WHO Reconsiders Public Health Emergency Declaration Over Wuhan Coronavirus – As Cases Skyrocket

The World Health Organization is set to reconsider a declaration of an international public health emergency over the novel coronavirus discovered in Wuhan – as the number of confirmed cases soared to 6086, the death toll to 132, and infections were reported in 15 other countries.

WHO announced that it would reconvene its Emergency Committee on Thursday to reconsider an announcement of a “Public Health Emergency of International Concern” (PHEIC) over the outbreak– just a few days after experts had deferred such a move saying “it was too soon.”

Momentum was clearly building towards a PHEIC announcement now, as the case load approached that of the 2002-2003 SARS epidemic. While not as deadly as SARS, the new coronavirus, dubbed 2019-nCoV, appears capable of being transmitted between people even before symptoms appear.

Citizens of Wuhan lining up outside a drugstore to buy masks

“Not sure what @WHO is waiting for….not acting now will not age well,” tweeted Florian Krammer, a professor of microbiology at Mount Sinai School of Medicine in New York City. “This is a PHEIC. We are all China at this moment.”

“It’s PHEIC time,” tweeted Ian Mackay, another respected infectious disease researcher.

@WHO is monitoring the new #coronavirus outbreak every moment of every day…. We will have more news following tomorrow’s Emergency Committee meeting,” tweeted Dr Tedros Adhanom Ghebreyesus after returning from Beijing today with the head of WHO’s Emergencies Department, Mike Ryan.

“The decision to reconvene the committee is based on the evidence of the increasing number of cases, [and] human to human transmission that has occurred outside of China,” said Ryan,  in a press conference convened Wednesday evening. Ryan described the outbreak as one “of grave concern”  but also praised China for “doing the right things” and said that the outbreak has “spurred countries to action.”

“The whole world must be on alert right now,” said Ryan.

Dr Tedros, however, added that the Emergency Committee was also considering a new “traffic-light” approach for declaring a PHEIC in the wake of the advisory committee’s 50-50 stalemate last week over whether to declare an emergency over the outbreak at that point.

“Right now the PHEIC declaration is either ‘yes’ or ‘no’ – green or red,” Dr Tedros told journalists. “It would be good to have the green, the yellow, or the red. We need to have something in between; we are considering that. I think the traffic light approach will help, so the yellow would be a warning, something that shows that it is quite serious, but not totally red.”

There has also been speculation, however, that WHO has been reluctant to declare an emergency as long as Chinese authorities, who want to be seen as in control of the emergency response, were opposed to such a move.

Latest Developments

However, while the case load remains heavily concentrated in China, the novel virus was also increasingly spilling over international borders. According to confirmed reports, the new virus, believed to have jumped from an infected wild animal to people visiting, or working in, a Wuhan market, has now spread to 15 countries in Asia, Europe, North America and the Middle East. Most of those infected, however, had recently returned from Wuhan, and no deaths have been reported among the victims abroad.

Confirmed cases were highest in Thailand (14), Singapore (10), Malaysia, Japan and Australia (7 each); followed by the United States (5); France, Korea and Germany (4 each); and including Japan Korea, Thailand and Singapore in Asia; Canada (3) Vietnam (2) and Nepal, Cambodia, Sri Lanka and the United Arab Emirates (1 each).

Novel Coronavirus (2019-nCoV) Global Cases as of 28 January 2020 at 11pm EST, collected by Johns Hopkins Center for Systems Science and Engineering

While exacting a lower fatality rate than the infamous SARS epidemic of 2002-2003,  the coronavirus appeared to be leaving about 17% of peple with confirmed cases seriously ill, according to the latest official Chinese government case data.

Unlike SARS, however, the virus may be infectious even before people began showing symptoms – and thus with great potential to spread silently to unknowing contacts. But it is too early to determine whether so-called “asymptomatic transmission” is a large risk in this outbreak, Ryan told reporters at Wednesday’s press conference.

Maria Van Kerkhove, WHO’s head of Emerging Diseases, said that there was evidence of so-called “fourth generation” infections inside Wuhan, a city of 10 million people, where the outbreak first began around the beginning of January. This means that a person originally infected by an animal source transmitted the virus to another person, who passed it on to another person, who then infected someone else.

Van Kerkhove added that second generation infections had been seen elsewhere in China, and in limited cases outside of the country as well.

Approximately 99% of the cases remain concentrated in China, along with all 132 deaths, with the majority  majority concentrated in Hubei Province.

Dr Tedros said disease control efforts thus need to focus “on the epicentre” in Wuhan and the province of Hubei – as the “most effective” way to quash an outbreak.

Like Ryan, he praised the response of Chinese authorities so far, saying, “the fact that we have only seen 68 cases outside of China has shown… its actions have helped prevent it from spreading to the rest of the world.”

Still, the few reports of human-to-human transmission in other countries including in Germany and Japan, clearly have disease control experts worried.

The greatest fear is that human to human transmission of the virus might be sustained in a country with a “weaker” health system, with less capacity to enact strict public health and infection prevention measures, the WHO officials said.

Ryan emphasized the importance of reinforcing countries’ “preparedness” efforts, saying those with “fragile” health systems, may also need help containing the transmission of the virus.

“We don’t see many media coming to press conferences about preparedness,” Ryan quipped. “Maybe that’s part of the problem.”

Countries Evacuate Ex-Pats & Airlines Suspend Flights as Wuhan Digs in for Seige

Multiple airlines had, meanwhile, suspended flights in and out of mainland China; foreign nationals evacuated from the epidemic’s epicentre were being placed in isolation, and Wuhan was laying down the foundations of two new hospitals to deal with the overwhelming influx of coronavirus patients.

Three carriers, British Air, Lufthansa and United, announced Wednesday that they were temporarily suspending flights into the mainland, although flights in and out of Hong Kong continued. American Airlines canceled some flights to mainland China.

Multiple countries were in the process of evacuating their foreign nationals. California-bound American passengers were being rerouted to Anchorage, Alaska for health checks, before landing at an air base in California, ABC News reported. British officials said that evacuated nations should be “safely isolated” for 14 days, The Guardian reported.

Australia is taking precautions one step further, quarantining evacuees offshore on Christmas Island for 14 days before allowing Australian ex-pats to return to the mainland. Japan, South Korea, the Philippines are among the other countries planning to evacuate expats.

In Wuhan, meanwhile, social media reports from citizens were lamenting the overwhelmed hospital systems. One Wuhan reporter tweeted that patients were waiting hours in the hospital for diagnosis due to a shortage of testing kits.

Two makeshift hospitals with a total capacity about 2,600 beds were frantically under construction. Some 1905 are reported ill in the capital of Hubei province, with more infections expected to be reported daily. The first, the Huoshenshan hospital, with an area of 25,000 square meters and capacity for 700 to 1,000 beds, is expected to be put into use by next Monday.  The second hospital, Leishenshan is expected to be operating by next Wednesday. Chinese social media was rife with livestream reports of the rapid hospital construction, which Chinese authorities see as a test of their capacity to combat the disease.

US Secretary of Health and Human Services Alex Azar told journalists that the US had offered to send a group of experts to China to support the response, although China had not so far responded. “We’re urging China: More cooperation and transparency are the most important steps you can take for a more effective response,” Azar told the press conference.

Meanwhile, WHO will assemble an international team of “the best minds in the world” to explore different dimensions of the response effort along with Chinese experts, Dr Tedros told journalists Wednesday evening.  And that is apparently an offer that Beijing will not refuse.


Grace Ren contributed to this story

Image Credits: China News Service/中国新闻网, John's Hopkins CSSE.

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