14  Discussion

14.1  The differences between SARS and SARS-CoV-2
Although SARS-CoV-2 and SARS-CoV have certain similarities in biological, epidemiological and pathological characteristics, there are some important differences. First, the most fundamental difference between the two viruses lies in their gene sequence. Second, during the SARS epidemic, a total of 8422 patients worldwide were infected with SARS-CoV, of whom 919 died, with a mortality rate of 9.5% [9]. A total of 5328 patients in China were infected with SARS-CoV, of whom 349 died, with a mortality rate of 6.5% [9]. As of February 17, 2020, there were 72,436 confirmed cases of 2019-nCoV in China, of whom 1868 have died, with a mortality rate of 2.6% [10]. Compared to SARS, there are more confirmed cases, suspected cases and deaths of SARS-CoV-2, but the mortality rate is lower than that of SARS.
From 2017 to 2018, influenza ravaged the world, affecting up to 45 million people and killing about 95,000 people, with a reported mortality rate of about 0.2%. Every year millions of people are infected by influenza despite the existence of a yearly vaccine. According to the United States CDC weekly report, the number of childhood deaths in the United States so far from influenza during this flu season alone is 105. Compared with influenza, the number of patients who have died of coronavirus infection is less, but the virulence and mortality rate of coronavirus is significantly higher.
Clinically, the patients with COVID-19 have no upper respiratory symptoms (such as runny nose, sneezing, sore throat). In 2003, a large number of medical personnel were infected, and iatrogenic transmission occurred in SARS. In contrast, although there are cases of nosocomial infection in SARS-CoV-2, most of them are out-of-hospital infections.

14.2  What can we learn from the 2020 nCoV epidemic in China?
The SARS-CoV-2 epidemic of 2020 in China is an international crisis, affecting human lives, the global economy, societal views and lifestyle. During times of crisis, misinformation, blame and conspiracy theories abound. It is probably prudent to not entirely trust the media, whether local, regional or international, as each most likely has their own agenda. On the other hand, it is the responsibility of doctors and scientists to evaluate the events to ascertain whether or not more effective management of the crisis could have been attained. This comes with its own set of challenges, as hindsight is always 20/20.
The quarantining of an entire country has been extreme, astounding and unprecedented. This not only involves quarantining measures within China but also internationally, as countries canceled flights into China, quarantined their own nationals as they returned from China and installed thermal scanners to detect ill people. But the quarantine measures inside China are certainly eye-opening. The entire city of Wuhan was shut off, and this was extended to every other city in China. In effect, the entire country was told to stay home, creating an enormous impact on the economy and on people's daily lives. Roads and stores became deserted (Fig. 10 ). In Ningbo, each household was only permitted to send one person out for groceries every other day. Schools were closed till the end of March. Everyone wears masks. The objective was to starve the virus, to eliminate hosts. Yet even with these measures, new cases continued to appear. The quarantine measures in China have obviously come under a great deal of scrutiny, with so called “experts” weighing in, some saying that it will not work, that isolating a city deprives it of medical resources. Whatever the criticism, it is humbling to think of what may have happened without these draconian measures. It is also difficult to comprehend if such measures could actually take place in other parts of the world, or if the implementation of these changes could have taken place as quickly. For example, hand shaking is not part of Chinese culture, but it is almost automatic in other parts of the world, and it is normally done without even thinking. This is the first thing that would have to stop to help contain the virus.
Fig. 10 Life in China in Beijing and Hubei during quarantine measures. Quarantine measures have led to empty streets and shopping centers.
Then there is the matter of the ophthalmologist and others who voiced concerns in the media about a cluster of cases of a flu-like illness near the end of December. At the present time, it is difficult to say whether or not the response could have been faster than it actually was, as this corresponds to the time when work began on viral sequencing. It is possible that medical teams were already working on the sequence at that time. It is also quite possible that officials did not initially sound the alarm publicly because they did not want to cause a panic. Perhaps this was the wrong decision, but these decisions are difficult in times of crisis and it is of course easy to second guess. It is easy to understand that this can be perceived as withholding information and why the public would be frustrated. The lesson here is that dissemination of accurate and validated information and establishing guidelines to prevent the spread of infections is critical.
There are many “heroes” in these crises, people who have risked their lives and made incredible sacrifices to help society rid itself of this scourge, including those who work on the front lines, epidemiologists, scientists, doctors, first responders, and members of the public. Unfortunately, these events also bring out the worst in people. Numerous accounts of racial discrimination have been perpetrated against Asians across the world, many rising to the level of hate crimes. One must not forget the psychological impact of an infection such as this on people who are not even infected or who will never encounter an infected person.
The emergence of SARS-CoV, MERS-CoV, and now SARS-CoV-2, suggests that coronavirus will pose a lasting threat to human beings. The epidemic will eventually be contained, and people's memory of the coronavirus may gradually blur. But we must not forget the lessons learned from this crisis, and already begin to take measures to prevent the next new outbreak of Coronavirus or some other virus from appearing in the future. If it does appear, how will we respond to it? What if it does not happen in China? Will other countries have the fortitude to implement even more drastic measures and mobilize resources to prevent the spread of the virus and to care for the sick?
We can always improve on the handling of global pandemics or epidemics. From the lessons learned during the SARS and now the SARS-CoV-2 epidemics, we can nearly provide a roadmap for the response to future outbreaks. The development of a vaccine for coronavirus is a critical step in prevention, but it may not be effective for future strains, and we must be ready for the next epidemic.