JANUARY 30, 2020
The World Health Organization on Thursday declared the outbreak of a novel coronavirus a global health emergency, an acknowledgement of the risk the virus poses to countries beyond its origin in China and of the need for a more coordinated international response to the outbreak.
In making the announcement, WHO leaders urged countries not to restrict travel or trade to China, even as some have shut down borders and limited visas.
Late Thursday, the U.S. State Department increased its travel warning for China, saying people should avoid going to the country. In a tweet, Secretary of State Mike Pompeo cited the emergency declaration and the ongoing spread of the virus for the decision, despite what WHO leaders said about travel policies.
“This is the time for science, not rumors,” WHO Director-General Tedros Adhanom Ghebreyesus said following a meeting of the agency’s emergency committee. “This is the time for solidarity, not stigma.”
Tedros, as he is called, stressed the decision was not meant to criticize the Chinese response to the outbreak, which he and other WHO officials have gone out of the way to praise. Instead, he said, the declaration of a public health emergency of international concern, or PHEIC, is meant to help support less developed countries and to try to prevent the virus from spreading in those places that are less equipped to detect the disease and handle infections.
“We don’t know what sort of damage this virus could do if it spread in a country with a weaker health system,” Tedros said.
Last week, the committee had recommended that a PHEIC not be declared yet because of limited spread of the virus outside of China. Tedros reconvened the committee this week because some other countries, including Japan, Germany, Vietnam, and, as of Thursday, the United States, had reported limited human-to-human transmission of the virus — a warning sign that the virus could start circulating more broadly outside China.
Members of the emergency committee had previously been divided over whether to recommend Tedros declare a PHEIC. Those opposed seemed to want to see if China’s efforts to control the outbreak could prevent broader worldwide transmission. Some 99% of the global cases have been in China, and the large majority of infections in other countries have been in people who picked up the virus while in China and then traveled to the other nations.
Didier Houssin, who leads the committee, said members on Thursday “almost unanimously” backed the PHEIC because of the rise in cases in China, the number of countries outside of China — now 18 — with cases, and what he called “questionable measures” taken by countries in their travel policies toward China.
As of Thursday morning, there have been more than 7,800 confirmed coronavirus infections around the world, all but 98 of which were in China. There have been 170 deaths, all in China. Infections caused by the coronavirus, provisionally called 2019-nCoV, were first reported in December in the central Chinese city of Wuhan, though it’s possible the virus was spreading among people there before then.
The declaration comes as individual countries have started to close borders and restrict trade to China, and as airlines have halted some flights. Experts say such measures are not effective in stopping the spread of a virus and may discourage countries experiencing outbreaks from being forthright. The PHEIC gave Tedros the authority to formally recommend that countries not limit travel and trade to China, though other nations do not have to comply.
Still, the PHEIC could rally some global coordination for a more unified response. Dr. Michael Ryan, the WHO’s emergency chief, told reporters Wednesday that 194 countries implementing unilateral trade and travel restrictions was an economic, political, and social “recipe for disaster.”
Tedros on Thursday said more important than the PHEIC declaration were the recommendations from the emergency committee, which included speeding the development of vaccines and therapeutics, combating misinformation, and supporting countries with weaker health systems.
“The only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation,” Tedros said. “We are all in this together and we can only stop it together.”
So far, there have been no confirmed cases of the virus anywhere in Africa. But public health experts worry that countries there may not be as equipped to detect cases and control the potential transmission of the virus as many countries with stronger health infrastructure. China has made huge investments in Africa in recent years, with increasing travel back and forth; experts fear that the virus could easily move to the continent from China.
Also Thursday, the WHO said it plans on provisionally calling the disease caused by the virus “2019-nCoV acute respiratory disease” until officials settle on a name.
WHO officials stressed that they and national health officials around the world had still mounted a wide-reaching and aggressive response to the outbreak. At a press conference Wednesday, they seemed to lament that so much attention was paid to the binary of whether something was a PHEIC or not a PHEIC. Tedros said he wished it was more like a stop light, with yellow serving as a warning.
