It was 27 April 2009, and Israel’s deputy health minister had convened an emergency press conference. A mysterious new flu virus was on the rampage, and the country was expected to announce its first case any minute. But as he addressed the media from a local hospital, it soon became clear that Yaakov Litzman wasn’t just there to reassure the public.
“We will call it Mexican flu,” he said, defiantly. “We won’t call it swine flu.”
Though the virus is now officially called H1N1, swine flu acquired its popular epithet almost as soon as it emerged. After all, the virus looked suspiciously like one known to infect pigs, and patient zero lived in a village next to an industrial farm that held 50,000 of the animals at any given time. (Read more about the search for "patient zero" in the coronavirus outbreak.)
Of course, in Israel the name “swine flu” was deeply offensive to the country’s Jewish and Muslim citizens, many of whom shun pork on religious grounds. The suggestion of “Mexican flu” followed a long tradition of naming viruses after the places they were discovered or emerged from.
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Think about the Marburg virus, a hemorrhagic fever named after a German university town; Hendra virus, which bears the name of the Brisbane suburb where it was first discovered; Zika is also a forest in Uganda; Fujian flu, which is named after a Chinese province; Ebola too carries the name of a river in the Democratic Republic of the Congo; and the infamous Spanish flu of 1918.
On this occasion, however, the Mexican ambassador to Israel hit back with an official complaint, saying that naming the virus after his country was deeply offensive. Naturally, no one wants their country associated with a deadly disease. In the end, Israel agreed that the original name was fine – swine flu would not be rebranded.
Health officials have faced a similar political tightrope recently, as the coronavirus first identified in the city of Wuhan, China, continues to be a source of growing concern. Mere weeks after it was first discovered and started spreading, it had already amassed an impressive array of sobriquets, such as “Wuhan flu”, “Wuhan coronavirus”, ”coronavirus”, “2019-nCoV”, and the rather long-winded “Wuhan seafood market pneumonia virus”. (Read more about the global efforts to fight the new coronavirus.)
On 11 February, the World Health Organisation (WHO) called a press conference to announce the official name for the disease caused by the new coronavirus – Covid-19 (a contraction of coronavirus disease-2019).
But before it was even over, the International Committee on Taxonomy of Viruses released a paper proposing a name for the virus itself: Severe Acute Respiratory Syndrome Coronavirus Two, or Sars-CoV-2 for short. This reflects research that suggests it is a close relative of the Sars virus.
The WHO won’t be using this virus name, in case the word “Sars” causes extra panic
Bizarrely, a spokesperson for the WHO told the magazine Science that they won’t be using this virus name, in case the word “Sars” causes extra panic. Meanwhile some news outlets are still calling it the “coronavirus”, while others have conflated the disease name and the species name, using both synonymously.
Are you confused yet?
The official process of naming a virus species works like this: once it’s confirmed that a new species of virus has been discovered, the scientists responsible normally think up some name suggestions, which they send to the International Committee on Taxonomy of Viruses. The committee then pick one.
The problem is, a virus can have two names – just as we refer to ourselves as humans, although our species is officially known as Homo sapiens. Unlike the species name, there is no official process for coming up with the common name for a virus. Ideally, the two would overlap, to avoid baffling situations like the one we’re currently in with the coronavirus. But this doesn’t always happen.
One reason it’s so difficult to get us all to agree is that, though there are some 7,111 languages in the world today, collectively encompassing millions of words, it’s surprisingly difficult to find an option that won’t ruffle any feathers. If the wrong word sticks, it could stigmatise an entire region, decimate an industry, or even cause a diplomatic crisis.
“It's a complex thing that people don't think much about,” says Jens Kuhn, a specialist in highly virulent viruses at the National Institutes of Health (NIH). “It riles people up in all different ways. “There are so many things in life which are controversial, but when it comes to naming, people go completely through the roof.”
The longer it takes for a virus species to be named, the more likely it is that something else will stick as the common name – like how H1N1 is commonly referred to as swine flu. The natural human instinct to name things is a powerful thing – people even started naming the machinery being used to build an emergency 1,000-bed hospital for victims of the coronavirus in Wuhan, China, after a livestream of the construction became a viral hit.
There are already 17 or so “Wuhan” viruses in existence, which range from cricket viruses to mosquito viruses
According to Kuhn, the best way to make sure the world uses the same word to refer to a virus is choose the species name well.
So what should the ideal name look like?
First, it should be unique. Calling the new virus the Wuhan coronavirus would have been problematic, explains Kuhn, who is a member of the International Committee on Taxonomy of Viruses. There are already 17 or so “Wuhan” viruses in existence, which range from cricket viruses to mosquito viruses, and most are harmless to people. Any name that links these to a human outbreak may complicate matters and make them harder to research.
