Stories are broken into chapters to give a structure and pacing to the reader. Doing the same to the global mega event which is the Coronavirus pandemic is an important tool in testing assumptions and agreeing where priorities in fighting the virus should be.

Chapter One was the China story, one told at the most local level imaginable in the city of Wuhan. Officially the virus appeared in December, yet that story is already being challenged and could be rewritten as satellite imagery showed busier than normal hospital activity as early as August, with a corresponding spike in online searches for symptoms associated with the deadly contagion.

The world watched in awe as the Chinese made unimaginable decisions that are of course today considered a norm. Locking down cities, people in hazmat suits, building hospitals in weeks; it was action that had not been seen before to this scale in the modern age and those people keeping a close eye on it hoped that it could contain and throttle further contagion.

Chapter Two showed that the Wuhan net was either put on too late or was not tight enough to contain the virus. The second chapter of Coronavirus is that of its global spread with a focus on the developed and rich world. The worst affected countries - the USA, the UK, Italy, France and Spain - are wealthy with advanced healthcare systems.

Despite having the money and the expertise the price paid by these countries in handling the virus has been huge. Tens of thousands dead, millions of jobs lost, billions of dollars worth of stimulus or welfare paid. The economies of all of these states have dropped off a cliff with a fragile recovery threatened by the potential of a second wave of the virus.

The other part of Chapter Two was the success of certain countries in dealing with the virus. South Korea, which had learnt bitter lessons from the SARS virus, operated a highly localised test and trace scheme. Greece shut down early and quickly. Germany led Europe in terms of testing. New Zealand effectively isolated as a island nation and was able to reduce the viral count to zero.

There are exceptions to this narrative but at a trend level the story of these two chapters plays true. We are now at the start of Chapter Three where less developed countries are being hit hard by the virus. Latin America, with Brazil leading the way, Russia and now India are struggling to cope with the virus spreading.

The nature of the virus and its estimated reproductive rate - with the average person estimated to infect three others in the absence of social distancing or other protective measures - sees the virus increasing exponentially. This perhaps explains where certain countries with initially low levels of infection were unwilling or unable to take drastic actions. Yet tens of cases would translate to hundreds and then to hundreds of thousands.

The UK failed to take steps when Italy’s curve was taking off, but now studies show that the virus entered the country largely through that country as well as France and Spain. Italy’s health system was somewhat overwhelmed, with iconic pictures of patients being treated in corridors. The impact of less resourced health services being overwhelmed in the developing world is particularly bleak.

A powerful story highlighting this concern has already captured this challenge. In India a man and his pregnant wife - who happened to have a persistent cough - was alleged to have been refused access to several hospitals and tragically went on to die. An experience of the richer health care systems is that to prevent being overwhelmed they had to clear the deck of treating other health issues.

Yet cancer and other illnesses haven’t suddenly disappeared. Hospitals across the world didn’t have lots of surplus capacity to treat patients when the virus struck and the impact of Coronavirus is multiplied by denying patients treatment for other illnesses.

That is why this third chapter may be the worst so far. The prospect of under resourced health systems being overwhelmed is more likely as many of the developing countries being hit have acknowledged that their economies are too fragile to enact stringent lockdowns like the ones seen in China and Europe. If they did, these countries warn, people already living in severe poverty could starve.

The third chapter will focus on countries like India and Mexico but it will also signpost the progression to the next chapter which I would describe as the ‘forgotten impact’. In conflict affected countries like Yemen and Syria, the health systems have been targeted and dramatically reduced in operations. Here a handful of ventilators are in operation yet the data around infections and deaths are suppressed and it may be sometime before the full impact of virus is understood.

Indeed it may be that historians write chapter four. It is worth remembering that the death toll of the Spanish Flu of the early 20th century was dramatically revised upwards some 75 years after the crisis itself. A shocking but timely reminder that whilst we live in a very connected world parts of those connection provide very inconsistent data.

If chapter four is for another time, let us hope that the prospects for chapter three and the countries in the eye of the Covid storm can handle it better than some of those who were hit in chapters one and two. The fact is we know more about the virus and how it spreads than we did at the start of the year, we have early treatments available and dozens of vaccines are at a human testing stage so there is always hope.

by : jamse danselow