Coronavirus now a Global Health Emergency

The number of confirmed cases of Coronavirus has topped 8,000, with more than 12,000 suspected. Of the confirmed cases, 1,370 are severe and 170 people have died. 124 people have recovered and been discharged from hospital.

China continues its efforts to build at least two hospitals in a less-than-two-week time period to handle the sick, primarily in the Wuhan province.

Yesterday, a cruise ship was detained because of 2 people on board with suspected cases of Coronavirus. The Italian cruise ship, the Costa Smeralda, is being detained in an Italian port. The Chinese couple aboard is being held in quarantine. There are 6,000 people on board.

Some airlines have started to restrict flights to and from China. Americans in China are still having difficulty in getting out, and when they are coming back to the US, they are being quarantined until their health status can be determined.

Coronavirus has been confirmed in the United States in Illinois, California, Washington state, and Arizona, while other states as close as Connecticut, New Hampshire and New Jersey have cases under investigation.

Not only is this virus dangerous, but not controlling it impacts global economics, the stock market, travel and vacation plans, and a sense of fear and panic.

At approximately 4pm ET yesterday, the World Health Organization (WHO) declared the Coronavirus situation a Global Health Emergency.

From the World Health Organization (WHO):

Representatives of the Ministry of Health of the People’s Republic of China reported on the current situation and the public health measures being taken. The WHO Secretariat provided an overview of the situation in other countries. There are now 82 cases in 18 countries. Of these, only 7 had no history of travel in China. There has been human-to-human transmission in 3 countries outside China. One of these cases is severe and there have been no deaths.

Conclusions and advice

The Committee welcomed the leadership and political commitment of the very highest levels of Chinese government authorities, their commitment to transparency, and the efforts made to investigate and contain the current outbreak. China quickly identified the virus and shared its sequence, so that other countries could diagnose it quickly and protect themselves, which has resulted in the rapid development of diagnostic tools.

The very strong measures the country has taken include daily contact with WHO and comprehensive multi-sectoral approaches to prevent further spread. It has also taken public health measures in other cities and provinces; is conducting studies on the severity and transmissibility of the virus and sharing data and biological material. The country has also agreed to work with other countries who need their support. The measures China has taken are good not only for that country but also for the rest of the world.

The Committee also acknowledged that there are still many unknowns, cases have now been reported in five WHO regions in one month, and human-to-human transmission has occurred outside Wuhan and outside China.

The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. It is important to note that as the situation continues to evolve, so will the strategic goals and measures to prevent and reduce spread of the infection. The Committee agreed that the outbreak now meets the criteria for a Public Health Emergency of International Concern and proposed the following advice to be issued as Temporary Recommendations.

The Committee emphasized that the declaration of a PHEIC should be seen in the spirit of support and appreciation for China, its people, and the actions China has taken on the front lines of this outbreak, with transparency, and, it is to be hoped, with success. In line with the need for global solidarity, the committee felt that a global coordinated effort is needed to enhance preparedness in other regions of the world that may need additional support for that.

Advice from WHO

The Committee welcomed a forthcoming WHO multidisciplinary technical mission to China, including national experts. The mission should review and support efforts to investigate the animal source of the outbreak, the clinical spectrum of the disease and its severity, the extent of human-to-human transmission in the community and in healthcare facilities, and efforts to control the outbreak. This mission will provide information to the international community to aid in understanding the situation and its impact and enable sharing of experience and successful measures.

The Committee wished to re-emphasize the importance of studying the possible source, to rule out ongoing hidden transmission.

The Committee also emphasized the need for enhanced surveillance in regions outside Hubei, including pathogen genomic sequencing, to understand whether local cycles of transmission are occurring.

The Committee would welcome strong leadership to engage in the discussion about proportionality in control measures, particularly with regard to potentially damaging travel and trade restrictions.  

WHO should continue to use its networks of technical experts to assess how best this outbreak can be contained globally.

WHO should provide intensified support for preparation and response, especially in vulnerable countries and regions.

Measures to ensure rapid development and access to potential vaccines, diagnostics, antiviral medicines and other therapeutics for low- and middle-income countries should be developed.

WHO should continue to provide all necessary technical and operational support to respond to this outbreak, including with its extensive networks of partners and collaborating institutions, to implement a comprehensive risk communication strategy, and to allow for the advancement of research and scientific developments in relation to this novel coronavirus.

The Director-General declared that the outbreak of 2019-nCoV constitutes a PHEIC, accepted the Committee’s advice and issued this advice as Temporary Recommendations under the IHR (2005).

To the People’s Republic of China

Continue to:

• Implement a comprehensive risk communication strategy to regularly inform the population on the evolution of the outbreak, the prevention and protection measures for the population, and the response measures taken for its containment.
• Enhance rational public health measures for containment of the current outbreak.
• Ensure the resilience of the health system and protect the health workforce.
• Enhance surveillance and active case finding across China.
• Collaborate with WHO and partners to conduct investigations to understand the epidemiology and the evolution of this outbreak and measures to contain it.
• Share full data on all human cases.
• Strengthen the efforts to identify a zoonotic source of the outbreak, and particularly the potential for ongoing circulation with WHO as soon as it becomes available.
• Conduct exit screening at international airports and ports, with the aim of early detection of symptomatic travelers for further evaluation and treatment, while minimizing interference with international traffic.

