WHO’s team of experts lands in Tehran to support the COVID-19 response in Iran.

As Iran faces one of the most serious surges in COVID-19 cases around the world, WHO’s Director General Dr Tedros Adhanom Ghebreyesus, welcomed US President Donald Trump’s olive branch toward its bitter enemy, who on Monday told the Conservative Political Action Congress  “if we can help the Iranians with this problem we are certainly willing to do so.”

“I would like to comment on the statement of the United States, in support of Iran,” said Ghebreyesus, speaking at a WHO press briefing, shortly after a WHO team had touched down in Tehran, laden with materials for 200,000 COVID-19 lab tests as well as health worker protective equipment, funded by the United Arab Emirates.

“I think we have a common enemy now, and using health, and especially fighting this virus as a bridge for peace, is very, very important,” Dr. Tedros said, adding that the United Arab Emirates support for the aid parcel was “another example of solidarity.”

“This is very encouraging,” he added.  “We would like to thank the two countries, but also stressing the importance of solidarity at this time. It’s a common enemy and we have to stand together in unison to fight it. These early signs are very encouraging and as humanity we should stand together.

Despite reports of some 8739 infections proliferating in over 60 countries abroad, WHO Officials remained optimistic that containment of the new COVID-19 virus might still be possible – even to the point of eventually interrupting transmission “if we are effective and lucky.”

But even if that endgame proves elusive, the same aggressive measures will slow down the virus’s onward march – as China’s example has now demonstrated, said WHO’s top emergency team leadership on Monday.

The effects of China’s containment strategy were visibly on display Monday, Dr Tedros underlined. China was reporting just 207 cases in the last 24 hours, the lowest numbers since 22 January, and only 8 of those cases had occurred outside of the virus epicentre of Hubei Province. In contrast, cases abroad were nine times higher than the previous day. Along with Iran, epidemics in in Italy, the Republic of Korea and Japan continued “are our greatest concern,”  the WHO Director General underlined.

Global Cases of COVID-19 as of 5:30PM CET 2 March 2020.

UN in Geneva, Louvre and Other European Institutions Follow Italy In Closing Doors To Public

In Europe, both governments and institutions were ramping up their responses, amidst spontaneous reactions of public concern.

The UN headquarters in Geneva, which welcomes about 100,000 visitors a year, “temporarily” suspended public tours on Monday. Switzerland banned public gatherings of over 1,000 people, a move that was soon followed by the cancellation or postponement of upcoming meetings and events in the Geneva hub of international institutions and NGOs, which are clustered in the city.

And the Louvre Museum in Paris which welcomes some 30,000 visitors a day, remained closed for a second day, while employee union representives reviewed personal protective measures with the museum management, which had offered them hand sanitizer, while they were requesting masks.

Currently, there is no WHO recommendation for workers in such settings to wear masks. Rather WHO has said that wearing masks by healthy people in the workplace is only necessary in health care settings, for emergency response teams and cleaning crews, or for interviews of suspected COVID-19 cases by border guards. The Louvre’s union representatives, however, had also asked why the museum wasn’t covered by the official French ban on gatherings of more than 5,000 people, which issued last week as a COVID-19 response.  “You will easily admit that the Louvre Museum is a confined space and that it receives more than 5,000 people a day,” union representative Christian Galani was quoted as saying to the Associated Press.

Such moves followed Italy’s temporary closure last week of several major Milanese tourist sites and the premature closure of the Venice Carnivale, while cases in northern Italy escalated throughout the week.  As of Monday evening, Italy was reporting some 1694 cases, and 34 deaths, nearly three times as many as it had reported on Friday.

However, Dr Tedros expressed hope that the sharp increases of infections in the European country most affected by the outbreak would soon begin to subside, saying that Italy had dramatically boosted its surveillance.  “Of course they were surprised, but they have strong institutions and we believe that they can bring it together,” he said.

In countries such as Korea, which was reporting some 4,335 cases, nearly double the number of last Friday, the virus epicentre continued to revolve around known infection clusters around the city of Daegu, where the outbreak first began amongst members of a cult-like church.  However that also offers hope that the outbreak can be brought under control, said the WHO Director General.

“Containment is possible in all countries that are affected. That is why we are saying the comprehensive approach is very, very important,” said Tedros.

“OK,  we are close to 90,000 cases, we have more than 3,000 deaths and some 65 countries are affected.  But among those countries, 38 have less than ten cases. And among other 20 countries, you have 120-140 cases,” he said.

“So a one side fits all approach doesn’t work, blanket recommendation doesn’t work,” he said.

Treatment of Seriously Ill – Big Confounder for Health Systems

One of the biggest confounding factors is not just the fatality rate of the new virus – which at 2% is still much higher than seasonal flu – but the threat it poses to health care systems ability to provide adequate intensive care at the sheer numbers that could be required if the virus spread accelerates.

While 80% of people only experience mild symptoms, some 20% of victims require hospitalization. And of those hospitalized, about 30-40% of people require care with medical oxygen, supplied  through a respirator, said WHO technical lead Maria Van Kherkove.

Hospital intensive care units and respiratory beds in middle- or high-income countries with excellent health systems can easily become overwhelmed by people who become seriously ill, said WHO officials, citing the experience in Hubei Province as such an example. In lower income settings, such equipment may be rare or non-existent in many hospital settings.

“Most countries, even sophisticated health systems, have very limited intensive care capacity, in terms of the clinical beds that they have,” said Mike Ryan, WHO Emergencies head. “Ventilators need trained technicians, extra-corporeal oxygen support requires very high level of technical support. This is not just an issue for weaker health systems.”

Ryan said that focusing on early diagnosis and provision of care will also help prevent some of the progression to more serious cases. “Most countries will struggle if they see large numbers of patients needing intensive care.”

The length of care required is another challenge, he added, saying. “We are seeing patients spending many, many days, up to 24 days, in a critical care environment. That is occupying a lot of beds for a very long time.  So all countries are going to have to think very carefully about how they manage the critical care component of this disease.”

That reinforces the message, that tough containment strategies, including vigilant identification of suspected cases, testing, quarantine and treatment of those found ill, along with aggressive tracing and following of contacts, all are essential to bring down the overall case load that countries might face, Ryan said.

“Here we have a disease where we don’t have a vaccine, we don’t have treatments, we don’t understand its transmission and its mortality,” he said. “All countries can be looking for cases right now and can aggressively find cases and follow them, so we can help each other.

“Here we have seen that with the right measures, it can be suppressed.”

WHO Updates Travel Advice – Acknowledges that “Temporary” Restrictions May Be Useful

Following a spike in cases around the world, which were traced back to travel from the new  COVID-19 hotspots of Italy and Iran, WHO issued new travel restriction recommendations, most notably acknowledging that “in certain circumstances, measures that restrict the movement of people may prove temporarily useful.”

That contrasts sharply with the strong advice against any travel restrictions whatsosever that the Agency had maintained until this point.

However, the updated advice still contains the caveat that such bans should be “short in duration,” and reassessed regularly to make sure they are “proportionate” to public health risks.

“Travel measures that significantly interfere with international traffic may only be justified at the beginning of an outbreak, as they may allow countries to gain time, even if only a few days, to rapidly implement effective preparedness measures,” the guidance states.

At a press conference of the European Commission, officials pledged to maintain the “mobility” of European citizens, and maintain open borders between countries of the so-called Schengen zone – although health checks in some instances could be reinforced. A new assessment by the European Centres for Disease Control (ECDC) Risk Assessment described the regional risks associated with the COVID-19 epidemic to be “moderate to high.”

The ECDC warned, however, that “In the event of established and widespread community transmission, current containment measures may no longer be an efficient use of resources. If this occurs, action should be taken to prepare for a mitigation strategy that includes co-ordinated efforts to protect the health of EU/EEA and UK citizens by decreasing the burden on healthcare systems and protecting populations at risk of severe disease.”

