Image Credit: Pixabay, user name: geralt
This week has been another intensive week for the World Health Organisation and government health institutions as the outbreak of the Coronavirus (COVID-19) worsens. The incoming data within the past week is starting to provide a clearer picture around it’s transmission as well as the risk it presents to populations and their economies. Below is a factual summary of some of the key developments and information published by the WHO over the past week.
On the 6th March, the global number of COVID-19 reported cases surpassed 100,000. As of 10am (CET) 7th March, China has 80,813 reported cases in a population of 1.4 billion people. In the rest of the world, there are 21,110 reported cases, in a population of 6.3 billion. This has resulted in a total of 3,486 deaths or 3.4% of the reported case count.
Time-series data continues to show falling numbers of new cases from China and the focus is now on the rest of the world. From 26th February onward, there have been more new cases of COVID-19 reported from countries outside of China than from China.
Since Monday 2nd March, a total of 26 countries and regions reported their first COVID-19 cases:
- Monday 2nd March: (8 new) Andorra, Jordan, Latvia, Morocco, Portugal, Saudi Arabia, Senegal, and Tunisia.
- Tuesday 3th March: (4 new) Argentina, Chile, Poland and Ukraine.
- Wednesday 4th March: (5 new) Bosnia and Herzegovina, Gibraltar, Hungary, Slovenia, and occupied Palestinian territory.
- Thursday 5th March: ( 4 new) Bhutan, Cameroon, Serbia, and South Africa
- Friday 6th March: (5 new) Colombia, Holy See, Peru, Serbia, and Togo
The spread of COVID-19 is still categorised as a global epidemic with the potential to become a global pandemic. On 30th January, the WHO declared COVID-19 as a public health emergency of international concern, which is the highest WHO warning level. On Friday 28th February, the 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. That said, it remains categorised as a global epidemic. During a WHO briefing on 28th February, 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 within certain geographies is no longer an option, which the data does not currently support.
While comparisons have been made between COVID-19 and influenza, SARS and MERS; it is a unique virus with its own unique characteristics. The influenza virus and COVID-19 are similar in that they both cause respiratory disease and they are both transmitted by contact, droplets and fomites, hence similar public health measures are important to prevent infection. A few of the key differences relate to the speed of transmission, reproductive number and severity of the viruses. Firstly, Influenza can spread faster than COVID-19 although the reason remains unknown. It is thought that the transmission of Influenza occurring pre-symptomatic (transmission of the virus before the appearance of symptoms) is behind a higher speed of transmission. There is very limited evidence that COVID-19 is transmitting pre-symptomatically. Secondly, the reproductive number (the number of secondary infections generated from one infected individual) is understood to be between 2 and 2.5 for COVID-19 virus, higher than for influenza. So while COVID-19 may transmit slower than Influenza, it may eventually infect more people. These estimates remain highly contextual and time-specific, making direct comparisons difficult. Thirdly, the frequency of severe cases as well as mortality from COVID-19 appears to be higher than seasonal Influenza. For COVID-19, the current data suggests that 80% of infections are mild or asymptomatic, 15% are severe infection, requiring oxygen and 5% are critical infections, requiring ventilation. While the true mortality of COVID-19 will take some time to fully understand, the data so far indicates that the crude mortality ratio is between 3-4%. For seasonal influenza, mortality is usually below 0.1%. Finally, antivirals and vaccines are available for influenza whereas no vaccine currently exists for COVID-19.
More than 20 vaccines for COVID-19 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.
On Friday 6th March, the WHO published an R&D roadmap which distills the research priorities identified during its convention of more than 400 scientist. All ideas have been distilled into a core group of priorities in 9 key areas, including, the natural history of the virus, epidemiology, vaccines, diagnostics, therapeutics, clinical management, ethical considerations, social sciences and more. The R&D roadmap focuses on research that can save lives now, as well as longer-term research priorities for vaccines and therapeutics.
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 25th February, 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”.
Figure 2 below, from the WHO’s daily situation report, shows the number of newly reported cases of COVID-19 outside of China by their reported date. On Tuesday 3rd March the WHO Director-General commented: “the increase of COVID-19 cases in the Eastern Mediterranean Region is of great concern”.