On Dec. 31, 2019, China reported to the World Health Organization (WHO) cases of pneumonia in Wuhan, Hubei Province, caused by a novel coronavirus. Cases have now spread to at least four continents. China rapidly isolated the coronavirus on Jan. 7 and shared viral genome data with the international community three days later.
Multiple countries have now confirmed travel-associated cases, including Australia, Cambodia, Canada, France, Germany, Japan, Nepal, Singapore, South Korea, Taiwan, Thailand, the UAE, US, and Vietnam. Vietnam identified the first human-to-human transmission outside China, while the first death recorded outside of China was in the Philippines. The real death toll in China is unknown.
After the Centers for Disease Control and Prevention declared the first human-to-human transmission of the coronavirus on US soil, officials from the WHO declared the outbreak a Public Health Emergency of International Concern (PHEIC), thereby activating a worldwide effort to stop the virus’ spread. Waiting for the US to declare coronavirus was extremely self-centered when the approaching pandemic from Wuhan was already clear.
The initial restraint shown by the organization in declaring the emergency, in light of the now more than 8,200 cases worldwide, borders on negligence based on the obvious findings streaming from reputable counterparts and sources. This US-centric declaration process to activate the global response was reactive instead of being proactive.
In the US, after three different emergency meetings of public health officials, it was announced that anyone not a US citizen would be restricted from entering the country if they had visited China in the past 14 days. Citizens will face mandatory quarantine in order to prevent pathogen spread. The WHO announcement that “the only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation” is testimony to the challenges that lie ahead.
With the coronavirus outbreak now encompassing more than 20 countries, the global health emergency status is supposed to trigger a system of aid delivery. Each of the 196 participating countries is given 48 hours to “assess the situation” in their territory, after which they must issue a report to the WHO about confirmed and potential cases. Moving forward, all countries are required to: Detect (test for potential cases), assess (keep track of new cases as they arise), report (share updates through an international network), and respond (stay in contact with the WHO). Each week, the WHO will release a situation report based on these findings. For the WHO, establishing baselines are important and understandable. But the rapidity of effort and lessons learned from previous PHEICs are showing actions that are a little late.
During a PHEIC, countries within the WHO system follow a series of regulations concerning specifics for detection and prevention that are required at ports, airports and ground crossings in order to “limit the spread of health risks to neighboring countries.” But many countries are taking issues into their own hands by launching their own health detection and prevention systems, including active media campaigns to inform citizens. These important and life-saving information campaigns are emerging rapidly in South Asia and in major hubs of the Middle East. These actions occurred earlier than the WHO’s PHEIC announcement because key countries that act as transit hubs are more susceptible to economic disruption. Quicker action helps alleviate potential economic shocks from the city down to the community, depending on disease spread patterns by country.
Importantly, the WHO’s actions are aimed at preventing “unwarranted travel and trade restrictions” that can prove detrimental to the global economy. The WHO announcement is affecting oil and gas markets and, as China is the world’s top importer of oil and gas, the impact of this will likely reverberate through the global economy. More than a decade ago, the global economic loss from SARS was estimated to be $40 billion; while estimates regarding the coronavirus are clearly not yet measurable, the amount will be substantially higher.
What is ongoing is how worldwide organizations contend with global health issues on an emergency basis and, conversely, how countries are taking up their own tactics, techniques and procedures of health maintenance and disease prevention. To its credit, of course, the WHO provides millions of dollars in aid to the poorer countries that need to boost their monitoring and prevention of coronavirus. Nevertheless, the principal point of impact may be Africa, as data emerges. Many African countries were not equipped to monitor for coronavirus until very recently. Given the amount of travel between China and Africa, either directly or via points in between, the probability of coronavirus on the continent is quite high, even though there have, as yet, been no reported cases because of that missing capability to measure and report. The reporting will be telling and relevant.
Here, the international health community, through the advocacy of practitioners, could have helped to prepare for such a PHEIC. But that norm is not acceptable and must be changed. It is time for new and urgent thinking in the global public health field, with proactive and timely application necessary. Many countries are well on their way to greater capacity but, for those lagging, there is a severe need for help when contending with a pandemic.
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