WHO: Coronavirus outbreak not yet a global public health emergency
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An emergency committee convened by WHO Director-General Tedros Adhanom Ghebreyesus, PhD, MSc, met for the second time today to review the ongoing coronavirus outbreak that originated in Wuhan, China, and recommended against declaring it a Public Health Emergency of International Concern, or PHEIC, at this time.
Tedros convened the emergency committee for the first time on Wednesday, amid a dramatic increase in the case count in China, reports of cases in Thailand, Japan, South Korea and the United States, and additional reports that human-to-human transmission has occurred. The committee determined there was not enough information to make a decision at the time and agreed to reconvene Thursday.
During Thursday’s meeting, the committee was split on whether the outbreak met the criteria for a PHEIC, and Tedros decided against declaring one.
“I’m not declaring a PHEIC today. As it was yesterday, the emergency committee was divided over whether the outbreak of novel coronavirus represents a PHEIC,” Tedros said in Thursday’s meeting. "Make no mistake. This is an emergency in China, but it has not yet become a global health emergency.”
To date, there have been 575 confirmed cases reported in China, including 17 deaths. WHO officials have reported additional cases in Thailand, Japan, South Korea, Singapore, Vietnam and the United States, bringing the total case count to 584.
Following reports of the U.S. case, the U.S. CDC and local health officials have begun screening for infected travelers coming from Wuhan on direct and indirect flights at five airports: Los Angeles International Airport, San Francisco International Airport, JFK airport in New York, Hartsfield-Jackson Atlanta International Airport and Chicago O’Hare International Airport. The airports in Atlanta and Chicago were added to the list of airports to be screened later, after the initial announcement on Jan. 17.
Other nations have announced their own precautions to help prevent further spread of the virus. Chinese officials said they will temporarily halt public transportation in Wuhan beginning Thursday morning and will cancel all flights and trains leaving from the city to reduce the risk for spread. According to more recent reports from the China Daily newspaper, Wuhan officials have also temporarily closed local and long-distance buses, subways and ferries, starting Thursday.
Additionally, the British government has also announced special measures for flights arriving from Wuhan to help prevent the outbreak spreading. Flights from Wuhan arriving at London's Heathrow Airport will now land in an isolated part of Terminal 4, where a health team will check travelers for symptoms.
Had a PHEIC been declared, additional precautions would be implemented by WHO to prevent further international transmission. According to Tedros, WHO is not recommending any broad travel or trade restrictions, though they do recommend that all countries have measures in place to detect cases.
“Again, I’m not declaring a PHEIC today, but that should not be taken as a sign that WHO does not think the situation is serious. Nothing could be further from the truth,” Tedros said. “WHO is following this outbreak every minute of every day. I will not hesitate to reconvene the committee at a moment’s notice.” – by Caitlyn Stulpin
Disclosures: Tedros reports no relevant financial disclosures.
Perspective
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Lawrence O. Gostin, JD
I agree that it is too soon for Dr. Tedros to declare a PHEIC for NCoV-2019, but the global level of concern should be high. There is a significant risk for major international spread, just as the one that occurred with SARS. Despite early reassurances from China, we now know there is human-to-human transmission with the potential for “super-spreader” events, which are key elements of an emerging epidemic. There are also vital facts we don’t know, such as the efficiency of human transmission and whether it is sustained, and the precise animal vector.
China was widely criticized for inaction and secrecy during SARS. While China did promptly report the Wuhan NCoV outbreak and shared vital genetic sequencing data, it has lacked candor and transparency. Mounting cases suggest that its contact investigations have not been adequate. Many, if not all, of the cases now in wider China, Asia and the United States were not on known contact lists. Infected or exposed passengers unknown to Chinese authorities were allowed to board airplanes. With mass movement during the Lunar New Year, the threat of a wider outbreak is real.
Despite rising levels of concern, however, the international community must remain calm and prepare wisely. Overreaction through travel or trade restrictions and unnecessary quarantines will only make matters worse and provoke public fear. It is also unlikely that border screening will work, as it was shown to be ineffective during SARS and other outbreaks. The best way to prepare is through solid surveillance and contact tracing, public health education and investing in vaccines and treatments. Governments must also be honest and transparent, giving full cooperation to WHO.
I have great faith in Tedros and WHO to bring this outbreak under control. But WHO needs more funding and support. WHO’s health emergency department and emergency contingency fund are seriously under-funded. WHO must also work with China to strengthen surveillance and contact investigations. Failure to do so will place the region and the world at great risk.
The bottom-line message for world leaders is to prepare for the international spread of this virus, but to keep calm and not overreact. Now that a case has been reported on United States soil, it is essential for President Trump to help fund and lead a global response and to avoid politicizing the outbreak through travel and trade restrictions or unwarranted quarantines.
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