The name should also be short and catchy. “I find Middle East Respiratory Syndrome (Mers) very awkward,” says Kuhn, who admits he often struggles to remember the order of the words. And if a name is too cumbersome, the public simply won’t use it. “So you want to have something nice and succinct like ‘measles’. Measles is an awesome term.”
Finally, and perhaps most importantly, it should offend as few people as possible.
“The biggest problem that I see is that the majority of people don't understand that names are just labels,” says Kuhn. Instead, we like to find meaning where none exists – and this can be treacherous.
During the 2009 swine flu outbreak, pig farmers protested that the term had led to huge losses in their industry as the public mistakenly believed that pork might be infectious. In fact, though it was a pig virus, it is thought to have been transmitted to people via a different animal – possibly migrating birds. The pigs themselves were not the problem. Nevertheless, Egypt ordered a cull of every single pig herd in the country, with some even buried alive. It was a naming worst case scenario: the words “swine flu” had sparked a fearful killing frenzy.
Similarly, when an outbreak is named after a geographical area, it’s often the wrong one.
Back in 1918, as World War One drew to a close, a formidable new flu virus was emerging. “Spanish flu” affected almost every corner of the world, from the frozen wastelands of the Arctic to the South Pacific Islands. Just a handful of obscure settlements and asylums emerged unscathed. (Read more about why the flu of 1918 was so deadly.)
Many countries suppressed the news, out of concern that it might affect public morale at a crucial moment in a long war, but not Spain. As the first cases popped up, the nation’s newspapers dutifully reported what was going on. There’s overwhelming evidence that it didn’t start there, but as one of the first countries to admit having cases, Spain acquired the dubious honour of sharing its name.
In some cases, these naming accidents can be catastrophic. Back in the 1980s, the virus now known as HIV was initially called gay-related immunodeficiency (Grid). Not only is the name offensive, but may have hampered efforts to control it. It’s been argued that associating the virus exclusively with gay white men made it difficult for the US congress to pass critical preventative legislation, because it was relegated to being a “niche liberal issue”.
It’s one thing to share your name with a natural disaster, and quite another to be associated with a potentially gruesome virus
Though the latest coronavirus has now been named, the damage may already have been done. After being explicitly linked to Wuhan in thousands of headlines across the globe for several weeks, it’s hard to imagine it being known to the public as anything other than the “Wuhan virus” in the future – though only time will tell.
In an effort to avoid a repeat of similar incidents in the future, various alternative naming systems have been proposed. One idea is to designate viruses with human names, in the same way as hurricanes are. Imagine making this call to your boss: “I can’t come to work, I’ve come down with a bout of Steve”.
But it’s one thing to share your name with a natural disaster, and quite another to be associated with a potentially gruesome virus.
Take norovirus, which causes vomiting and diarrhoea and is notoriously easy to catch (as few as 10 viral particles can do the trick). In 2011, a Japanese man reportedly filed a complaint to the International Committee on Taxonomy of Viruses about it, because Noro is a popular surname in Japan – there are approximately 19,369 Noros in the country. The organisation attempted to intervene, and suggested that it be called “Norwalk virus” instead. But it didn’t work – among the general public, norovirus was already entrenched.
Another possibility is to number them. But again, this is problematic. “There are very consistent studies out there that the human mind is really not good with numbers,” says Kuhn. Apart from anything else, he points out that small numerical mistakes have a much bigger impact than linguistic ones. The word “measles” is still broadly recognisable with a typo – “meaples” – while a number with a single digit wrong can have a different meaning entirely.
To avoid all these potential pitfalls, the WHO has published some guidelines, which suggest avoiding human, animal or place names altogether – and simply describing the symptoms a virus causes instead. Incredibly, even this system has the potential to offend.
Severe Acute Respiratory Syndrome has a name entirely by the book. And yet, according to “The Social Construction of Sars: Studies of a health communication crisis”, Hong Kong officials continued to use the term “atypical pneumonia” to describe the 2002 outbreak for quite some time, after noticing the unfortunate similarity of Sars to “Hong Kong SAR” – Hong Kong Special Administrative Region. If “Sars-CoV-2” catches on, this is one part of the world that might not be happy.
However, not everyone is so keen to avoid being associated with a virus; in some cases, naming can be a source of pride and comfort. Kuhn is aware of patients who have specifically asked to have a virus species named after them – seeing it as a small consolation prize, after all their suffering. We have a long history of naming diseases after their discoverers or victims, stretching back hundreds of years, and from “Buschke-Lowenstein's tumour” to “Cushing’s ulcer”, regardless of how grisly its symptoms were, it was always regarded as an honour.
Regardless what we call a virus, giving it a name will not prevent its spread. Perhaps it would be better to put our petty squabbles aside, and focus on that instead.
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