Global coronavirus response sheds harsh spotlight on longstanding crises

With his first visit to Wuhan since the city became "Ground Zero" of the COVID-19 pandemic, China's President Xi Jinping marked an important turning point in his country's battle against the coronavirus pandemic that has raised the prospect of collapsing health systems and a new recession. Even as European countries like Italy implement nationwide shutdowns, the drop in new COVID-19 cases across China is giving researchers the chance to observe some surprisingly positive side effects of the country's response efforts.

The most prominent of these has been a precipitous drop in air pollution levels in major Chinese cities. Officials there acted to slow the spread of the virus by reducing industrial activity and allowing many workers to stay home. By taking factories and power plants offline and removing cars from the road, these public health measures have seen levels of harmful pollutants like nitrogen dioxide (NO2) fall by up to 30%. Levels of PM 2.5 fine particulate matter, linked to asthma, heart attacks, and respiratory issues, are at their lowest in six years.

These substantial improvements in air quality across China, while impressive, are sadly little more than an ephemeral silver lining of the country's response to extraordinary circumstances. China's air pollution levels will almost certainly go back to their typical, harmful levels once COVID-19 has been tamed, just as they did after the Beijing Olympics in 2008.

In this lies the paradox of the global response to coronavirus. Governments and international institutions have quickly marshaled billions of dollars to tackle a pandemic that has killed just over 4,700 people. Those same entities, however, have proven incapable of saving millions of lives each year by ensuring access to clean air and safe water in developed and emerging economies alike.

Dangerous air and deadly water

China, with its estimated toll of 1.6 million people felled by air pollution each year, is a poster child for a global public health crisis that will never be solved with a vaccine. In neighboring India, air pollution killed an estimated 1.24 million people in 2017. Fully 95% of the global population breathes air that does not meet the World Health Organization (WHO) guidelines for PM 2.5 levels. Even in wealthy, industrialized countries like the United States, PM 2.5 is blamed for over 85,000 deaths per year.

While most of the world does not have clean air to breathe, a substantial minority also lacks access to clean water and sanitation. These are dangers to public health in their own right but can become catastrophic in the event of an epidemic. Analysis of coronavirus patients in Wuhan and the United States, for example, found that the virus could be transmitted through stool, and a previous outbreak of a related virus – the 2003 SARS epidemic – saw the virus transmitted to hundreds of residents of a Hong Kong housing estate through airborne fecal matter. 17 years later, Hong Kong officials once again found themselves investigating whether COVID-19 was spreading between neighbors through improperly-sealed sewage systems in a housing complex.

Of course, while the presence of links between water and sanitation systems and the spread of diseases such as SARS and COVID-19 remains an open question in wealthy jurisdictions such as Hong Kong, waterborne and fecal-borne pathogens remain a fact of life across the developing world. WHO Director-General Tedros Adhanom Ghebreyesus declared coronavirus a pandemic this Wednesday, March 11^th. Cholera – the "forgotten pandemic" that has largely disappeared from Europe and North America – has for its part been an active pandemic for nearly sixty years.

Cholera infects as many as four million people each year, killing anywhere from 21,000 to 143,000 patients across Africa and Asia. Haiti's 2010 cholera epidemic went on for nearly a decade and killed nearly 10,000 people. Yemen, whose healthcare system and infrastructure have been shattered by years of warfare, registered over 2,236,000 cases between October 2016 and November 2019. Cholera has largely been eradicated in the world's richest countries, but 663 million people, nearly half of whom live in sub-Saharan African countries, still drink water from unprotected sources that put them at risk for this and other maladies.

Not all victims are treated equally

Of course, even after water sources have been "protected," they can still be contaminated by dangerous pathogens, pollution, or faulty infrastructure. The infamous water crisis in Flint, Michigan in the United States, where the water supply for a city of 100,000 people was contaminated by dangerous levels of iron and lead, demonstrates that even those living in the world's wealthiest economies are not immune from all of the potential dangers borne by unsafe water.

Nevertheless, the fact that diseases such as cholera, dysentery, and typhoid fever overwhelmingly impact lower-income countries is one of the best examples of how the unevenness of global development has radically altered the quality of life across much of the planet. The private sector has helped address at least part of this gap, with many in high-income and low-income countries relying on bottled water when their municipal water supplies put them at risk.

Once the global health community has managed to bring the coronavirus pandemic under control, it should leverage the spirit of international cooperation created by this crisis to tackle the many other threats that the planet's deeply flawed development poses to public health. The impacts of pollution, unsafe drinking water, poor sanitation, and even climate change pose a clear and present danger to the well-being of billions of people on a daily basis. As the rapid spread of COVID-19 has once again taught us, no public health threat stays localised in a globalised world.