Have we finally opened Pandora’s Box?

It is 2025 and there’s already the fear of a new emerging pandemic.

A surge in cases of the flu-like human metapneumovirus (HMPV) in China has raised fears of another COVID-style pandemic. Images of hospitals overrun with masked patients have circulated widely on the social media. Like many respiratory infections, the HMPV is most active during late winter and spring. This is because viruses survive better in the cold and can pass more easily from one person to another as people spend more time indoors with closed windows.

In northern China, the current HMPV spike coincides with low temperatures that are expected to last until March. Many other countries in the northern hemisphere – including the US – are also experiencing a growth in the rates of HMPV.

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Is HMPV the new COVID? Are we headed for another pandemic?

The CDC says that fears of a COVID-style pandemic are overblown, noting that such events are typically caused by new viruses, which is not the case with HMPV.

First identified in the Netherlands in 2001, HMPV spreads through direct contact between people, or when someone touches a contaminated surface. The virus leads to a mild upper respiratory tract infection for most people and is usually almost indistinguishable from the flu. The disease is already globally present and has been around for decades. This means that most people across the world already have some degree of existing immunity due to previous exposure.

So, there is no cause for alarm.

And yet, despite all the advances in health care over the past centuries, new viral outbreaks keep popping up, causing significant morbidity and mortality.

Have we finally opened a Pandora’s box?

According to Greek mythology, Pandora was the first woman created by the gods. This woman, Pandora, was given life and endowed with gifts from the gods: beauty from Aphrodite, wisdom from Athena, charm from Hermes and curiosity from Hera. Her name, “Pandora,” means “all-gifted” or “all-giving.”

Zeus also gave Pandora a jar (commonly misinterpreted as a box due to a mistranslation of the Greek word pithos). This jar contained all the evils and misfortunes of the world, but Pandora was instructed never to open it. Driven by her curiosity—a trait given to her by the gods – Pandora eventually opened the jar. As soon as she did, all the evils, diseases, sorrows and hardships the gods had sealed inside flew out, spreading across the world. Terrified, Pandora quickly closed the jar, but it was too late; most of its contents had already escaped.

As a child whose imaginary world was filled with dragons and fairies and whose curiosity always got me in trouble, this mythical story often served as a cautionary tale about the consequences of curiosity and disobedience.

Of course, we know that these viruses did not escape from a jar: RNA sequences closely resemble those of viruses that silently circulate in bats, and epidemiologic information implicates a bat-origin virus infecting unidentified animal species sold in China’s live-animal markets.

We have recently seen many such emerging zoonoses, including the 2003 bat-coronavirus–derived SARS (an earlier severe acute respiratory syndrome caused by a closely related coronavirus), which came terrifyingly close to causing a deadly global pandemic that was prevented only by swift global public health actions and luck.

In 2019, the COVID pandemic hit. Now, 25 years after SARS, we stand at a similar cliff. How did we get to this point, and what happens next?

The reality is that in our crowded world of approximately 7.8 billion people, a combination of altered human behaviours, environmental changes and inadequate global public health mechanisms now easily turn obscure animal viruses into existential human threats.

We have created a world dominated by humans, where animal viruses—especially RNA viruses known for their quick mutations – find plenty of chances to jump to new hosts and ecosystems. While it took humans 8 million years to evolve by just 1 per cent, some RNA viruses can achieve that level of change in just a few days. It is no wonder we are seeing more of these zoonotic viruses emerging. It is like a very scary horror movie unfolding before our eyes.

We have actually been watching such dramas play out in slow motion for more than a millennium as in the case of pandemic influenza, which begins with viruses of wild waterfowl (the host)-switch to humans and then cause human-to-human transmission.

A bird virus thereby becomes a human virus. Coronavirus emergence took a different trajectory, but the principles are similar: SARS, the Middle Eastern respiratory syndrome (MERS), and COVID-19 all apparently have their origins in enzootic bat viruses. One human cultural practice in one populous country has thus recently led to two coronavirus near-pandemics and thousands of severe and fatal international cases of “bird flu.”

If it had been Nigeria, the whole world would have crucified our ‘backward eating habits and culture.’

But these are not the only examples of deadly viral emergences associated with human behaviours. HIV emerged from primates and was spread across Africa by truck routes and sexual practices. The origin of Ebola remains uncertain, but in 2014–2016, the virus spread explosively in West Africa, in association with fear and secrecy, inadequate infrastructure and information systems and unsafe nursing and burial practices.

Emergences of arenaviruses causing Argentines and Bolivian hemorrhagic fever are associated with agricultural practices, and Bolivian hemorrhagic fever was spread across Bolivia by road building that fostered migration of reservoir rodents. In Southeast Asia, Nipah virus emerged from bats because of the intensification of pig farming in a bat-rich biodiversity hot spot. Human monkeypox emerged in the United States because of a booming international wildlife trade. In the 1980s, Aedes albopictus mosquitoes were being spread globally by humans; in 2014 and 2015, we had pandemics of aedes-borne chikungunya and Zika viruses.

With luck, public health control measures may be able to put the demons back in the jar. If they do not, we face a daunting challenge equal to, or perhaps greater than that posed by the influenza pandemic of a century ago.

As the late Nobel laureate, Joshua Lederberg famously lamented emerging infectious diseases, “It’s our wits versus their genes.” Right now, their genes are outwitting us by adapting to infectivity in humans and to sometimes silent spread without so far revealing all their secrets.

But we are catching up. As we push ahead, we should take heart in the Hesiod version of the Pandora myth, in which Pandora managed to prevent a single escape: “Only hope was left …, she remained under the lip of the jar and did not fly away.”