We are in week two of legislated social lockdown in Gibraltar.

We are restricted from leaving our homes unless it is to attend work that has been deemed essential; to purchase essential items; to care for someone who is unable to care for themselves; to take a pet for a short walk; or for exercise. The “exercise” category is interesting, for I have noticed that the public service announcements on the radio have stopped listing this as a legitimate reason for being outdoors. We are also prohibited from having contact with anyone other than household members.

These exemptions apply to those under 70. Those over 70 are to remain home, unless they must go out for medical attention or to purchase essential items, but even then, it is strongly encouraged that others do their shopping for them. Four of the government-owned seniors homes now have 24-hour security to prevent anyone except essential services from entering. Volunteers receive good left by friends and family, and sanitize them before they are delivered to residents.

Police patrols are constant. I, and all of my friends, have been stopped at least once. So far, they have only asked where you are going, or given warnings, and then let people carry on.

These restrictions are much less onerous than those facing many other citizens around the world, and the punishment for breach is much less daunting. For example, right adjacent to us in Spain, you can leave your house only to purchase essentials. Walking a dog or exercising is illegal.

As for breaching the restrictions, people in India have been sprayed with a bleaching agent that caused damage to their skin, eyes, and lungs. Social shaming is being used in places like Paraquay, where people have been forced to lay face down on the ground and repeat, “I won’t leave my house again, officer”. In Kenya a 13 year-old boy was shot for being out after curfew – he was on his family’s balcony.

Well over 2 billion people – over one third of the entire global population – is now subject to legislated social lockdown within their own home towns or cities. Over 7.2 billion people live in countries that have imposed travel bans.

“Social distancing” or “physical distancing” are clever political correctness terms, but let’s be honest about what is really happening. We are law-abiding citizens forced into confinement, without discussion or debate, by the very governments that are supposed to serve us.

And it never had to happen.

COVID-19 is a form of coronavirus, of which there are several. Some coronaviruses are associated with the common cold, but others can cause severe respiratory infections, as we are experiencing now.

There have been other recent outbreaks of severe forms of coronaviruses.

In 2002-2003, the world experienced the severe acute respiratory syndrome, or SARS epidemic. There were more than 8,000 cases in 26 countries. Another viral respiratory illness, Middle East Respiratory Syndrome, or MERS, struck in 2012. There were about 2,500 confirmed cases of MERS, most in Saudi Arabia.

Like COVID-19, SARS and MERS originated in animals and then spread to humans. SARS and MERS spread from human to human mainly through respiratory secretions. COVID-19 is spread the same way; an uninfected person can become infected when they come into contact with respiratory droplets from one already carrying the virus. This is why transmission of the virus occurs commonly in the close confines that are necessary when a sick person is receiving health care treatment. In addition, SARS and COVID-19 can also be spread if an uninfected person comes into contact with a surface contaminated by respiratory droplets. That is why we are continually being told to wash our hands. Other methods of transmission may also be at play.

One of the main reasons that SARS spread rapidly was because of the “super-spreader”; an individual who transmits an infection to a significantly greater number of people than the average infected person. Research is underway to confirm that this is also a factor in the spread of COVID-19.

Thus, COVID-19 is not a new phenomenon; we have dealt with severe respiratory illnesses spread through respiratory secretions more than once in our recent past.

A brief overview of the SARS epidemic is also foreboding.

The SARS epidemic started in Guangdong province in China in November of 2002. It spread internationally when one of the doctors who had been treating SARS patients in China went to Hong Kong for a wedding. Those initially infected by the Chinese doctor were mainly fellow guests in the same hotel, and then the health workers that he infected when he finally went to hospital. He arrived in Hong Kong on February 21; he fell ill and died in Hong Kong on March 4. This doctor was classified as a “super-spreader”; 80% of Hong Kong’s over 1,750 cases were later estimated to have originated from him.

SARS spread even further when the hotel residents that the Chinese doctor had infected travelled abroad. One went to Vietnam, another to Toronto, Canada. Perhaps it is not surprising that as they were the first SARS cases in those respective countries they also took ill and died, but not before they infected others. Another hotel guest carried the virus to Singapore. She survived, but several of her family members did not.

The woman who went to Toronto died in her home, and her son, whom she infected, died a week later in hospital. When he was initially taken to hospital and placed in the emergency room, he was in a bed adjacent to one person, and three beds away from another person. Both of those people were treated for the non-SARS conditions that had caused them to seek attention in the emergency department. One of them was sent home after about nine hours in the ER, and the other was transferred to a ward for 3 three days and then sent home. They were in the ER with the SARS-infected patient on March 7; both were dead from SARS by March 29.

