Over the years, I have made it my mission to notify the public (those that will listen, at least) of new infectious disease outbreaks. There have been quite a number in the last decade: Swine flu, Ebola, Zika, Chikungunya, and now, COVID-19 caused by SARS-CoV2. My first posting on the current pandemic was on January 7th, when I read reports from China of a mysterious pneumonia that had sickened a total of 60 patients in the city of Wuhan.

Now there is a report from Chinese officials about a new respiratory infection in the neighboring country of Kazakhstan. Once part of the U.S.S.R., Kazakhstan is (to my surprise) one of the largest countries in the world, but is still dwarfed by bordering nations such as Russia and China.

According to the Chinese report, the unidentified pneumonia has killed more than 1,700 people in Kazakhstan. Kazakh health ministry officials say the report doesn’t “conform to reality” but admit to seeing viral pneumonia cases in which the cause is unspecified. They add, however, that the word “unspecified” is often used for cases of COVID-19 diagnosed based on symptoms but not confirmed with laboratory tests.

The World Health Organization (WHO) believes the unspecified pneumonias are probably COVID-19. Kazakhstan has had a surge of over 10,000 COVID-19 cases in the last week or so. The organization says they are investigating the quality of testing as a possible issue. Indeed, the country has recorded 56,000 cases but only 265 deaths. This unusually low number of COVID-19 deaths makes one suspect that some of the unspecified infections are actually positive for the virus. WHO officials state that they are keeping an “open mind”.

(Aside: I believe that total cases are wildly underestimated, probably at a multiple of 10 or 20, which lowers the death rate percentage from COVID-19. I think that imprecise reporting accounts for the low death numbers in Kazakhstan more than anything else, however.)

Uncertainty about numbers can affect the ability to understand and control viral outbreaks. Statistics may be manipulated on purpose or simply by poor quality testing and reporting. I’m not an expert on the Kazakh medical infrastructure, but it’s possible that the numbers of cases and/or deaths there are not accurate.

A government may put out inaccurately low numbers in an effort to avoid panic in its citizens.  China has been accused of low-balling their case numbers and deaths.  On the other hand, a country may post inaccurately high numbers to panic another nation’s people. Could this be what’s happening in Kazakhstan?  

Totalitarian regimes may limit the dissemination of information to give an unclear picture of an epidemic’s real effect on a country. A prime example is North Korea, which like Kazakhstan, borders China. There have been no COVID-19 cases reported by North Korean health officials, but it’s likely that they exist.

Numbers may also be affected by the limitation on lab facilities to test for a disease. Testing in the U.S., one of the most highly-developed nations in the world, has been criticized. In some emerging infectious diseases, it may take months to develop an accurate test. Could Kazakh testing be any better?

The number of tests available also play a factor in the reporting of new cases. Want to drop the numbers of cases of a virus? Stop testing for it. If the tests don’t exist, COVID-19 cases aren’t recorded unless you drop the standard. If you use x-ray evidence of pneumonia instead of testing, does everyone with pneumonia become labeled a COVID patient? What happens to all the influenza cases that kill thousands of elderly every year?

These are just some of the factors that confound scientists trying to get a handle on a new viral disease. Time will tell if the mysterious pneumonia in Kazakhstan turns out to be an entirely new virus or just a new or existing strain of COVID-19. Keeping an open mind is a wise approach to emerging viral threats.

(Aside: What is going on in Kazakhstan anyway? Entire herds of native critically endangered Saiga antelope recently dropped dead of an unknown disease. During May and early June 2020, 130,000 died, /about half of the total number in existence. Veterinarians say the extent and speed of the deaths is alarming. A bacterium is suspected as the cause.)

Joe Alton MD

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