EU COVID-19 response site has been established to provide situation updates and relevant information on medical, transport and economic issues linked to the epidemic.

Elsewhere, the US confirmed it’s first two deaths by the coronavirus in Washington state over the weekend, where a cluster of 10 cases in King County is suspected to be the first identified local outbreak of COVID-19 in the country.

Nancy Messonier, director of the US CDC’s Center for the National Center for Immunization and Respiratory Diseases (NCIRD) said in a statement on Saturday, “We will continue to respond to COVID-19 in an aggressive way to contain and blunt the threat of this virus. While we still hope for the best, we continue to prepare for this virus to become widespread in the United States.”

Still, the new WHO recommendations do not explicitly sanction restrictions on the movement of people within so-called “affected-areas” – locales which are seeing sustained local transmission of the virus rather than just a cluster of imported cases.

Citing Hubei Province as an example of an “affected” area, WHO indicates that recommended containment measures should include: “control measures that focus on prevention… active surveillance for the early detection and isolation of cases, the rapid identification and close monitoring of persons in contacts with cases, and the rapid access to clinical care, particularly for severe cases.” 

The agency falls short of recommending measures some of the more drastic that were taken in Hubei, and have been tried  more recently in countries such as Italy, including restricting public transportation and locking down towns and villages with local transmission. 

However, the spirit of the new measures clearly is influenced by the recent report issued by the WHO-China Joint Mission, that returned last week from China and reported how effective measures there had been.

Image Credits: Twitter: @DrTedros, John's Hopkins CSSE.

Abdul Rasyid, a TB MDR patient, works as a motivator in the inpatient TB MDR ward at the Persahabatan Hospital in Jakarta, Indonesia

While health leaders battle a global outbreak of a dangerous new virus, a consortium of partners is entering the fight against one of humankind’s oldest infectious diseases, tuberculosis.

A group of philanthropic, non-profit, and private sector organizations on Thursday launched a collaboration to accelerate development for a “pan-TB” treatment regimen to treat drug-sensitive and drug-resistant forms of the deadliest infectious disease in the world.

The first-of-its kind Project to Accelerate New Treatments for Tuberculosis (PAN-TB collaboration) aims to develop safe treatment regimens that have little to no drug resistance and advance them through phase 2 clinical trials – universal regimens that can treat multiple different strains of TB.

“The development of a regimen that can treat both drug-sensitive and drug-resistant tuberculosis could be a game changer for how the world addresses TB and growing antimicrobial resistance,” said Penny Heaton, chief executive officer of the Bill & Melinda Gates Medical Research Institute, a founding member of the consortium, in a press release. 

The need for new treatment options is high. There exists no single treatment available to treat all forms of TB. Only three new drugs have been approved for the treatment of TB in the past 50 years – bedaquiline, delamanid, and pretomanid, which was just approved in August 2019 by the United States Food and Drug Administration.

In 2018, the World Health Organization estimated that there were 10 million new cases of TB and almost 1.5 million deaths. It’s estimated that there were 500,000 cases of drug-resistant TB, in which almost half of the patients died.

Currently, even the easiest to treat strain of TB – known as drug-sensitive or drug-susceptible TB – requires a regimen of four core drugs taken for at least 6 months.

Despite being known as the easiest to treat form of active TB, the current WHO-recommended regimen for drug-sensitive TB still consists of a grueling 6 month treatment – a combination of four different antibiotic pills taken daily for two months, followed by another four months of taking two antibiotics per day.

But even this regimen is not sufficient to treat forms of drug-resistant TB, or strains resistant to any of the four core drugs. These deadly strains require different treatment courses – which may contain more than 5 different drugs and take up to two years to complete. It’s estimated such drug-resistant TB strains killed 230,000 people in 2017.

However, to diagnose drug-resistant TB, patients must undergo additional testing.

The new PAN-TB initiative aims to develop regimens that can be used to cure both drug-sensitive and drug-resistant strains of TB, cutting down on the need to test for drug-resistance and potentially giving patients safer, shorter, and simpler treatment options.

A spokesperson for the consortium told Health Policy Watch that the exact drug candidates for the phase 2 trials are still being identified.

However, the spokesperson added that the Bill and Melinda Gates Foundation has committed grant funds for non-clinical studies to identify promising compounds for the treatment course. The Bill and Melinda Gates Medical Research Institute will fund and lead clinical studies in the partnership.

The pharmaceutical partners include Evotec, GlaxoSmithKline, Johnson & Johnson, and Otsuka Pharmaceuticals, and will contribute in-kind resources, including providing access to a library of candidate compounds, and dedicating scientific and technical expertise to the initiative.

The global PAN-TB collaboration aims to link up with another TB drug development initiative launched just a few weeks prior on 29 January, the European Accelerator of Tuberculoses Regime (ERA4TB) project, a 30-partner initiative funded by the European Commission. ERA4TB aims to accelerate preclinical identification of promising compounds, while PAN-TB aims to take such preclinical discoveries through to the end of costly phase 2 clinical trials.

Image Credits: Bill & Melinda Gates Foundation/Prashant Panjiar.

Governments around the world are ramping up COVID-19 containment measures as new infections outside of China surged by 497 cases over the past 24 hours, outnumbering those inside the country for the first time ever during the epidemic.

The increase abroad was largely linked to an acceleration of COVID-19 outbreaks in Italy, Iran, and South Korea, which also were spilling over into other countries, in Europe and the Middle East.  Officials were aggressively restricting movement in areas with confirmed local transmission in an effort to curb person-to-person spread of the contagious virus.

On a more positive note, nine countries with COVID-19 cases had not reported any new cases in two weeks, including Belgium, Cambodia, Finland, India, Nepal, Philippines, the Russian Federation, Sri Lanka, and Sweden.

“The primary objective of all countries with cases must be to contain the virus,” said World Health Organization Director-General Dr Tedros Adhanom Ghebreyesus in his opening remarks at a WHO briefing to UN Missions in Geneva on the emergency.  “I read the list of 9 countries who have not reported cases for two weeks. We should do the same: try to contain.”

Map shows growing case numbers in Italy, Iran, and South Korea. (Source: Johns Hopkins CSSE Global Map of COVID-19 Cases)

As of 4:30PM CET, China continued reporting a downwards trend in new cases, with 416 infections and 52 deaths by COVID-19 over the past 24 hours, for a cumulative total of 78195 cases and 2718 deaths since the epidemic began. Around the world, there have now been a total of 81,265 cases and 2770 deaths.

The highest overnight increase in cases was in South Korea, which reported 368 new infections and 4 new deaths in the past 24 hours. The country, now the largest center of an outbreak outside of China, has reported a total of 1261 cases and 12 deaths. Iran, meanwhile, reported 46 new infections, for a total of 139 cases and 19 deaths, making it the country with the highest number of deaths from the virus outside China. Italy saw an increase in 52 infections, to 374 total cases and 12 deaths.

Across all three countries, authorities have undertaken aggressive measures to lock down cities and communities with the highest concentration of cases.  Classes suspended in schools and universities; local public transportation was shut down, mass gatherings were canceled, and community members were strongly encouraged to stay home.

Despite the escalation of cases in multiple countries, the WHO director-general emphasized that, for the moment, the COVID-19 emergency had not reached “pandemic status” as there was no “sustained and intensive community transmission” of the virus, nor was there “large-scale severe disease or death.”

However, he underlined that all countries, whether they have cases or not, must prepare for a “potential pandemic”.  

Officials Pursue Containment of Outbreak in Italy and Iran

Officials across Europe were ramping up measures to stop the virus in its tracks, as cases linked to Italy were confirmed in Austria, Croatia, Germany, Spain, and Switzerland. An Italian adult who arrived in Algeria on 17 February became the second confirmed case of COVID-19 on the African continent on Tuesday, and a 61-year old patient in Brazil who had recently traveled to Italy was confirmed by the Brazilian Ministry of Health as the first case on the South American continent.

