Published on 10 July 2023

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Infectious Diseases: Are Humans the Dominant Risk?

Published on 10 July 2023

The European Commission has stated that COVID-19 will not be the last pandemic in our lifetime.

Infectious pathogens have always existed; we constantly live and work in their presence. Communicable diseases are illnesses that result from these pathogens being passed from human to human. Typically, we fight off minor infections with no long-term consequences. The world is well-versed in dealing with outbreaks – over the last 100 years it has experienced four influenza pandemics, with an occurrence every 15-30 years. Yet why does it feel like infectious diseases present a greater threat than ever before?

The European Commission has stated that COVID-19 will not be the last pandemic in our lifetime. All the next pandemic requires is a new, highly transmissible virus strain that can replicate in humans and to which the general population has little or no immunity.

There is a tendency to perceive each endemic or pandemic separately, yet some scientists maintain they are all just a symptom of how we live today. Director of the Center for Infectious Disease Research at the University of Minnesota, Michael Osterholm, said the mass threat from infectious diseases the world currently faces is “just the evolution of microbes and humans coming to a collision course”.

The Age of Humans

Last year, a scientific study confirmed what many had suspected: climate change aggravates 217 (or 58%) of the 375 infectious diseases listed in the Global Infectious Diseases and Epidemiology Network.

It's widely agreed that rising temperatures exacerbate the risk of diseases spreading to humans. Changes in climate prompt animals to move habitat, and this also provides opportunities for viruses to spill into human populations. Bacteria thrive in warmer environments, and increased flooding provides fertile ground for water-borne diseases.

Increased human mobility in the form of air travel and ever-expanding global supply chains mean that a virus can spread across the world in a matter of hours. Risks also exist from intensive livestock and poultry farming practices and the import/export of animal products, while deforestation and encroachment into virgin forests expose humans to new pathogens.

Urbanization has, in some cases, created dense, overcrowded cities, while unstable geopolitics has led to an influx of migrants in refugee camps and temporary housing – all potential hotbeds for spreading disease. According to Bloomberg, 2023 threatens to be the worst year since 1945 for people displacement. Roughly 13 million Syrians, 14 million Ukrainians, one million Rohingya and six million Venezuelans have left their homeland, along with untold others from Africa and South/Central America fleeing poverty and/or persecution.

In December, The International Rescue Committee reported worrying developments in Kenya, with the Dadaab refugee camp reporting 504 cholera cases, while a measles outbreak hit the Kakuma refugee camp following the arrival of 20,000 Somalian refugees. In October, Manston Airfield in Kent confirmed an outbreak of diphtheria – 3,000 asylum seekers were sleeping in tents in a center that was originally designed for 1,000 inhabitants.

Technological advancement in bio-weaponry also increases the risk of deliberate release, while poor biosecurity measures in laboratories could result in accidental release. In 2001, letters containing powdered anthrax spores were knowingly mailed through the US postal system. In total, 22 people, including 12 mail handlers, contracted anthrax, and five died. Consequently, federal agencies have collaborated with health departments across the country to plan and prepare for another anthrax attack.

Zoonotic Spillover

Emerging zoonotic diseases are one of the biggest threats to global health, and the number of these outbreaks is increasing annually. Zoonotic pathogens originate in animals and can be transmitted across species to humans – examples include zoonotic influenza, Ebola virus and SARS-CoV-1, SARS-CoV-2.

Although the cause of COVID-19 is yet to be determined, the principal theory is zoonotic spillover. If this is the case, it is likely the virus jumped from bats to a bridge animal and then to humans. A recent study on bats found the risk of zoonotic spillovers is on the rise due to habitat loss combined with food shortages related to climate change. Since 1996, humans have cleared a third of bats’ winter habitat and consequently they now spend longer periods of time roosting near humans and livestock.

A separate study on the same topic found that climate-induced animal habitat change was expected to double the rate of first encounters between mammal species. The study concluded that 90% of first contacts in tropical, mountainous parts of Asia and Africa involve bats. There has been a subsequent call to restore bats’ natural habitats to help prevent the next pandemic.

Outbreak Shift

There are countless examples of diseases cropping up in new and unusual places. Polio, Strep A and Monkeypox have all been in the public spotlight due to recent outbreaks. Last year, the latter was identified in 98 countries, 89% of which had never previously experienced a monkeypox outbreak. There have been occurrences of malaria and dengue in the highlands of Africa, Asia and Latin America, as well as local transmission of dengue in Europe – a development that would have been unthinkable 15-20 years ago.

