LONDON – The COVID-19 epidemic has reached a “decisive point” as the number of new cases in the rest of the world exceeded the number of new cases in China, and seven countries reported infections for the first time.

“We are in a very, very delicate situation, where the outbreak can go in either direction, depending on how we handle it,” said World Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus, giving an update on the outbreak of the novel coronavirus on Feb. 27.

“It can be contained, but if we don’t do the right thing, it can get out of control. The window of opportunity is getting even narrower,” Ghebreyesus said. “No country should assume it won’t get cases. That could be a fatal mistake, quite literally. This virus does not respect borders.”

He warned the governments of Brazil, Georgia, Greece, North Macedonia, Norway, Pakistan and Romania to “act quickly” after they reported their first cases. “My message to each of these countries is: This is your window of opportunity. If you act aggressively now, you can contain this virus. You can prevent people getting sick. You can save lives. So my advice to these countries is to move swiftly,” said Ghebreyesus.

As of 6 am CET on Feb. 27, China had reported 78,630 cases of COVID-19 to WHO, including 2,747 deaths. Elsewhere, there are now 3,474 cases in 44 countries, and 54 deaths.

Outside China, the epidemics in Iran, Italy and South Korea demonstrate what the virus is capable of, Ghebreyesus said. “But this virus is not influenza. With the right measures, it can be contained.”

That is one of the key messages from the work that has gone into contact tracing and building understanding of the epidemiology of COVID-19 in China. “The evidence we have is that there does not appear to be widespread community transmission,” said Ghebreyesus.

For example, in the province of Guangdong, scientists have tested more than 320,000 samples from the community, of which only 0.14% were positive for COVID-19.

Ghebreysus said that suggests containment is possible, and a number of countries have done exactly that. Belgium, Cambodia, India, Nepal, Philippines, the Russian Federation, Sri Lanka and Vietnam, which have reported infections, have not had a new case for two weeks.

Each of those countries shows that “aggressive, early measures can prevent transmission before the virus gets a foothold,” Ghebreysus said.

But that does not mean those countries will not have more cases. Both Finland and Sweden detected no cases for more than two weeks, before reporting new infections on Feb. 26.

“That’s why we advocate a comprehensive approach. Every country must be ready for its first case, its first cluster, the first evidence of community transmission and for dealing with sustained community transmission. And it must be preparing for all of those scenarios at the same time,” Ghebreyesus said.

“The point is not only to prevent cases arriving on your shores. The point is what you do when you have cases,” said Ghebreyesus. He warned governments to be ready to detect cases early, to isolate patients, trace contacts, provide quality clinical care, prevent hospital outbreaks, and prevent community transmission.

Every country needs to ensure it is ready for the first case and has planned what to do when it arrives, Ghebreyesus said, itemizing a list of actions they all should take, saying these “will be the difference between one case and 100 cases” in the coming days and weeks.

“Even developed countries could be surprised,” Ghebreyesus warned. “Our message continues to be that this virus has pandemic potential.”

WHO continues to try to treat the thin line between stirring people to act and being seen to scaremonger. Ghebreyesus cautioned against fear and panic, calling on government to take action. “People can have concerns and rightly so,” he said. “The most important thing is to calm down and do the right things to fight this very dangerous virus.”

Increasing infections outside China

The case in Brazil is the first time COVID-19 infection has been seen in South America. Michael Ryan, executive director of health emergencies at WHO, said it is disappointing to see it has spread there. He has been in touch with health officials in the country.

There is a supposition, that as with influenza, COVID-19 would not be transmitted in warmer weather. But Ryan said with the current state of knowledge there is no evidence to say if the novel virus will spread or not in different climatic conditions. In his assessment, Brazil’s history of dealing with epidemics, notably Zika virus, indicates the country will be able to respond, however.

WHO is particularly concerned about the sudden increase in cases in Italy, South Korea and Iran, and the way in which COVID-19 is spreading out from those clusters.

There are now cases in Bahrain, Iraq, Kuwait and Oman that are linked to travel to Iran. In Europe, infections in Croatia, Germany, Spain and Switzerland have been traced to travelers from Italy, as has one case in Algeria, in the north of Africa.

The increase in the number of infections outside China, and in the number of countries reporting infections has again raised the question of whether COVID-19 is a pandemic infection.

Ghebreyesus said using the word pandemic “carelessly” has “no tangible benefit,” but does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems. “It may also signal that we can no longer contain the virus, which is not true,” he said.

WHO is monitoring the evolution of the epidemic around the clock and engaging experts internally and externally on the issue. For the moment there is no sustained and intensive community transmission of COVID-19, and no large-scale severe disease or death.

“Of course, we will not hesitate to use the word pandemic if it is an accurate description of the situation,” Ghebreyesus said.

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