“In the European Union we are still in the containment phase, it is important to underline this,” Stella Kyriakides health commissioner of the European Center for Disease Control (ECDC) said at a press briefing in Rome at the conclusion of a joint WHO-ECDC mission to Italy.

However, “given how quickly the situation can change, even if we are currently in the containment phase, our public health care response across the EU must be ready to deal with increased numbers of COVID-19 infections,” she stressed. EU member states are currently reviewing pandemic plans, health care capabilities, and capacities for tracking contacts of infected individuals, diagnosing and testing cases, and treating acute respiratory illnesses.

Kyriakides praised countries for keeping borders with Italy open rather than “resorting to what at this point could be considered disproportionate and inefficient measures.” In Italy however, train service had been interrupted and there were barriers on roads around the 11 towns in Lombardy and Venetto at the center of Italy’s outbreak. Residents remained largely confined to their homes as authorities try to track down all suspected cases of COVID-19.

Health officials in Algeria discuss the country’s first COVID-19 case

Meanwhile, Algeria confirmed its first case of COVID-19 on Tuesday, just days after Dr Tedros met with African Ministers of Health at an emergency meeting on the coronavirus outbreak on 22 February. A WHO survey previously had determined that the African regional readiness level for COVID-19 was about 66% of what should be full preparedness capacity. Algeria was among 13 countries on the continent initially identified as “high priority” due to direct links and a high volume of travel to China, although the first confirmed case was in an Italian adult.

“The window of opportunity the continent has had to prepare for coronavirus disease is closing,” said Dr Matshidiso Moeti, WHO’s Regional Director for Africa in a press release. “All countries must ramp up their preparedness activities.”

WHO will be sending a team of experts to assist the response in Algeria in the coming days to assist in response efforts.

This upcoming weekend, the agency is also sending a team of experts to Iran, where numbers of cases and fatalities have climbed rapidly as officials tracked down suspected cases. Following in the footsteps of other countries with larger outbreaks, Iran has begun to limit large gatherings and public events, including suspending classes at 10 universities across the country by the end of the week, including schools in Qom where Iran’s first cluster of COVID-19 cases, rapidly followed by an out-sized number of deaths, was detected.

US CDC Warns Communities To Prepare For Community Spread

Across the Atlantic in the United States, US Centers for Disease Control officials warned journalists at a press briefing on Tuesday to “ultimately expect” to see community spread of the virus and prepare for “severe” disruption to everyday life.

The messaging represents a huge shift in tone for the US, which had up until then been largely focused on “largely successful” existing quarantine measures.”  There are currently 54 confirmed cases and no deaths in the country.

Nancy Messonier, director of the National Center for Immunization and Respiratory Diseases at the US CDC said that the country is now pursuing a “dual strategy” of continuing measures to contain the disease, while preparing “strategies to minimize the impact on communities.” She added that if communities experienced local transmission, the government may enact measures such as “school closures and dismissals,” encourage businesses to allow workers to telecommute, and postpone or cancel mass gatherings – similar to the strict measures China has taken to attempt to curb the outbreak.

“CDC is concerned about the situation… And now is the time for businesses, hospitals, community schools, and everyday people to begin preparing as well,” said Messonier.

COVID-19 response planning at the US CDC’s Emergency Operations Center.

Image Credits: European Center for Disease Control, Johns Hopkins CSSE, WHO AFRO, US Centers for Disease Control and Prevention.

Pilgrims visit the Holy City of Qom in Iran. (Photo Credit: Pierre Le Bigot)

Containing an explosion of COVID-19 cases in Korea and Iran have become top priorities for global health officials battling to prevent the epidemic from growing into a worldwide pandemic. While new lab-confirmed cases in China on Friday numbered 896, more than double the day before, that was still part of an generally downward trend as compared to the two weeks before. But expanding clusters of cases in prisons, including one in the eastern Chinese province of Shandong, elevated concerns about Chinese hotspots outside of Wuhan, the epicentre of the outbreak.

Early Friday evening, meanwhile, Italian health officials announced a cluster of 8 new cases in the northern Italy town of Codogno, five among medical staff at the local hospital, where 3 infected patients who had contracted the virus, were already being treated. The new reports brought Italy’s total of confirmed cases to 16.

The Italian, Korean and the Iranian cases illustrate how seemingly random events involving just a few individuals can drive much larger outbreaks of the highly contagious virus. In South Korea, just one woman has infected dozens of other fellow members of her church in the city of Daegu.

In the case of Iran, a mysterious series of geographically dispersed clusters led to reports of some 18 infections as of Friday, four deaths in the pilgrimage city of Qom, and onwards transmission of the virus by two infected travelers who were identified upon arriving in Canada and Lebanon.

“The window of opportunity may be closing,” said Dr Tedros Adhanom Ghebreyesus in a press briefing on Friday. “Although the total number of cases outside China remains relatively small, we are concerned about the number of cases with no clear epidemiological link, such as travel history to China or contact with a confirmed case.”

Origins of Iran’s COVID-19 Cases Unclear 

While most of the cases outside of China have until now been linked to travel to the epicenter of the outbreak or known contacts of confirmed cases, the transmission patterns in Iran are so far unclear. Reports of cases in Lebanon and Canada, linked to recent travel from Iran, but not to China, were later confirmed by health officials in both countries.

An Iranian Ministry of Health official told CNN news that it was “possible” more cases existed in cities across the country, and speculated that the virus was possibly imported by Chinese workers living in Qom, an important center of Shiite Muslim pilgrimage. China has continued to do business with the Islamic Republic in defiance of US sanctions. However, a Ministry of Health official told Iranian News Agency IRNA on Thursday that two patients who had died of COVID-19 in Qom had not reported any contact with foreigners or Chinese nationals, and their families had not yet been subjected to quarantine.

“We’re getting information [from Iran], but we need to engage with them more,” said Tedros. “These dots or trends are very concerning and we’re working with the government to fully understand the transmission dynamics.”

Meanwhile, cases in South Korea shot up by 100 new cases in the past 24 hours to a total of 204 confirmed cases, making South Korea the country with the highest number of cases outside China. According to the Korean Centers for Disease Control, at least 129 of those cases are members of the Shincheonji church, a Christian organization considered cult-like by many mainstream churches. Most cases related to the church have been clustered in Daegu, although cases in church members have also been reported in Seoul and Gwangju.

Sweeping Closure of Commercial Activities & Public Events In Italy’s Lombardy Region 

In response to outbreak in northern Italy, Minister of Health Roberto Speranza announced a sweeping series of measures in Codogno and about ten other surrounding towns, including: suspension of all public events, commercial activities, schools and day care centers, municipal works, public transport services, and recreation services.

The total number of people infected in the Lombardy region now stands at 14, said the minister and other health officials at a press conference Friday.  The officials’ descriptions of the infection chain illustrates how very casual contacts played a role in the expanding outbreak. The first person to be infected was a 38-year-old man who had become ill after meeting a friend recently returned from China.  He then infected his wife, and a running group acquaintance. They were all hospitalized. Three older friends of the runner, who all frequented the same bar, were then infected, followed by the five health workers at the local hospital, who were treating the initally infected patients, and several others.  There are reportedly two other COVID-19 cases in Italy’s Veneto region.

Despite the fast-changing path of the virus, WHO’s Director General said he still believed that the outbreak could potentially be contained, if countries step up preparedness measures.

“The window of opportunity is still there but [it] is narrowing, and that is why we call on the international community to act, including the financing, and that is not what we see.”” said Dr. Tedros.

