The World Health Organization has determined that the outbreak of the SARS-like coronavirus spreading rapidly across China is not yet a global health emergency — a rare designation the agency gives outbreaks that pose an international risk.
“Make no mistake, this is an emergency in China. But it has not yet become a global health emergency,” said Tedros Adhanom Ghebreyesus, the director general of the WHO. He was referring specifically to the formal “public health emergency of international concern,” or PHEIC, declaration an expert committee at the agency had considered.
But because of the limited number of cases that have spread outside of China to date, and China’s efforts to control the outbreak, the committee determined it was too early to use the designation. “At this time, there is no evidence of human-to-human transmission outside China, but that doesn’t mean it won’t happen,” Tedros added.
The outbreak was only reported to the WHO by Chinese officials 3.5 weeks ago, on December 31. It appears to have originated in Wuhan, a city of 11 million in Hubei province. At that point, cases centered on Wuhan’s Huanan South China Seafood Market and the leading hypothesis was that the virus was spreading directly from animals to humans there.
Source: Johns Hopkins University Center for Systems Science and Engineering
But since last week, cases have jumped from around 50 to 634. By Tuesday, the WHO’s Western Pacific Regional Office said there may be “sustained” human-to-human transmission, meaning the virus can transmit easily from one person to the next and then onward to others, raising the specter of another pathogen in the coronavirus family, SARS.
On Thursday, WHO confirmed that there is “fourth-generation” spread of the virus in Wuhan, meaning there are cases where an individual has spread it to a second person, that second person spread it to a third, and the third to a fourth. Outside of Wuhan, they also have evidence of second-generation cases.
Now, the toll is expected to continue to increase as hundreds of millions of people across China travel for Lunar New Year in the world’s largest annual human migration. Chinese authorities have been scrambling to control the spread of the virus, even taking the extraordinary measure of imposing travel restrictions on the 20 million people who live in Wuhan and two neighboring cities.
For these reasons, global public health experts expected an emergency might already be declared Thursday. “This is a very serious outbreak with the potential for widespread transmission,” said Tom Inglesby, director of the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health. A declaration would have been a “means to gaining deeper international cooperation.”
“This outbreak satisfies the criteria of [a global health emergency] under the law,” said Alexandra Phelan, a member of the Center for Global Health Science and Security at Georgetown University. “It’s very likely we’ll see more cases around the world. Now, we need to ensure hospitals and doctors are prepared and ready to respond when someone does come in” with the virus.
The WHO has only declared a global health emergency five times
The WHO doesn’t take the decision to sound the global alarm about outbreaks lightly. Formally, a PHEIC — pronounced “fake” — is defined as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.”
In reality, it’s a political tool the WHO can use to draw attention to a serious disease that has caught the world off guard and put people’s health in danger. It’s meant to engage the global community in a coordinated outbreak response, galvanize resources, and stop the disease from spreading further across borders.
A key consideration in declaring a PHEIC is whether the disease threat is dire enough to risk countries enacting travel and trade restrictions. Declarations can be devastating to local economies and are often associated with economic losses. According to Reuters, the global economic losses from the 2003 SARS outbreak totaled $40 billion, and the world’s gross domestic product “suffered a 0.1% hit due to the outbreak.”
The WHO has only declared a public health emergency five times, since the International Health Regulations — which govern global health emergency responses — were enacted in 2007. The first time was in 2009, with the outbreak of the H1N1 swine flu pandemic. The second was in May 2014, when polio seemed to surge again, threatening the eradication effort. The third time, in August 2014, came as the Ebola outbreak in West Africa was growing out of control. The fourth was related to Zika in 2016. And the fifth, in 2019, was another outbreak of Ebola that’s ongoing in the Democratic Republic of Congo.
WHO’s Tedros said he wouldn’t hesitate to convene another meeting in the near future to deliberate on whether the outbreak constitutes a PHEIC. For now, he warned that more coronavirus cases may soon spread outside of China, and that countries need to be ready. The agency stopped short of recommending any travel or trade restrictions at this time, instead suggesting people take precautions like making sure their hands are clean and that they don’t cough on others if they’re sick.
There’s a lot we don’t know about the virus
There’s still a lot to learn about 2019-nCoV, but here’s what we do know. It’s part of a large family of viruses that attack the respiratory symptom, called coronaviruses. In humans, coronaviruses can lead to symptoms that range from the common cold to severe pneumonia and death in the case of SARS and MERS. It’s not yet clear where 2019-nCoV falls on that spectrum.
We also don’t know exactly which animal carries this virus, how exactly it spreads, and how easily it spreads among people. According to a preliminary estimate from WHO, each individual transmits the virus to 1.4 to 2.5 others. That makes this virus, at least right now, about as contagious as the flu but less contagious than SARS.
Even so, the fact that cases are already turning up in so many countries mere weeks after this outbreak was first declared suggests we should brace ourselves for an escalation.
“Now compared to 24 hours ago, I’m more concerned about how infectious it is,” said Tom Frieden, the former director of the US Centers for Disease Control and Prevention. “If the sustained human transmission and a high rate of severe illness are confirmed, then it clearly is an event of international concern.”
Others compared the new coronavirus outbreak to the 2003 SARS outbreak, which eventually killed 774 people and infected more than 8,000. “Three weeks ago, we thought this would be a small localized outbreak, but at this point, it’s looking like a SARS-like event,” said Peter Daszak, the president of EcoHealth Alliance, a US global health research organization working in China. “The mortality rate is beginning to creep up. Health care workers are infected. We got our first case in the US.”
Daszak noted that there are also important differences from the SARS outbreak. This time, the public health system is stronger. Chinese authorities appear to be sharing information more readily. (They were heavily criticized in 2003 for withholding information for too long and exacerbating the spread of the virus.) Chinese scientists also released the genetic sequence of the virus early in the new year, which meant diagnostic tests to find cases could be developed rapidly.
It’s also possible that as officials find more patients with the virus, we’ll learn it is milder than it appears to be right now, Frieden said. “There is still an enormous amount we don’t know about how and how readily it spreads and how often it causes severe illness.” He added, “The fact that hundreds of millions of people will be traveling right now in China, let’s just say, is not great timing.”