When the subsequent two patients fell ill from SARS, they had both already been released from hospital. When they returned, it was still not known that they had been in the emergency room with the SARS-infected patient. As a result, no precautions were initially taken. They infected paramedics; family members; a firefighter; other emergency room patients; emergency room staff; other hospital staff; hospital housekeeping; and emergency room visitors. These two individuals, whom had done nothing but end up being placed in an emergency room with an infected patient, infected a total of 39 other people in Toronto.

After being spread to Hong Kong, Vietnam, Singapore and Canada, SARS also then started to appear in other countries.

As more people became infected and died, countries started to impose quarantine and other distancing measures. For example, Singapore started to enforce compulsory quarantine of infected persons at the end of March, and then gradually implemented other measures such as school closures. On March 25, the province in which Toronto is located, Ontario, declared a public health emergency, and requested that thousands of people go into quarantine. All hospitals were closed to visitors except for parents visiting children or those seeing critically ill patients.

Within months, SARS had spread to more than 24 countries.

As more cases were confirmed, travel restrictions were put into place which decimated travel and associated industries. On April 24, Hong Kong announced a HK$13 billion relief package to assist the tourism, entertainment, retail and catering sectors.

The World Health Organization (WHO) placed teams in China and elsewhere to learn about the virus and track its spread. It also continuously issued alerts and travel warnings.

On April 30 the travel warning which WHO had issued for Toronto, Canada was lifted. However, on May 24, 20 new suspected cases were reported in Toronto, and by May 29, more than 7,000 Canadians were instructed to go into quarantine. It is said this second outbreak occurred because once the initial outbreak subsided, so too did Ontario’s vigilance.

The spread of SARS was stopped before it became a major health crisis in Europe, Africa, and the Americas (Toronto, Canada, being the exception), and on July 5th, WHO declared that the global SARS outbreak was contained. There were more cases in Asia throughout late 2003 and into 2004, but no cases have been reported since.

Lessons learned from SARS, and other viral outbreaks, have taught that the key to fighting such viruses is:

• to identify that there is an infectious disease
• to isolate symptomatic individuals
• to have a test for the disease
• to test symptomatic individuals and have a quick result turnaround to identify infected individuals
• to trace those who have been in contact with infected and symptomatic individuals
• to isolate and test those identified by tracing
• to have proper stocks of personal protective equipment for health care workers, and training on how to use it

The Toronto SARS experience is the perfect example of what happens when tracing is not done of those who have been in contact with an infected individual. If the two individuals that contracted SARS from their co-patient in the emergency room on March 7 had been traced, the spread to 39 other people could have been significantly reduced if not eliminated.

Other countries have taken heed of the lessons learned from past outbreaks of viral disease.

In the current COVID-19 outbreak, South Korea and the United States identified their first COVID-19 cases on the same day. South Korea immediately undertook testing and tracing, and required targeted isolation of individuals identified through the tracing. The United States did not. As of the time of writing, South Korea has 10,156 confirmed cases, and the United States has 277,522.

Unfortunately, on a global scale, testing, tracing and targeted isolation of those in contact with suspected or confirmed cases is the abnormality, not the norm.

And that is why we are in this mess.

Our governments have failed to pay attention to the lessons of the past. For all the studies that have been conducted on coronaviruses, and particularly on the SARS and MERS outbreaks, our governments have failed to take preventative measures to be prepared for another such outbreak. They do no have adequate supplies for testing nor facilities that can be converted to analyze mass testing. They have not stockpiled adequate amounts of personal protective equipment for hospital staff, nor provided adequate training for them on how to use it.

These are the very basic preventative measures that could, and ought, to have been put in place by every first world government in the world. They did not. Our governments failed to do the long-term planning and take the basic precautions necessary to protect us. So over a third of the world’s population now finds itself in chaos.

Having failed to prepare, governments did the only thing they could to prevent utter catastrophe – they imposed mass social isolation. To quote one BBC health expert, and he’s putting it mildly, mass social isolation is a “blunt instrument”. Because our governments failed to prepare to be ready to identify and track a virus with a high transmissibility rate, we have no choice.

We as individuals must now each sacrifice enormously to flatten the curve because our government chose to ignore the reality that such a curve could well come to exist.  

So let’s stop thanking our governments for taking care of us. Let’s stop praising governments for doing the best they can in these “unusual times”. The times are unusual because of the draconian measures being imposed. But the draconian measures were preventable.

We must demand that our governments stop looking only towards short term, and that they start looking towards the long term. We must demand that they become proactive, not reactive. We must fundamentally shift the way that our governments operate, and we must learn from this short term crisis, so that we can overcome the other challenges facing us.

We will get through COVID-19. But’s let’s not lose the lesson. This is our wake-up call to action.