China Changes Reporting Protocol Again Amid New Spread In Prisons

As of 5:30pm CET, there were 896 new cases of the virus in China according to official Chinese data, higher than the increase of 404 cases recorded yesterday, but much lower than the 2,000-3,000 new cases reported almost daily in the previous week. Total cases in China were 75,571, while abroad the total number of cases exceeded 1,225 in 27 countries, late Friday afternoon, as Israel also reported its first coronavirus case – in a passenger returning from the Diamond Princess cruise ship.  That latest count did not include the late breaking reports of infections in Italy.

The significant decline in new confirmed Chinese cases may indicate that authorities there are finally getting the infection more under control.  But it is also partly due to another change in the way China reports numbers. After adding over 14,000 clinically diagnosed cases to the number of confirmed cases in Hubei province on Wednesday last week, authorities have reverted back to only including lab diagnosed cases in the count, WHO officials said today at the press briefing. They said that the zig zag was due to the fact that with less pressure on health systems, most suspected cases were now being rapidly lab confirmed.

In a place with the lab capacity to test every suspected case for the virus, the “recommended approach” is to classify lab-confirmed cases as confirmed, and other cases as “suspected,” explained Tedros. “We’re glad China has gone back to this approach, we think it will bring more clarity.”

In response to concerns about the confusing changes in reporting measures, WHO’s director of epidemic and pandemic diseases Sylvie Briand stressed, “As long as we understand the situation, it helps us. Surveillance or monitoring disease is about taking the best possible decision and collecting numbers for action, not numbers for numbers… Beyond the numbers what’s important is trends.”

“Understanding the definition” rather than where the numbers are reported is the basis for decisions, she added. “At the end of the day, as long as the decision behind the numbers is a good decision, that is what matters most.”

WHO Director General Expresses “Concern” Over Increase of Cases In Shandong Province – Reference to Prison Hotspot   

WHO’s Tedros also said that WHO was “concerned about an  increase in the number of cases in Shandong province.” According to a local news station Qilu Evening News, 200 of the 202 new cases reported in Shandong Thursday night occurred in Rencheng prison. Some 207 cases have been reported in total from the prison, including 7 prison guards and 200 prisoners.

The reports were confirmed by state owned news agency Xinhua on Friday, which reported that the index case was a prison guard who was diagnosed on 12 February. However, proper infection prevention control measures were not taken until much later, leading to a dramatic overnight rise in confirmed cases in the prison. The debacle led to the national government launching a formal investigation into the handling of the outbreak, which resulted in the replacement of the director of the Provincial Justice Department and sacking of a number of prison officials, including the director of Rencheng prison, according to Xinhua.

But the South China Morning Post reported that there have been a number of other prisons in China where outbreaks are flourishing in confined and closed conditions. These include a Wuhan Woman’s Prison, which has reported some 230 cases, and smaller clusters in Shayang Hanjin prison in Hubei province and Shilifen Prison in Zhejiang province.

Reports about the contagious virus’ spread in prisons mirror the growing concern around transmission of the virus in so-called “re-education” centres in Xinjiang province, where China has reportedly detained 1-1.5 million ethnic Muslim Uyghurs in overcrowded facilities with limited access to medical care, contact with friends and family, according to a report by the UN’s Office of the High Commissioner for Human Rights (OHCHR).

So far, WHO has not made any public comment on the potential transmission of the virus in the camps, which have been criticized by the OHCHR as “amounting to detention centres” due to their “coercive nature.”

Updated Saturday 22 February 

Image Credits: Flickr: Pierre Le Bigot.

The Diamond Princess, docked in Yokohama, Japan, now has a total of 454 cases, the largest case load outside of mainland China.

The rise in new cases of COVID-19 seemed to be slowing in mainland China, but concerns remain about local transmission in cities abroad such as Hong Kong, Singapore, and Japan, and on cruise ships.

China has confirmed 70644 cases and 1772 deaths as of 5 p.m. Central European Time, representing an increase of 2060 cases in the last 24 hours, according to the latest Chinese data. This comes even after the Chinese health authorities expanded diagnostic criteria to count “clinically confirmed” cases on top of lab-confirmed cases, the rate of new infections appears to have slowed.

However, “this trend must be interpreted very cautiously,” WHO Director General Dr Tedros Adhanom Ghebreyesus told reporters at a press briefing Monday. “It is too early to tell if this reported decline will continue.”

The slow, but steady growth in cases outside of China, however, particularly in Singapore and Japan, has also been a cause for concern among public health experts closely watching the epidemic unfold.  A total of 694 cases in 25 countries have been reported, along with three deaths.

Of particular note is yet another huge spike in the number of infections on the quarantined cruise ship, the Diamond Princess, to 454 confirmed cases as of Monday evening, which now represents the largest cluster of cases outside China. Some 189 passengers were classified as “asymptomatic carriers,” according to a statement from Japan’s Ministry of Health. The ship has been docked in Japan’s Yokohama port since 3 February.  Many of the original 3,600 passengers remain under a two-week quarantine while the Japanese government tests every one on the ship.  Some 1,723 have been tested so far. Those found to be infected with the virus, elderly people and those with other medical conditions have been allowed to disembark and complete their quarantine period in special facilities on shore.  Most of the 400 Americans on board the ship were evacuated earlier this morning, although they will they will have to undergo another two weeks of quarantine in the United States.

The strict measures being enacted for passengers on the Diamond Princess were not repeated for the Westerdam, a cruise ship that was finally allowed to dock in Cambodia last week after being stranded at sea for two weeks. Once clearing temperature and health checks, passengers were allowed to continue on their travel itineraries. However, one COVID-19 case was confirmed in a passenger after she had already disembarked and traveled to Malaysia.

Two more former Westerdam passengers, were, however, suspected of being ill are awaiting lab results for the virus after traveling to Singapore. Some 255 guests and 747 crew members are still waiting aboard the ship to complete further health checks.

Holland America, the owner of the Westerdam, said in a statement that no passengers had elevated temperatures upon disembarking. The 20 individuals who reported to the ship’s medical center also later tested negative for COVID-19.

The drastically different treatment of the passengers on the Westerdam and Diamond Princess highlight the very different national policies governing public health responses to contain the spread of the virus, as well as the different circumstances involving each ship. WHO’s Director General Dr Tedros Adhanom Ghebreyesus last week strenuously urged the government of Cambodia to allow the cruise ship to dock.  In the aftermath, he has not commented on the discovery of cases aboard the second ship, or on the very different procedures undertaken by Cambodia to screen and disembark passengers, as compared to Japan.  The Westerdam, which departed Hong Kong on 1 February had not identified any cases aboard while at sea, although the incubation period of the virus is believed to average 14 days.

“Measures should be taken proportional to the situation… Blanket measures may not help,” said Dr Tedros, in a press briefing today. “”There is no zero risk…[every action] has to be proportional to the situation.”

Number of COVID-19 cases worldwide, collected by Dingxiangyuan, which tracks national and sub-national press releases from health authorities.

Will COVID-19 Become a Pandemic?

Experts are worried that, despite the decline in new cases on mainland China, there may be potential for further spread, leading to some questioning whether it was time to label the outbreak a “pandemic” – or a global outbreak where every citizen could be infected.

The media frenzy around the outbreak has also been whipped up by published and pre-print studies estimating that the current number of infections is much higher than reported due to a high number of asymptomatic and mild cases, with some estimates in the range of 75,000 thousand infections in Wuhan alone. A WHO advisor, Ira Longini from the University of Florida, was quoted by Bloomberg News as projecting that up to two-thirds of the world’s population could be afflicted by COVID-19 if current measures to contain the virus’ spread are unsuccessful.

However, WHO scientists are cautious about using the “p” word, for fear of inducing widespread panic.

“For the general public, I think [pandemic] means the worst-case scenario. We need to be cautious… because it can create panic unnecessarily,” said WHO’s Sylvie Briand in Monday’s press briefing.

Added Mike Ryan, WHO’s head of Emergencies, “We have said that the risk for regional and global spread is high – that is not high of a pandemic, it’s high for further spread.

