stories of loss and sacrifice emerged every day, in almost every country around the globe. On the front lines, some of the courageous health workers who had been honored in the WHO chief’s new-year speech paid for their continued dedication with their lives.

It would be May 5, 2023, more than three years after COVID-19 was designated a pandemic, before the WHO declared the global public health emergency to be over.

Victory over SARS-CoV-2 came at terrible cost: more than 14 million lives lost between Jan. 1, 2020, and Dec. 3, 2021, alone; billions left seriously ill; and traumatic disruption imposed on economies and everyday life across much of the world.

In Saudi Arabia, the Interior Ministry signaled an early victory over the virus, lifting the bulk of precautionary and preventive measures on June 13, 2022.

During the 833-day war against the virus in the Kingdom there were 780,135 confirmed cases and 9,176 deaths. Almost 43 million COVID-19 tests were carried out and 66.5 million vaccinations administered.

The virus has not disappeared from the planet. But improved treatments and the fact that a critical mass of more than 70 percent of the world’s population has now been vaccinated means that the first great plague of modern times is now no more — or less — of a threat than the flu.

The “Keep Your Distance” stickers on pavements, shop floors and public transport have mostly faded away, and most of us have forgotten the advice we once followed so diligently: cover your cough, practice good hand hygiene and, if a home test reveals you have COVID-19, stay home until you have been fever-free for at least 24 hours.

But public-health agencies, at least, remain vigilant. XEC, one of the latest variants of the virus, caused concern when it emerged in the autumn of 2024. It seemed genetically equipped to evade both our immune defenses and the barriers erected by vaccines. But so far, hospitalizations in the US, where tests have revealed high levels of the XEC variant in wastewater, have not risen.

Either way, the next pandemic is only a matter of when, not if, whether it is a variant of SARS-CoV-2 or another virus altogether.

As a global reaction to the COVID-19 pandemic, member states of the World Health Organization will gather at the World Health Assembly in May to agree a Pandemic Preparedness Treaty designed “to foster an all-of-government and all-of-society approach, strengthening national, regional and global capacities and resilience to future pandemics.”

Unfortunately, though, it seems that one of the world’s largest countries will not be there. On Jan. 20, 2025, the first day of his second term, President Donald Trump signed an executive order withdrawing the US from the WHO.

One immediate consequence of this could be that the US stops sending data on the occurrence of diseases to the organization and, especially in terms of monitoring the SARS-CoV-2 virus, that would be of great concern. In the 28 days to Jan. 12, 2025, there were 2,861 deaths from COVID-19 reported to the WHO, the vast majority of them in the US.

• Jonathan Gornall, a writer for Arab News, was a former investigative medical journalist for the British Medical Journal.