It’s seen as “PHEIC, no PHEIC, either green or red,” Tedros said. “I think we have to revise that. It would be good to have the green, the yellow, and then the red, something in between. … There could be some intermediate situation.”
China has taken unprecedented steps to try to contain the outbreak, quarantining tens of millions of people in Wuhan and other cities by shutting down travel within, to, and from the areas. Experts, however, say, it’s not clear such massive efforts are likely to prove effective, given that the virus seems to be spreading in many locations in China and that the lockdowns could keep or drive people away from seeking care if they are sick.
There have been some questions about China’s response, including whether it was equipped for such an outbreak, it has documented all deaths from the virus, and it has been forthcoming about when the virus started spreading among people. But WHO officials have repeatedly lauded the country’s response.
On Thursday, Tedros said that were it not for China’s efforts, “we would have seen many more cases outside China by now.”
In the United States, officials have been screening passengers arriving from Wuhan for signs of illness and informing them to call a health care provider if they start to get sick. (Officials from the Centers for Disease Control and Prevention have said the number of people arriving from Wuhan has dropped since China imposed the travel ban from there, but that they were continuing with their screening policies.) The CDC has also boosted surveillance at 20 entry points where officials are normally based in case an arriving traveler shows signs of a disease.
There had been five confirmed cases of the coronavirus in the United States, all related to travel to China. But just hours before the WHO declared the PHEIC, the CDC announced that one of those people — a woman in Illinois — had passed the virus on to her husband. U.S. officials had anticipated an incidence of such limited transmission and are working to prevent any broader spread of the virus.
WHO officials have said if sustained transmission of the virus occurs outside China, it becomes much harder to stop overall.
The virus can cause severe cases of pneumonia and milder cases of cough and fever, according to studies of early infections in Wuhan. It’s likely that authorities have not been able to keep track of many mild cases, including people who were not sick enough to seek care, and researchers have documented cases of the virus in people showing no symptoms.
It’s not clear if people need to be showing symptoms to pass the virus on, though even if asymptomatic people can spread the virus, they may be less likely to than people who are sneezing and coughing — routes for the virus to jump from one person to another.
Coronaviruses, a family that includes SARS and MERS, are thought to originate in bats and can jump from there or another animal to humans. Many of the early cases in Wuhan — though not all — were tied to a seafood market that also sold live animals for meat.
The emergence of a global coronavirus outbreak from China is reminiscent of the SARS outbreak of 2002 to 2003, which went on to kill nearly 800 people. The PHEIC designation was created following an update to the International Health Regulations after that outbreak.
The first PHEIC was declared for the 2009 H1N1 flu pandemic, and others have included the 2014-2016 West African Ebola outbreak and the Zika outbreak in 2016. The WHO set up an emergency committee to assess whether MERS should be declared a PHEIC, but it concluded after meeting several times that the disease did not constitute a global health emergency.
Ahead of WHO’s decision Thursday, there were two active PHEICs: the ongoing Ebola outbreak in the Democratic Republic of the Congo and the continued transmission of polio.
This story has been updated with information about U.S. travel warnings for China.
Did WHO’s China ties slow decision to declare emergency?
GENEVA/BEIJING — A day after the World Health Organization declared the new coronavirus a global health emergency, some are questioning whether the Chinese government’s ties to the United Nations agency may have contributed to the time it took to make the decision.
WHO Director-General Tedros Adhanom Ghebreyesus heaped praise on China in Thursday’s news conference in Geneva announcing the emergency.
“The Chinese government is to be congratulated for the extraordinary measures it has taken to contain the outbreak,” Tedros said.
“The speed with which China detected the outbreak, isolated the virus, sequenced the genome and shared it with WHO and the world are very impressive and beyond words,” he said, and noted that China is setting “a new standard” for outbreak response.