“We need to be careful not to drive fear in the world right now.”

On the WHO advisor’s prediction that the majority of the world could get infected by COVID-19, Ryan added that, “all predictions are important. But most predictions are wrong.”

Image Credits: Flickr/ Yoshikazu TAKADA, ncov.dxy.cn.

[Press Information Bureau, Government of India]

In light of the threats to human health and biodiversity due to climate

and pollution, India marks the beginning of the “super year of Biodiversity” with the hosting of the 13th Conference of Parties (COP) of the Convention on the Conservation of Migratory Species of Wild Animals (CMS), an environmental treaty under the aegis of United Nations Environment Programme, from 17th to 22nd February 2020 at Gandhinagar in Gujarat.

Shri Prakash Javadekar (left) and Sveinung Rotevan (right)

Addressing a press conference, Union Environment Minister Shri Prakash Javadekar said that the year 2020 is a super year of Environment and will set the tone and tenor for the decade ahead. Highlighting the urgent nature of global environment issues including marine plastic litter, plastic pollution and microplastics, the Union minister said the issues cannot be solved by any one country alone.

On the side-lines of the COP, the Union Minister met a delegation led by Norwegian Minister of Climate and Environment, H.E. Mr. Sveinung Rotevan. India and Norway today agreed to jointly tackle concerns related to oceans, environment and climate matters.

The text of the Joint statement is as follows:

India – Norway Joint Statement on Climate and Environment

  1. Meeting at the beginning of the ‘2020 Super Year’ for the environment, the Ministers stressed that they will do their share to ensure that the 2020s will be a decade of rapid action on climate and environment.
  2. The two sides expressed interest to continue and strengthen the mutually beneficial cooperation on environment and climate between the two countries, including on ocean affairs.
  3. Actions that target climate change and air pollution at the same time pose a win-win situation. The two sides recognized that such actions should be stepped up, and agreed to work together to raise this agenda.
  4. The Ministers recognized that the Kigali Amendment to the Montreal Protocol for phasing down use of Hydrofluorocarbons (HFCs) could prevent up to 0.40C of warming by end of the century, Further, noting that universal ratification of Kigali Amendment to the Montreal Protocol shall allow realization of its full potential.
  5. The Ministers noted the results of the projects supported by Norway on issues / aspects related with phase down of HFCs. It was agreed to continue such projects for facilitating a smooth transition towards energy efficient solutions and technologies while phasing down HFCs.
  6. If managed properly, the ocean holds the key to meeting many of the Sustainable Development Goals. Integrated ocean management is central to achieving a sustainable blue economy. In 2019 Prime Minister Modi and Prime Minister Solberg welcomed the signing of the MoU on India-Norway Ocean Dialogue and the establishment of the Joint Task Force on Blue Economy for Sustainable Development. The two Ministers were pleased with the progress that has been made under this MoU, including the establishment of the Marine Pollution Initiative. They were particularly satisfied that Norway and India will sign a Letter of Intent on integrated ocean management including sustainable Blue Economy initiatives.
  7. The Ministers also noted the importance of delivering concrete, scalable solutions for ocean health and wealth at the UN Ocean Conference in Lisbon on June 2020.
  8. The Ministers further noted the importance of sustainable management of chemicals and waste and welcomed the cooperation between India and Norway on the implementation of the Stockholm Convention on Persistent Organic Pollutants and on the minimisation of discharge of marine litter.
  9. The Ministers emphasized a shared understanding of the global and urgent nature of marine plastic litter and microplastics and underlined that this issue cannot be solved by any one country alone. They are committed to supporting global action to address plastic pollution and exploring the feasibility of establishing a new global agreement on plastic pollution.
  10. The Ministers agreed to support and work together with other political leaders to prompt a global and effective response to curb the direct and indirect drivers of biodiversity loss. They agreed to work together to deliver an ambitious, strong, practical and effective global biodiversity framework at COP15 of CBD to be held in Kunming, China, in 2020.
  11. The Ministers further discussed the conservation of migratory species of wild animals. The Ministers recognized the importance of integrating ecological connectivity into the post-2020 global biodiversity framework.
  12. The Ministers stressed that international supply chains and finance must de-invest from deforestation and destruction of nature and invest in companies and projects that improve smallholder livelihoods while promoting sustainable production and consumption. They agreed to continue the discussion on forests and deforestation free supply chains.
  13. The Ministers stressed that the fifth United Nations Environment Assembly of the United Nations Environment Programme offers a good opportunity to call for greater international action on several environmental issues, in particular strengthening action for nature to achieve the Sustainable Development Goals.
  14. Minister Rotevan thanked Minister Javadekar for the great hospitality extended to him and his delegation during the visit. He invited Minister Javadekar to visit Norway and the Arctic, to further strengthen the collaboration between India and Norway on climate and environment.
  15. Norway and India will explore areas of cooperation in forestry and linking the same with climate change

The Opening Ceremony and Plenary session of the COP will take place on 17th February followed by Side Events and Working Group meetings till the Closing Ceremony on 22nd February. Prime Minister Narendra Modi will inaugurate the COP 13 via video conferencing. Numerous national and international organizations will showcase best practices in wildlife conservation during the course of the conference.

As the host, India shall be designated as the Presidency during the intersessional period following the meeting. The COP Presidency is tasked to provide political leadership and facilitate positive outcomes that further advance the objectives of the Convention, including steering efforts towards implementing the Resolutions and Decisions adopted by the Conference of Parties.

Migratory species of wild animals move from one habitat to another during different times of the year, due to various factors such as food, sunlight, temperature, climate, etc. The movement between habitats, can sometimes exceed thousands of kilometers/miles for some migratory birds and mammals. A migratory route will typically have nesting sites, breeding sites, availability of preferred food and requires the availability of suitable habitat before and after each migration.

India is home to several migratory species of wildlife including snow leopard, Amur falcons, bar headed Geese, black necked cranes, marine turtles, dugongs, humpbacked whales, etc.

Image Credits: Press Information Bureau Government of India.

A healthcare worker vaccinates a man against Ebola.

The Director General of the World Health Organization today decided that the smoldering Ebola outbreak in the Democratic Republic of the Congo should remain a “public health emergency of international concern,” following recommendations from a committee of experts convened under the International Health Regulations.

The last embers of the 1.5 year long outbreak appeared to be dying out, with only 3 cases reported in the past week, and no cases in the past 3 days. The outbreak has been contained to only two health districts.

“As long as there is a single case of Ebola in an area as insecure and unstable as eastern DRC, the potential remains for a much larger epidemic,” said Dr Tedros Adhanom Ghebreyesus, director general of the WHO at a press briefing Wednesday.

With the WHO and worldwide media attention occupied by the coronavirus outbreak, “we must not forget Ebola,” added the Director General.

“Strengthening a health system may not be as sexy as responding to an outbreak, but it’s just as important,” he added. Dr Tedros will be flying to Kinshasa, DRC tomorrow to meet with president Félix Tshisekedi and discuss plans to further strengthen the country’s capacity to handle health emergencies.

There is a high “risk of resurgence” and a “risk of complacency” if the  PHEIC designation is abandoned, added the chair of the Emergency Committee, Robert Steffen.

Additionally, Steffen pointed to “two dark clouds on the horizon” – one being the continued security incidences that have “compromised the action of the health teams,” and the second being a lack of “solidarity” in the response. Security incidences have continued to be on the rise in the past few months, according to the Emergency Committee’s assessments.

For those reasons, WHO has determined that the risk of national and regional spread is still “high.”

Nonetheless, the Director general said, the “signs are extremely positive” in the Ebola outbreak. It seems likely that all districts affected by the outbreak will reach the 42-day Ebola-free threshold needed to declare the outbreak over by the next time the Emergency Committee reconvenes.

