LONDON – The World Health Organization (WHO) has officially declared COVID-19 a pandemic, but is pushing back strongly against countries giving up on stringent control measures.
“Pandemic is not a word to use lightly or carelessly,” said WHO Director General Tedros Adhanom Ghebreyesus. “It is a word that if misused can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.”
Describing the situation as a pandemic does not alter WHO’s assessment of the threat posed by the coronavirus. “It doesn’t change what WHO is doing, and it doesn’t change what countries should do,” Ghebreyesus said.
“We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic,” said Ghebreyesus. If countries detect, test, treat and isolate cases, and trace contacts, those with a handful of cases can prevent them from becoming clusters, and those clusters from becoming community transmission.
“Even those countries with community transmission or large clusters can turn the tide on this virus,” Ghebreyesus said.
WHO is insistent that the COVID-19 pandemic should not be viewed in the same light as seasonal flu, and that control measures and contact tracing can level out the rate of infection. Michael Ryan, executive director of health emergencies, said the examples of China, South Korea and Singapore demonstrate “there is a strong chance of bending the curve.”
That can buy time to prepare. “In many cases, what we are seeing is a lack of resilience. Health care systems are running at 99% of capacity and can’t take more on,” Ryan said. At the very minimum, contact tracing will suppress the epidemic and reduce the number of cases per day. Maintaining this effort “is better than shutting down whole communities,” said Ryan.
WHO shifted its position in the light of cases outside China increasing 13-fold over the past two weeks. In that time, the number of affected countries has tripled to 114, and there have been more than 118,000 confirmed cases. As of March 11, 4,291 deaths from COVID-19 have been reported.
“WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,” Ghebreyesus said in a press briefing on March 11.
WHO declined to name countries it considers have not made adequate preparations. Ryan said, “We don’t criticize member states in public,” adding, “You know who are.”
Reacting to WHO moving to classify COVID-19 as a pandemic whilst maintaining its advice on how to respond, Mark Woolhouse, professor of infectious disease epidemiology at Edinburgh University, said it is important any control measures are sustainable. “It is now clear that COVID-19 is going to be with us for a considerable length of time and the actions that we take must be actions that we can live with for a prolonged period,” he said.
Ghebreyesus acknowledged control measures are “taking a heavy toll on societies and economies.” All countries “must strike a fine balance” between protecting health and minimizing economic and social disruption, he said.
Newly published data from China on how non-medical interventions, including case isolation, contact tracing, self-quarantine and travel bans, influenced the course of the epidemic there, show these measures led to the decline in the numbers of cases being reported. The study also suggests that had measures been implemented just two weeks earlier, there would have been significantly less spread within China (and presumably, beyond).
Some control measures are now being lifted in Hubei province and the city of Wuhan, the epicenter of the epidemic. However, modeling in the study indicates lifting travel bans could open the way for a second wave of infections, unless person-to-person contact continues to be held below normal levels.
The authors suggest that similar interventions could control COVID-19 epidemics in countries outside China. If the same sort of control measures are to be introduced elsewhere, as is the case in Italy, for example, “they should be accompanied by a clear exit strategy that sets out the circumstances under which restrictions on normal life will be lifted,” Woolhouse said.
For Michael Head, senior research fellow in global health at Southampton University, U.K., the declaration of a pandemic is meant as a wake-up call for countries that have been slow to respond. “WHO stated that some countries are struggling with a lack of resources, but also a lack of resolve. This is clearly a direct indication that they consider many countries have been slow to scale up their responses,” he said.
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