But a diplomatic source in Geneva simply called the WHO declaration “too late.”
The WHO decided against declaring a global health emergency at a Jan. 23 meeting, when Tedros said there was no evidence of human-to-human transmission outside China. The number of patients grew more than 10 times worldwide to exceed 9,000 in the week that followed.
During the 2002-03 epidemic of severe acute respiratory syndrome, or SARS, the Chinese government was heavily criticized for hiding information. Beijing has put an emphasis on cooperating with the international community this time.
But it also allowed millions of citizens to travel abroad for the Lunar New Year holiday, even after the illness in Wuhan was known. Those travelers ended up becoming carriers of the coronavirus to multiple countries.
Chatter in diplomatic corridors has it that China’s roles in the global economy and the WHO itself may have played a factor in the U.N. agency’s delay in declaring an emergency. An emergency declaration would undoubtedly squeeze China’s tourism and logistics chains, exposing President Xi Jinping and his leadership team to increased public dissatisfaction.
When Tedros met with Xi in Beijing on Tuesday, the Chinese leader explained how the country had released information about the epidemic in a timely, open and responsible manner and had enhanced cooperation with the international community, China’s official Xinhua News Agency reported. Xi told Tedros that he “believes that the WHO and the international community will assess the epidemic situation in an objective, just, calm and reasonable way,” according to Xinhua.
It was seen as an expression of hope that the U.N. agency would refrain from designating the epidemic a global health emergency.
When Tedros met with Chinese Foreign Minister Wang Yi that day, he said that the WHO does not recommend the evacuation of nationals, citing his confidence in China’s epidemic prevention and control abilities, Xinhua reported. The U.S. and Japan flew citizens out of Wuhan by chartered planes the next day.
A source familiar with the WHO’s decision-making acknowledged that the agency had to consider not just the infectiousness of the coronavirus, but the economic impact of declaring a health emergency. China accounted for 4% of global gross domestic product in 2003, a share that has since grown to 17%.
“China and the WHO have extremely close ties,” a diplomatic source in Beijing said. China is the world’s second-largest financial contributor to the U.N. The WHO’s previous director-general, Margaret Chan, was nominated to the post by the Chinese government after spearheading Hong Kong’s response to SARS.
Using its diplomatic weight, China has blocked Taiwan’s attendance at the WHO’s annual health assembly since 2017, the year after China skeptic Tsai Ing-wen became the island’s president.
China also provides significant aid to Ethiopia, the home country of current WHO chief Tedros. And Xi’s wife, Peng Liyuan, is a longtime WHO goodwill ambassador for tuberculosis and HIV/AIDS.
While declaring an emergency, Tedros did hold back from imposing travel or trade restrictions. “There is no reason for measures that unnecessarily interfere with international travel and trade,” he said Thursday in Geneva.
Nonetheless, WHO members have begun erecting their own barriers.
The U.S. State Department is urging Americans to not travel to mainland China, the highest of its four travel advisory levels. while Russia has shut 16 border checkpoints with China.
The WHO has come under fire for its response to recent outbreaks. It declared a global emergency during the 2009 H1N1 flu outbreak, but was later accused of overreacting when the disease turned out to have a limited impact. It waited months to declare an emergency during the Ebola epidemic of 2014 to 2016, drawing criticism for dragging its feet as the death toll swelled.
Now the Coronavirus is not a Pandemic…..
What is a Pandemic??
Doshi argues cogently that the definition of pandemic influenza in 2009 was elusive but does not refer to the classical epidemiological definition of a pandemic.1 A pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”.2
The classical definition includes nothing about population immunity, virology or disease severity. By this definition, pandemics can be said to occur annually in each of the temperate southern and northern hemispheres, given that seasonal epidemics cross international boundaries and affect a large number of people. However, seasonal epidemics are not considered pandemics.
The coronavirus has spread to over 28 Territories …How many do we need til it’s a full blown disaster? I think we already have the answer.