Image Credit: Pixabay, user name: geralt
This week has been a particularly intensive week for the World Health Organisation (WHO) as well as many local government health institutions, due to the continued spread of the Coronavirus (COVID-19) and the risk it presents to their populations and economies. Here is a factual summary of some of the key developments this week, which I hope you will find informative.
On Monday 24-Feb, the WHO-China joint mission concluded its visit and the findings of its report have been published. The WHO-China Joint Mission was conducted from 16-Feb to 24-Feb in order to help brief leaders on the global status and response to the virus. Read Report
In terms of the latest numbers: as of 10am (CET) 29-Feb, China has 79,394 reported cases in a population of 1.4 billion people. In the rest of the world, there are 6,009 reported cases, in a population of 6.3 billion. This has resulted in a total of 2,924 deaths, currently 3.4% of the total reported case count.
The time-series data suggests that COVID-19 is not significantly worsening within China and the focus has shifted toward the rest of the world. As of 6am CET 27-Feb, China reported 329 new cases of infection, the lowest daily amount experienced in more than one month. From 26-Feb onward, there have been more new cases of COVID-19 reported from countries outside of China than from China.
Since Monday 26-Feb, the following member states reported their first cases:
- Monday 24-Feb: (4 new) Afghanistan, Bahrain, Iraq, and Oman.
- Tuesday 25-Feb: (4 new) Algeria, Austria, Croatia, and Switzerland.
- Wednesday 26-Feb: (9 new) Brazil, Denmark, Estonia, Georgia, Greece, Norway, Pakistan, Romania, and North Macedonia.
- Thursday 27-Feb: (5 new) Belarus, Lithuania, Netherlands, New Zealand, and Nigeria.
- Friday 28-Feb: (2 new) Mexico and San Marino
The spread of COVID-19 is not currently categorised as a global pandemic, although it has the potential to become one. The WHO has declared COVID-19 as a public health emergency of international concern, which is the highest WHO warning level. On Friday 28-Feb, WHO increased the assessment of the risk of spread and risk of the impact of COVID-19 from “High” to “Very High” at a global level, although for now, it remains categorised as a global epidemic. Why? During a WHO briefing on 26-Feb, WHO Director-General noted that “we are not witnessing sustained and intensive community transmission of this virus, and we are not witnessing large-scale severe disease or death. Furthermore, during a WHO briefing on 28-Feb, the WHO stated that it would declare a global pandemic if it thought that every person at a global level is likely to come into contact with COVID-19. At this stage, the data does not suggest this. Declaring a global pandemic implies that containment is no longer an option, which the data does not currently support.
The WHO is observing linked clusters of epidemics across various countries and most cases can still be traced to known contacts or a cluster of cases. The WHO is not seeing evidence that COVID-19 is spreading freely within communities and as long as this is the case, there is still a narrow window of opportunity to contain the virus and break the chains of transmission. The transmission dynamics favour containment as COVID-19 is primarily transmitted via droplets and fomites during close unprotected contact between an infector and infectee. The airborne spread is not believed to be a major driver of transmission based on the available evidence (WHO-China Joint Mission Report).
Based on the method of transmission and encouraging results from some countries, there is hope and confidence that this virus can still be contained. On Feb-25, 14 out of the 37 countries with reported COVID-19 cases had not reported any new cases within the past 2 weeks, indicting some successful containment. At this moment, the WHO is currently advocating for “aggressive containment” rather “mitigation” and that “this is a time for action and not fear”.
More than 20 vaccines are under development, globally. Several of these vaccinations are at the clinical trial stage and the WHO expects to receive the results of these trials within a few weeks. Despite this progress, the WHO’s stance is that containment, public education and encouraging calm decisive action rather than fear, remain the top priorities in order to prevent further transmission.
Figure 2 below, from the WHO’s 40th daily situation report, shows the number of newly reported cases of COVID-19 outside of China by their reported date. This graph started to look rather exponential last weekend, which was a trigger for the global financial markets to react with more volatility this week. The WHO Director-General commented: “the sudden increases of cases in Italy, the Islamic Republic of Iran and the Republic of Korea are deeply concerning”.
That being said, new infections based in China initially appeared to be growing exponentially, although they quickly dropped off once extensive measures were taken to cut off transmissions. The hope is that we will see a similar pattern emerge outside of China, supported by each country taking immediate action to deal with their own cases. This may be more challenging for less prepared nations than China as China has generally developed a high preparedness against this type of public health emergency. It has responded quickly, in part, due to its experience with the SARS (2002/03) pandemic, which originated from the Chinese Guangdong.
Below, the epidemic curve by symptom onset and laboratory-confirmed COVID-19 cases as of 20th February 2020 for all of China.
The coming days and week will be a real test of other nations ability to contain the virus. The coming week is likely to provide a clearer indication around whether this epidemic will evolve into a pandemic or whether the world can relax a little as new COVID-19 infections taper off in a similar pattern.
This is the graph to watch.