As of 10 February 2020, there were a total of 3431 cases and 2253 deaths. Between 3 and 9 February 2020, three new confirmed cases were reported in Beni Health Zone, North Kivu. More than 2000 contacts were being followed.

The Emergency Committee assessment noted that sustaining progress towards reducing the rate of new cases depended on the security situation and control of the well-known drivers of transmission, particularly in traditional health facilities, and on continued engagement with the community. A risk communication and community engagement programme has been developed, as has an EVD survivors programme.

Image Credits: Twitter: @WHOAFRO.

After two days of more hopeful signs that new cases of the novel coronavirus in China might be stabilizing, a sharp increase of 14,840 new COVID-19 infections was reported Thursday by the Province of Hubei, more than 10 times the previous day.

Meanwhile, Vietnamese authorities had reportedly imposed a mass quarantine on a number of villages in the Son Loi commune, about 40 kilometers from Hanoi, where six among the 16 cases confirmed so far in Viet Nam, have been reported. It was the first mass quarantine to be placed on an entire community outside of China where over 50 million people remain under partial or total lockdown in the city of Wuhan and around Hubei Province, where the novel coronavirus first first emerged in a wild animal market in December 2019.

CNA News report shows police patrol on perimeter of Viet Nam’s Son Loi commune. (CNA News)

The upsurge in China cases was in part due to an expansion of diagnostic criteria, said Hubei officials in a statement. Those who show clinical signs of COVID-19 were previously not included in the count, which only tallied lab-confirmed cases. However, officials amended the definition so that patients who show clear symptoms of the disease based on clinical exams and chest x-rays “can receive standardized treatment…as early as possible to further improve the success rate of treatment”[translated from Chinese].

A total of 59,907 cases had been reported in China on Thursday, according to the latest Chinese government data, posted just before midnight Beijing time. There was also a steep 48-hour increase in deaths, with total fatalities inside China now at 1,368. The second death outside of China was registered in Japan, in a woman in her 80s. Some 500 people in 24 other countries were also infected with the virus as of Thursday evening, central European time.

“This increase that you have seen in the past 24 hours is largely due to a change in how cases are being diagnosed and reported,” said WHO’s Emergencies Director, Mike Ryan at a press briefing Thursday, explaining the huge leap in case reports in Hubei Province, the epidemic epicentre.  “We need to be very careful in interpreting any extremes.” He noted that some of the increase is also attributable to clinical cases reported days or even weeks ago, but only included now after the reporting criteria was changed.

There were further spikes in the two biggest COVID-19 hot spots outside of China.  On the Princess Diamond Cruise ship, where more than 3600 passengers and crew remained quarantined in Japan’s Yokohama harbor, a total of 218 passengers tested positive for the virus, a leap of 44 cases since Wednesday. Singapore, the next largest cluster, was reporting 58 cases Thursday evening, 11 more than Wednesday.

Government-reported data for COVID-19 cases in China, on a popular health workers website, as of 16:51 Central European Time.

Experts are carefully watching trends in the Asian city-state, where original contacts for some of the Singaporeans falling ill cannot be traced. This has sparked fears that wider community-based spread of the virus may be occurring, making Singapore the next test ground for virus containment. Elsewhere, conferences and meetings were being delayed or cancelled, and school start dates suspended, as the fallout from the virus echoed across the Western Pacific region, Europe, and beyond.

The sharp uptick in reported cases on Thursday occured only hours after Dr Tedros Adhanom Ghebreyesus, World Health Organization director general warned that ¨the number of newly reported cases reported from China has stabilized over the past week, but that must be interpreted with extreme caution.”

“The outbreak could still go in any direction” he told reporters Wednesday after the conclusion of a two-day Global Research and Innovation Forum in Geneva, and just hours before Hubei province officials released the new daily numbers.

The forum sought to identify the best clinical care treatment for patients with the virus; explore why some people become seriously ill while others do not; as well as to forge ahead with a coordinated approach to research on potential treatments and vaccine candidates, said Dr Soumya Swaminathan, WHO chief scientist, describing outcomes of the meeting.

WHO Press Briefing on Coronavirus situation

First Large-Scale China Study Finds Case Fatality Rate Higher Than Previous Estimates

Meanwhile, the first large-scale study of some 4,021 Chinese patients with COVID-19 reported that the case fatality rate of confirmed people who fell ill in January was averaging about 3%, significantly higher than the 2% fatality rate that had been cited previously.

According to a pre-print version of the study by researchers from China Centers for Disease Control (China CDC), published on MedRXiv, patients 60 years or older had even higher fatality rates of 5.4%, as compared to 1.43% for that of younger patients.

Male patients also had a case fatality rate more than triple that of female patients – 4.45% as compared to 1.25%, the study found.

The study, which examined cases in 30 Chinese provinces including the virus epicentre of Wuhan, also provides the first detailed age distribution of confirmed cases of the virus, which had been known to researchers as 2019-nCoV, until WHO gave it a formal name on Tuesday.

Despite the higher fatality rates than previously assumed, the new COVID-19 virus is still less deadly than Severe Acute Respiratory Syndrome (SARS), which had a case fatality rate of 9.2%, during the 2002-03 epidemic, the study’s authors conclude. The COVID-19 virus transmissibility is similar to that of SARS – with a single infected person passing the virus to nearly 4 other people [3.77], on average.

Among those studied, people aged 30-65 years comprised the majority of reported cases, while 47.7% of patients were age 50 and over. The lowest incidence of reported cases was among people under 20 years of age.

Overall, more men than women were reported to be infected, the study found – although gender differences in incidence were only significant outside of Wuhan.

“The high incidence subpopulation outside Wuhan tended to be younger than in Wuhan,” the study’s authors also noted.

The study is the first published report covering a large group of Chinese patients.  But WHO scientists have noted that the true case-fatality rate remains difficult to assess in the early stages. The fatality rate could also prove to be lower if many people with asymptomatic or mild infections are missed by hospital-based surveillance systems.

Experts Closely Watching new COVID-19 hubs like Singapore

Outside of China, global health experts were closely watching trends in Singapore, which has the largest concentration of COVID-19 cases outside of China – with the exception of the Diamond Princess cruise ship.

Singaporeans clear out supermarket shelves on 8 February as coronavirus fears spike

The most worrisome aspect of Singapore’s outbreak is the emergence of cases in people whose original contact with the virus couldn’t be traced, experts have observed. If the outbreak expands from known chains of contacts into more “community-based” transmission, then it’s “game over” in terms of containment and preventing a worldwide pandemic, in the words of one BBC commentator.

In fact, some experts are already using the so-called “P” word. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told Health Policy Watch.  There is a “real possibility that it’s a pandemic – which means it could be a worldwide epidemic where most citizens are at risk of being infected,” he said in an interview.

But while WHO is closely watching the “behaviour of the virus outside of China,” Mike Ryan, WHO’s Emergencies head, has sought to mitigate fears about virus expansion abroad. He notes that the number of cases where contacts cannot be traced remains limited.

Ultimately, public health officials need to  pursue a two-track strategy of both containment and preparation for further expansion. “We must stop the virus while preparing countries for the arrival of the virus…. even if that sounds like a contradiction,” Ryan said, speaking in a press briefing on Wednesday.

Speaking on Thursday he said, “We can only find eight cases [abroad] that are not linked in some way to one of the identified transmission chains,” he observed. He said that researchers are rushing to develop a simple blood test for virus antibodies. But in the absence of such a test, it is difficult to determine how much broader “community” transmission might be occuring. “This may be only the tip of the iceberg, or the iceberg may not be as great,” he said.

Clinical Trials For Vaccine Candidates Could Begin In April

Following the conclusion of the WHO Research and Innovation Forum, WHO’s Chief Scientist Swaminathan told Health Policy Watch that clinical trials of the first COVID-19 vaccine candidate, could begin as early as April.