The Ebola outbreak in West Africa in 2014 was intensified by urbanization. In the previous two decades, the virus was viewed as a rural village disease – it existed in isolated outbreaks because it hadn’t yet reached any densely packed cities.

Despite tuberculosis (TB) being curable and preventable, in 2021 around 1.6 million people died from the disease. While in Jan-Feb 2022 measles cases globally spiked by 79%, despite a vaccine against the disease being available since 1963.

While no two viruses are the same, they can influence other viruses’ impact in the same environment. Last year the US Centers for Disease Control and Prevention issued health alerts noting the uptick in serious cases of parechovirus infections in infants across multiple states. One medical center in Tennessee hospitalized 29 cases from January – July 2022.

Children's Mercy-Kansas City Hospital has been regularly testing for and researching the virus for years and saw virtually no cases during the COVID-19 pandemic but reported 25 cases from January to July last year. There are a variety of theories for the jump in transmission rates – such as the easing of pandemic restrictions plus the limited exposure to parechovirus during lockdown.

Liability Litigation

COVID-19 precipitated one of the largest waves of insurance coverage litigation in history. While pandemic-related business interruption has been a driving force behind this, there has also been a growing global spread of liability lawsuits relating to infectious disease outbreaks. In May last year, the California Supreme Court allowed a first-of-its-kind case to go to trial – a woman sued her employer, See’s Candies, claiming her husband died after she brought home COVID-19 from on-site work during lockdown.

Negligence and wrongful death cases against long-term care providers in the US also mushroomed last year, with one Chicago law firm bringing 78 cases against nursing homes in March alone.

In 2022 at least 23 COVID-19 wrongful death suits were filed across the US against businesses. Currently none have ruled in favor of the plaintiff, but two were settled out of court.

If the cadence of infectious diseases continues to rise and spread, organizations are at increased risk of litigation regarding their handling of any future epidemic/pandemic. Negligence can arise on the part of organizations in a variety of areas, leading to potential lawsuits:

• Outbreaks
• Unsafe work culture
• Sanitation
• Reporting
• Pre-screens & Surveillance
• Vaccination & Testing
• Quarantine Process

 

Counter-Attack

Viruses and microbes don’t stand still – they are constantly mutating to cause higher infection and disease rates and longer infection chains. Therefore detection and containment measures are under pressure to continually evolve at the same pace.

Understanding, modelling, prediction, surveillance, intervention and prevention of infectious diseases has greatly increased in recent years. Developments in outbreak detection have improved how we deal with pandemics now. Contact tracing is routine following the COVID-19 pandemic, and testing and tracing will continue to play a part for notifiable diseases.

Rapid testing and pre-screening questionnaires have become a simple and expected part of day-to-day business in many industries. Consequently, testing has become faster and cheaper while advances in genetic sequencing can provide evidence of transmission through phylogenetic linkage in some cases.

Social media’s role in the spread of misinformation was highlighted during the COVID-19 pandemic. Greater education and awareness of medical information relating to infectious diseases is required to counter-act this toxicity. Other preventative measures are greater regulation the trade of wild animals, particularly live animals in wet markets, and wider reporting of sickness in poultry farming along with surveillance of wild birds.

Early detection of spill over events is important, alongside rapid reporting of cluster cases of infectious diseases in hospital. Overall, greater investment and data-sharing at country and global level is needed to understand the true nature of the evolving risk landscape.

Certainty of Coverage

COVID-19 and the increased threat of a new pandemic has irrevocably altered the insurance market. Communicable disease and pandemic exclusions are now commonplace and may have removed more cover than perhaps realized by the insured.

Affirmative protection can provide certainty of coverage (financial and otherwise) regarding outbreaks and infectious disease spread. This is where Alesco and its access to the London market can help with providing coverage to offer these organizations suitable protection.

MCI’s Infectious Disease Liability (IDL) policy is a fully researched and breakthrough insurance product designed to help entities reduce the uncertainties associated with infectious disease.

Summary of coverage:

• Third-party bodily injury claim coverage resulting from an infectious disease outbreak where negligence has been alleged
• Two or more people infected at the same location, with the same pathogen, within a 14-day period constitutes as one outbreak
• Each and every outbreak incurs one deductible
• Only one person needs to make a claim
• COVID-19 is covered in most instances, along with future variants
• Future unknown pandemic risks are covered
• Hospital-acquired infections or locally acquired infections that then develop into outbreaks on the Insured premises are covered
• Defence costs are within the limit.