Continued — Part Three of “Coronavirus: Facts We Need to Know and What We Can Do”

If we look at the history of dangerous viruses globally, one of the deadliest viruses of the twenty-first century has been the H5N1 influenza virus, known as avian influenza or bird flu. Since the suspicious death of a three-year-old boy in 2003 led to investigation and identification of the virus, and through the subsequent cases that have occurred, the virus has killed only 445 people, despite a reported fatality rate of 60 per cent. In other words, the likelihood of dying after contracting this virus is greater than the likelihood of surviving it. Yet we see that it has been contained effectively, because the severity of its symptoms, rapid identification of new cases, and international preparedness have prevented widespread transmission. Even two very dangerous close relatives of coronavirus, SARS and MERS, have each so far caused fewer than one thousand reported deaths, while even at this moment coronavirus has produced roughly three times the death toll of either one.

What makes coronavirus particularly dangerous is not an exceptionally high fatality rate, but its distinctive characteristics.

The virus is potentially fatal, but its fatality rate is not as high as that of some previous viruses and is estimated here at only around 1–3 per cent. Many infections produce only mild symptoms, making them difficult to identify even though those people may still transmit the virus to others. For this reason, over a wide population the virus could produce a much higher total number of deaths.

In this respect the virus can be compared with influenza. The fatality rate of influenza is only around 0.1 per cent, but hundreds of millions of people contract it each year and in the United States alone roughly forty thousand people a year die from the disease. Even if we assumed that Iran’s medical facilities were equal to those of the United States, given that Iran’s population is approximately one quarter of America’s, in the most optimistic scenario more than ten thousand people—and realistically many more than ten thousand—would die from influenza in a year, even though a vaccine exists.

Influenza is not a virus that can be completely controlled anywhere in the world, because complete control is impossible. At present, even in the most favourable estimate, coronavirus appears around ten times more lethal than influenza. In Iran, at this moment, the observed proportion is unfortunately far higher, and in China it has also been much higher. This situation will probably improve after vaccines become available in the coming years, but it is conceivable that the virus may remain endemic with seasonal outbreaks similar to influenza. This would mean that, in the first year, if complete elimination is not achieved, the number of deaths across Iran could be tens of times higher than deaths from influenza, a situation that, if it occurred in an unprepared society without an accurate understanding of what lay ahead, could bring that society toward social and psychological collapse.

Another major problem is how much remains unknown about the behaviour of this virus. With influenza we know that its pattern is largely seasonal and that after the cold season it usually becomes less visible. Although something similar may happen with coronavirus, it is also possible that the virus could continue taking lives throughout all twelve months of the year.