She said that tests of the first vaccine candidate, an mRNA vaccine, are being supported by the Oslo-based Coalition Epidemic Preparedness Initiative (CEPI) as part of a collaboration with the pharmaceutical company Moderna and the US National Institutes of Health. The vaccine candidate functions on principles similar to vaccines tested against other coronaviruses, such as SARS.

Swaminathan said that she was optimistic about China’s ability to quickly ramp up manufacturing capacity to produce any new vaccine shown to be effective. “There was a Chinese vaccine company present at the meeting, and they were very interested in collaborating on this, and they did raise the issue of exploring manufacturing capacity from an early stage,” she said.

In terms of therapies, trials have already started on the widely-used HIV drug combination, lopinavir-ritonavir as well as on an experimental drug called remdesivir, she noted, although it is “too early” to identify what might be the most promising treatments.

Ad for HIV/AIDS combination drug now being tested for effifacy against COVID-19

Tests of other antivirals, some Chinese traditional medicines, and the FDA approved treatment for seasonal flu, oseltamivir (Tamiflu) are also rapidly being scaled up, she said.

But there are a broad range of other potential treatments as well, she observed: “When we look at our clinical study registry there are about 87 – 89 trials [of antivirals] already under way, and about one-third of them are clinical trials.”

WHO Protests Cases of Stranded Maritime Passengers

Meanwhile, cases of COVID-19 continued to climb aboard the Princess Diamond, the cruise ship that has been under quarantine in while docked in Yokohama, Japan, since 7 February.

Of the 48 new cases of infection outside of China that were reported on Wednesday, 40 were on the ship, noted WHO’s Dr Tedros in his briefing to the press. That adds up to 174 passengers with confirmed cases of the coronavirus.

Dr Tedros protested the fact that in the wake of the Princess Diamond case, two other cruise ships have also been turned away from ports, despite having no suspect cases of the coronavirus.

He said that WHO would be issuing a communique with the International Maritime Organization, asking countries to respect the principle of “free pratique”, for ships’ movement, and proper care of passengers.

And he praised Cambodia’s government for finally agreeing to allow one of two other cruise ships, the Westerdam, to dock, after days of being stranded in international waters.

“Based on what we have been told, there are no suspected or confirmed cases of COVID-19 on board the Westerdam,” he said, noting that the ship is due to arrive in Cambodia Thursday morning.

“This is an example of the international solidarity we have consistently been calling for,” he said.

Inside China – Rising Concerns Over Health Worker Infections & Freedom Of Speech

Inside China, there were growing concerns about the rate of health worker infections, as the South China Morning Post reported that over 500 medical workers had been infected by COVID-19 in Wuhan by mid-January. Although the Chinese government has been releasing daily case counts, no separate tally of health worker cases has been made public.

That issue surfaced against the continuing current of protest over how the Chinese authorities’ repression of free speech might have delayed warnings about the virus and exacerbated its spread in the early days, highlighted by a new petition circulating on freedom of speech. The petition has been signed by hundreds of Chinese, including a number of notable Chinese academics, reported the South China Morning Press.

The petition followed the widely-mourned death on 6 February of Li Wenliang, one of eight doctors punished by Wuhan authorities in early January for “spreading rumors,” after he tried to warn fellow health workers about the new coronavirus on a social media chat.

WHO and its Director General Dr Tedros have also been criticized for white-washing the Chinese repression of initial reports of the novel coronavirus, which is believed to have first infected people working in, or visiting, a wild animal market in Wuhan in December 2019.

Asked about such criticism at Thursday’s press briefing, the WHO head was adamant that he was not pandering to Chinese political pressures in his repeated praise for the Chinese response.

“China doesn’t need, or want, to be praised. Let the truth speak for itself and the world can judge,” he told journalists, adding that thanks to China’s response measures,  “The rest of the world is still safer and in a better shape.

“If there is any failure, that should be challenged. We will assess and learn from it,” he said, adding, “We should not be stigmatizing or attacking a country, but stand in solidarity and fight against this common enemy, COVID-19, as humanity because we are one. This virus attacks every human being.”

Grace Ren contributed to this story.

 

This story was updated 13 February 2020, at 3:19AM & 19:00 CET .

 

Image Credits: CNA News, Dingxiangyuan, Yang et al.2020, Medrxiv, Cattan2011.

The novel coronavirus has been officially named by the World Health Organization as COVID-19, in the first day of a global consultation with about 400 researchers and public health experts charged with designing a coherent way forward to confront the expanding epidemic.

However, as the case count rose by Tuesday afternoon to 42,747 people with confirmed infections in China and 394 abroad, and the death count rose to 1018 people, according to the latest Beijing government data, there were still far more questions than answers about the new virus, which first emerged in December 2019 in a Wuhan, China food market selling wild animals.

“The main outcome we expect from this meeting is not immediate answers to every question that we have,” said World Health Organization Director General Dr Tedros Adhanom Ghebreyesus, at a Tuesday press briefing following the first day of the Global Research & Innovation Forum convened by WHO in Geneva.  “The main outcome is [to be] an agreed roadmap on what questions we need to ask, and how we will go about answering those questions.”

A scientist doing coronavirus research at the US National Institute of Allergies and Infectious Diseases (NAID) Vaccine Research Center (VRC).

While WHO and other partners have all placed a great deal of emphasis on the transparent sharing of scientific knowledge about the virus to rapidly advance solutions to the epidemic, the two-day forum ongoing Tuesday and Wednesday in Geneva has been closed to the public, and participants were reportedly asked to avoid speaking to the media.

“We were instructed not to speak externally really but what I’ll say is that the atmosphere was quite good and the report will be quite action focused,” one participant from a leading global health research institution told Health Policy Watch.

Key questions that remain unanswered by WHO, its global partners and advisors cover some of the most characteristics of the virus as well as the outbreak dynamics, such as:

How contagious is the virus and what preventive measures can the public take? And how easily can asymptomatic carriers pass it to others? WHO’s Dr Tedros stressed in Tuesday’s press briefing that the virus can be passed by the respiration of tiny airborne droplets from an infected person – and that makes it far more contagious than diseases such as Ebola, which raged for a year in the Democratic Republic of Congo, but now appears to be finally on the wane. At the same time, besides hand washing and maintaining distance from people who are visibly ill, WHO and other public health authorities have so far been unable to issue clear guidance as to what else the general public can do to protect themselves from the virus. For example, WHO experts have said that there is mixed evidence about the extent to which simple surgical masks may or may not provide an added measure of protection – despite their increasingly widespread use not only in China, but also in other potential outbreak hotspots, as well as on some airline carriers.

How long is the virus incubation period? Most scientists have estimated 14 days, but there have been some estimates of up to 24 days. However, 24-days so far appears to be an outlier figure, noted WHO’s Sylvie Briand, in a briefing on Monday,

What is the actual death-rate?  In terms of a simple calculation of the numbers of the confirmed infections as compared with those who died, the fatality rate has hovered around 2.4%, which is higher than the death rate for seasonal flu, running at about .05% in the US this flu season, and for which vaccines also exist.  Better tracking of the COVID-19 virus, and inclusion in records of more asymptomatic cases, which seem to be common, might yield a lower fatality rate, some WHO experts have suggested. At the same time, the death rate could also prove to be higher, cautioned Gabriel Leung, infectious disease specialist and dean of medicine at the University of Hong Kong, writing in the New York Times.  He noted that in the early days of the SARS epidemic, experts believed that the case fatality rate was hovering between 2-3 percent. It later proved to be much more deadly – with the fatality rate for SARS in Hong Kong a “staggering 17 percent.”

Why are there variations in the death rate of those infected in China and abroad? Among the latter 394 cases, only one person has died. The disparity has been attributed by some scientists to the fact that most of the cases abroad were among travelers who were presumably younger and more fit, whereas the cases in China have involved the whole population.

