Bipolar Media Disorder: The staged dynamics of tackling a global epidemic

A decade and a half ago, we started talking about "The New Normal". By that definition, it was predicted that we would have to get used to having, once in every few years, a new animal-to-human infectious agent threatening to spread around the globe. The potential impact of these events ranged from catastrophic (such as Ebola or the 1918 flu pandemic) to mundane (2009 influenza pandemic). The real problem in every new case is - how do we tell which scenario are looking at?

After experiencing the preparedness and response cycles to SARS, Avian Influenza and the 2009 influenza pandemic to name a few, I think it is possible to begin to understand and predict the public awareness dynamics of these events.

The first phase is the watchful waiting phase. Most pre-events end up as aborted event with small scale dissemination and local containment within the country of origin. This has happened in the case of several new influenza strains identified in the last decade, but only a limited group of engaged professionals were following these events in real time. In the case of nCoV2019 event, too, such a watchful waiting period took place.

Once international person-to-person spread occurs, the second phase begins. This phase, which we are now experiencing, is characterized by 'fog of war' that lasts for weeks at a minimum. Preliminary 'guestimates' about how lethal and transmissible the virus is, and the attempts to model and predict the risk for uncontrolled global dissemination, add to the confusion. What we usually experience are bipolar reactions among professionals and the media - from panic of impending apocalypse (usually as first round) to over-confident reassurance that this is a false alarm (usually as second round). The first round is fueled by social media, which always favors the extreme view. But we should expect an opposite round of (largely) false reassurance, driven as a rebuttal to the apocalyptic views. In some cases, these reassuring voices aim to be able to say 'I told you so' if they turn out to be right, but to take no responsibility if they turn out to be wrong.

Both of these extreme responses are unhelpful. We must acknowledge a prolonged state of uncertainty - it will take a few weeks for reliable information to be collected and validated. In the meantime, the bipolar discussion will proceed.

Let me go ahead and guess the outline: The 'false alarm' narrative will justly claim that in fact, every winter a new virus spreads globally and kills tens of thousands of people. It is called seasonal influenza. And we have no reason to think the event here is different - the bulk of the deceased are to-date among the elderly, frail and sick, as is the case in seasonal flu. Unlike flu, very few children have so far been seriously harmed in the event.

But then again, one would justly claim that even a mere case of severe seasonal influenza -like event this spring, will have a dire impact on global public health.

The third phase is when cases are identified in one's own country / hometown. The likelihood of this for CoV2019 in most countries not yet affected such as Israel is very high, almost certain. It is possible that such cases have already passed under the radar and have not yet been identified if they were uncomplicated. In local media, this will only exacerbate the dissonance between the two polarized views. But national authorities have only one choice - to prepare for the severe scenario and hope to be pleasantly surprised. When verified data on the fatality rate will become available (not be expected in the coming two weeks), authorities could consider a policy change.

The next few days and weeks will likely be characterized by erratic movement from panic to stoic reassurance. We must continuously reassess infectivity and virulence, and judiciously use public health measures to contain the cases outside of China to extent possible, with special attention to preventing mass dissemination in healthcare institutions. The SARS event taught us that this is possible.

In Israel, the healthcare system is stretched to the limit every winter, and an epidemic of this proportion would be quite challenging. We are, however, highly prepared for emergencies including biological events, both in the community and inpatient services, and should be able to handle the first stages of this event quite reasonably.

Let's hope that this wave will pass upon us all without heavy toll in patient lives, but we must remember - in our new normal state, even after the end of the 2019 corona virus event, the next event will be coming, and it's only a matter of time.