To all countries

It is expected that further international exportation of cases may appear in any country. Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoV infection, and to share full data with WHO. Technical advice is available on the WHO website.

Countries are reminded that they are legally required to share information with WHO under the IHR (2005).

Countries should place particular emphasis on reducing human infection, prevention of secondary transmission and international spread, and contributing to the international response though multi-sectoral communication and collaboration and active participation in increasing knowledge on the virus and the disease, as well as advancing research.

The Committee acknowledged that, in general, evidence has shown that restricting the movement of people and goods during public health emergencies may be ineffective and may divert resources from other interventions. Further, restrictions may interrupt needed aid and technical support, may disrupt businesses, and may have negative effects on the economies of countries affected by the emergencies.  

However, in certain specific circumstances, measures that restrict the movement of people may prove temporarily useful, such as in settings with limited response capacities and capabilities, or where there is high intensity of transmission among vulnerable populations.

In such situations, countries should perform risk and cost-benefit analyses before implementing such restrictions to assess whether the benefits would outweigh the drawbacks. Countries must inform WHO about any travel measures taken, as required by the IHR. Countries are cautioned against actions that promote stigma or discrimination, in line with the principles of Article 3 of the IHR.

The Committee asked the Director-General to provide further advice on these matters and, if necessary, to make new case-by-case recommendations, in view of this rapidly evolving situation.

To the global community

As this is a new coronavirus, and it has been previously shown that similar coronaviruses required substantial efforts to enable regular information sharing and research, the global community should continue to demonstrate solidarity and cooperation, in compliance with Article 44 of the IHR (2005), in supporting each other on the identification of the source of this new virus, its full potential for human-to-human transmission, preparedness for potential importation of cases, and research for developing necessary treatment.

Provide support to low- and middle-income countries to enable their response to this event, as well as to facilitate access to diagnostics, potential vaccines and therapeutics.

Under Article 43 of the IHR, States Parties implementing additional health measures that significantly interfere with international traffic (refusal of entry or departure of international travelers, baggage, cargo, containers, conveyances, goods, and the like, or their delay, for more than 24 hours) are obliged to send to WHO the public health rationale and justification within 48 hours of their implementation. WHO will review the justification and may request countries to reconsider their measures. WHO is required to share with other States Parties the information about measures and the justification received.

About the Coronavirus

Human coronaviruses are common throughout the world. Seven different coronaviruses, that scientists know of, can infect people and make them sick. Some human coronaviruses were identified many years ago and some have been identified recently. Human coronaviruses commonly cause mild to moderate illness in people worldwide. Two newer human coronaviruses, MERS-CoV and SARS-CoV, have been known to frequently cause severe illness.

What are the symptoms of this Coronavirus?

From Harvard Health: The symptoms can include a cough, possibly with a fever and shortness of breath. There are some early reports of non-respiratory symptoms, such as nausea, vomiting, or diarrhea. Many people recover within a few days. However, some people — especially the very young, elderly, or people who have a weakened immune system — may develop a more serious infection, such as bronchitis or pneumonia.

From the Rhode Island Department of Health

Chinese officials report that person-to-person spread of coronavirus is occurring in China. Person-to-person spread in the United States has not yet been detected. Officials are still learning more about how the novel coronavirus is spreading in China. However, because human coronaviruses most commonly spread through respiratory droplets, Rhode Islanders are reminded to take the same measures that healthcare providers recommend annually to prevent the spread of the flu and other viruses:

Get your flu shot and encourage the people around you to do the same. – Wash your hands often throughout the day. Use warm water and soap. If soap and water are not available, use alcohol-based hand gel. – Cough or sneeze into your elbow. Flu is spread through coughing or sneezing on other people or into your hands. Cover your coughs and sneezes to prevent others from getting sick. – Avoid touching your eyes, nose, or mouth. Germs spread this way. – Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious foods. – Keep surfaces (especially bedside tables, surfaces in the bathroom, and toys for children) clean by wiping them down with a household disinfectant.

The CDC has taken a number of steps in response to coronavirus. This has included developing a diagnostic test to detect this virus in clinical specimens and conducting entry screening of passengers on direct and connecting flights from Wuhan, China to five major airports in the United States: Atlanta (ATL), Chicago (ORD), Los Angeles (LAX), New York City (JFK), and San Francisco (SFO). Enhanced screening measures are also in place at 20 other airports. Finally, the CDC is now recommending that travelers avoid all nonessential travel to China.

For more Rhode Island information:  https://health.ri.gov

Photo: World Health Organization Director-General Tedros Adhanom Ghebreyesus in Geneva, 1/30/20