The Many Causes of COVID-19
As we struggle to come to grips with COVID-19, many of us are thinking about what happens after we get on top of the current crisis. New Zealand, is in week two of a four-week lockdown, and many are asking what comes next. When will we come out of lockdown? Should we come out later? Should we come out earlier? What do we need to do to minimise the chance of this happening again. What will we need to do differently?
I’d like to explore the boundaries we put on our thinking when we consider these questions. Because the system boundaries we set determine what we see, what we consider being important and the steps we think need taking to avoid the same thing happening again.
First, what is COVID-19? The New Zealand Ministry of Health answers that question very simply, it “… is a new virus that can affect your lungs and airways. It’s caused by a type of coronavirus.” The work by Kristian Andersen and her colleagues to study the genetic sequence of COVID-19 shows that it is not just ‘new’, it is the seventh coronavirus to infect humans. Her work also shows us it had animal origins, and from evidence to date, almost certainly came from bats, through pangolins. This is a simple causal chain:
However, few of the conversations about COVID-19 include all the elements and connections shown in this simple map. The dominant conversations sit within a small boundary, the interactions between the virus and humans, and between humans themselves:
If this is where you put the boundary of your thinking, your concerns are about how the infection affects people, how it is transmitted, and how transmission can be stopped. Around the world stopping transmission has focused on ‘physical distancing’, keeping people apart to reduce the risk of infection. In some countries, of which New Zealand is one of the strictest, physical distancing has extended to lockdowns, keeping people in their homes and shutting down large sections of the economy. Thinking within this boundary also highlights the value of vaccines as a mechanism to reduce infection rates and research is being conducted all around the world to produce one. No doubt a vaccine will arrive eventually, and although there is debate about when, there is little disagreement that it will be not available anytime soon. Some however are not waiting, instead making dubious claims about the efficacy of different drugs. The one with the highest profile at the time of writing is hydroxychloroquine, promoted by President Trump. Not only is it unproven but the stockpiling and panic buying that has resulted from Trump’s claims is depriving others who need the drug for reasons that have nothing to do with COVID-19.
If you extend your system boundary, you think about how and why the virus jumped from pangolins to humans.
It is almost certain that the jump occurred in the ‘wet’ markets of China. The theory is that the corona virus crossed into humans from the Pangolin, sold as a delicacy food at the WUHAN ‘wet’ market in Hubei province in China. Wet markets sell live fish, meat and wild animals. It is there that the first case of COVID-19 originated in December 2019, although it is likely that there were undetected cases before then. Many people see these ‘wet’ markets as the cause of the outbreak and some such as Dr Anthony Fauci, a leading health professional and prominent voice in United States media has called for them to be closed down, noting that ‘many diseases have come from the “unusual human-animal interface.”
Whether or not you agree with his views, Fauci’s argument broadens our perspective of what we consider being the ’cause’ of the current pandemic. No longer just a concern with biology, but now with social and cultural practices. Vaccines, when they arrive, could protect humans from COVID-19 by reducing the chance of infection, and the closing of ‘wet’ markets may reduce the chance of a new animal virus crossing over to the human population. But what about the link between pangolins and bats?
This was a question recently raised by Laura Spinney, writing in the Guardian. The focus in the media has largely been on the interactions between humans and the link between humans and pangolins, or some other intermediate hosts. But it needed all three links to ignite the pandemic. Expanding your system boundary to explore the link between bats and pangolins raises some very important and uncomfortable issues.
Laura Spinney asks why the pandemic arose now, not 20 years ago, given that the appeal of exotic species is not new in China. What she discovers adds a whole new perspective to what we consider as a cause of this pandemic. In the 1990s China ramped up food production to what we now refer as ‘industrial farming’. This pushed smallholding farmers out of the livestock industry. Cut out of their normal farming practices, they started farming ‘wild’ species. As large-scale industrial farming spread, these small-scale farmers were pushed further and further out to areas considered uncultivable, out to areas adjoining the forest. Pangolins and other wild animals were now being farmed in higher concentrations, and close to the ‘reservoir hosts’. This set the scenario for increased transfer from bats to pangolins. Pushing the human population into previously uninhabited ecosystems is increasing the number of viruses affecting humans that are of animal origin. Covid-19 is the seventh coronavirus emerging out of animal hosts, and unless things change it is unlikely to be the last.
So, what if you broaden the system boundary, not just by adding more variables but using different terminology? Ebola, HIV and a number of ‘Avian Influenzas’ are prominent examples of this pattern.
Our modern farming methods have not only pushed transmissions vectors, such as pangolins, in large numbers right next to reservoir hosts, but through intensive farming of large numbers of animals in confined spaces we have created the perfect conditions for mutations to occur. These mutations are a necessary step for the virus to move from bats, or any other reservoir host, to humans. Research by Madhur Dhingra and colleagues has shown that the mutations that have driven the emergence of novel and highly pathogenic viruses have predominantly taken place in food production systems “transitioning from backyard to intensive production systems.” Within this system boundary the focus is not just on vaccines, or the existence of ‘wet’ markets but about how we produce the food we eat and the industry infrastructure that underpins it. A system of food production that concerned scientists says has many hidden costs that go well beyond the immediacy of COVID-19.
If we are to avoid another pandemic, with all the human and economic costs associated with it, we will need to change. But what you believe needs to change will depend on what you think the primary causes are. And what you consider the primary causes are will depend on the system boundaries you put around your thinking. If your thinking includes all the elements and their connections in the very simple map I’ve drawn then you cannot ignore the impact of our current systems of food production. If you keep your thinking within boundary 1 then you can ignore such issues and focus instead on the impact of physical distancing and the eventual arrival of a vaccine.
We all put boundaries around our thinking, usually unconsciously. But we are at a time in our history when we all need to be conscious of the boundaries we work within and therefore the challenges and opportunities we see before us.