What is the age and gender breakdown of those seriously ill?  While WHO has reported that about 15% of cases are serious enough to require hospitalization, and these tend to be older, no more detailed breakdown of cases has released. However, a study published last week in JAMA of 138 people hospitalized in Wuhan in January noted that their median age was 55 years of age.  This suggests that a significant proportion of those becoming seriously ill could be younger than had been assumed. Slightly more than half of the hospitalizations were men. And while most people recovered, they also required long periods of hospital care, averaging ten days or more, the study noted – something that could overwhelm a health care system with weaker hospital capacity.

What about children?  There have not, however, been many reported cases in children, said Nancy Messonnier, director of the US Centers for Disease Control’s Center for Immunization and Respiratory Diseases, speaking at a panel on the coronavirus Tuesday at the Aspen Institute.  That should be good news, although if the cases are mild or asymptomatic, then children could also “seed” cases to other more vulnerable family members in the household.

What is the animal source of the novel infection?  WHO’s Sylvie Briand said in Tuesday’s briefing that the original source for the new coronavirus had likely been a bat, which are common carriers of many different types of coronaviruses. However, an assessment by Chinese researchers last week in Nature, and also cited by Leung, points to the endangered species of pangolins, or other small mammals, as likely the point of contact with humans. Pangolins are commonly hunted and sold in Asian live animal markets for their meat, while their scales are used as an ingredient in traditional medicines.

Aerial shots of a large quarantine site being built in Hong Kong as coronavirus cases climb above 40.
WHO Boosting Diagnostics Capacity – But Many Countries Lack Respiratory Care Facilities   

As soon as a public health emergency was declared on 30 January, WHO swung into action to equip low-income countries, particularly in Africa, with diagnostics to identify the virus in suspected cases. The results have been impressive, in just two weeks, 13 African countries as well as Iran have been equipped with the laboratory tests, and technicians from a dozen African countries were trained in their use last week. Another 150,000 tests were about to be shipped to more than 80 labs worldwide, WHO has said. Personal protective gear for health workers, critical to infection control, is also being shipped from WHO emergency stocks to countries lacking strong supplies.

However, if cases clusters appear in Africa, or expand more widely in hotspots of South-East Asia and elsewhere – other serious capacity issues will emerge for health systems, including quarantine and containment facilities, which are expensive to mount and maintain. There is also a lack of hospital respiratory equipment to support those with pneumonia-like symptoms – one of the most common features of serious illness, one WHO official noted on Tuesday.

“Severe cases tended to be taken in charge by an intensive care unit where you have to provide the respiratory equipment, and this capacity is very limited in many African cities,” said Michel Yao, head of emergencies in WHO’s African Regional Office, in an interview with National Public Radio. That lack of supportive care could lead to a much higher death rate in poor and underserved regions.

At least a dozen R&D biopharmaceutical companies are working on vaccines, antivirals or other treatments to confront the fast-spreading coronavirus, said Thomas Cueni, director general of the International Federation of Pharmaceutical Manufacturers, in an interview Monday with Health Policy Watch. The Chinese government has, meanwhile, authorized initial research or exploratory trials of some 30 existing anti-viral treatments developed to treat other serious viruses, including Ebola and HIV, as well as other coronaviruses such as SARS and MERS. Still, it may be some time before one or two of those being tested shows evidence of efficacy against this new virus.

And in the absence of effective medicines, providing good supportive care and preventing further infection spread, will be the main things that health care systems can do to combat the virus.

And that is why, for the moment, WHO’s Director General is placing his bets on “containment” strategies to slow the virus spread outside of China, what he is wont to call “a window of opportunity.”

“We are having a real problem in our hands, and we must take what is happening now seriously,” he said.  “I have a great concern that if this virus makes it to a weaker health system, it will create havoc. It will. For now, it doesn’t seem so, but this doesn’t mean that it will not happen. It depends on how we lead this response and how we respond to the outbreak,” he said.

Describing the virus as “Public Enemy Number 1,” the WHO Director General said: “The world talks about terrorism.  But to be honest, a virus is more powerful in creating economic, social and political upheaval than any terrorist attack.”

Grace Ren contributed to this story – Updated 12 February 2020

 

Image Credits: NIAID, Studio Incendo.

Governments are falling behind in the battle against a “global epidemic” of noncommunicable diseases (NCDs), say two new reports by the World Health Organization and the NCD Alliance, launched on the first day of a Global NCD Alliance Forum in Sharjah, United Arab Emirates.

Many countries are stalled in implementing basic prevention policies, such as reducing tobacco and harmful alcohol consumption; promoting health eating and physical activity; and strengthening early NCD detection and treatment in primary health care systems, according to the WHO NCD Progress Monitor 2020 report, released Monday. Such policies are among the so-called WHO “Best Buys” for NCD prevention.

Only 19% of 194 countries surveyed have fully implemented tobacco taxes; just 20% are meeting targets for salt-reduction, and one-third of countries are providing basic NCD health services such as drug therapy and counseling.  And less than half of the 194 countries surveyed met at least two of the ten targets that would reflect progress against NCDs – a “grim sign” as the report calls it.

Speakers of the opening plenary at the Global NCD Alliance Forum

“Countries are still failing to meet basic indicators. If they continue on this path then millions of people will die needlessly from heart attacks, stroke, diabetes, cancers, and respiratory disease.” said Ren Minghui, assistant director-general for Universal Health Coverage, Communicable & Noncommunicable Diseases at WHO in a joint press release, issued with the NCD Alliance at the Global NCD Forum.

According to the WHO report, about a quarter of all countries also do not have a national NCD plan in place, and one-third of all countries lack time-bound national targets to drive and monitor progress in the overall Sustainable Development Goal of reducing deaths from NCDs by one-third by 2030.

Data from the second report, the NCD Alliance’s Bridging the Gap backs up this stark reality. The report, based on surveys of national and regional NCD alliances, found that only 20 percent of members believed that their country is on track to meet global NCD targets. Some 82% of members did not believe their country had sufficient accountability mechanisms to ensure NCD targets were being met.

“This report confirms what we’ve long suspected – that the United Nations targets aimed at reducing NCDs are not bearing fruit on the ground,” said CEO of the NCD Alliance Katie Dain. “Unless the gaps in the response are addressed, we’ll be faced in 2030 with a tsunami of disease-related impacts, both human and economic, that could have been avoided.“

NCDs account for over 70% of all deaths worldwide. An estimated 41 million people die from NCDs such as cardiovascular disease, cancer, stroke, diabetes and respiratory illnesses every year.

5 Major Gaps Impeding Progress

The Bridging the Gap report points to gaps in five major areas that are impeding progress – political leadership, investment, care, community engagement, and accountability.

The report found that political commitment to NCDs at the country level is low – only Brazil and Turkey have implemented all five of the tobacco demand reductions measures from the Framework Convention on Tobacco Control for example. Additionally, while domestic financing in NCD control is increasing in some places, international funding for NCDs remains a paltry 2% of total multilateral aid for health.

Only about a third of all countries provide drug therapy and counseling to prevent heart attacks and strokes, and just 40% of countries provide palliative care in primary healthcare or in the community.

““We know what works — primary health care, with its emphasis on promoting health and preventing disease, is the most inclusive, effective and efficient way to reduce premature mortality from NCDs and promote mental health and well-being,” said Minghui.

The report also finds that countries are lagging in engaging communities of people affected by NCDs, and creating independent, civil-society led accountability mechanisms for monitoring progress on reducing NCDs. These measures, the report says, are crucial to push forward action on political promises for NCD control.

“The evidence before us is indicating that we need to move well beyond the health sector to really make a dent in the epidemic. We need to address the root causes of NCDs, in the food we eat, the water we drink, the air we breathe and the conditions in which people live, work and play,” said Minghui.

Image Credits: NCD Alliance/Gilberto Lontro, NCD Alliance.