Iran, Italy... Coronavirus outbreak a pandemic ’in all but name’, says expert

While WHO says virus still containable, sudden cases in Iran [1] and Italy causing alarm.

The World Health Organization has played down fears of a coronavirus pandemic sweeping the world, despite sudden serious outbreaks in Italy and Iran, but some experts said they believed it was now inevitable.

“Using the word pandemic now does not fit the facts, but it may certainly cause fear,” said the WHO’s director general, Dr Tedros Adhanom Ghebreyesus, at a briefing.

We are not there yet, said Tedros. “What we see are epidemics in different parts of the world affecting different countries in different ways.”

The word pandemic is used to describe a serious disease that is spreading in an uncontrolled way around the world. China, he pointed out, appeared to have contained it. The international team sent in by the WHO, which is about to report its findings, has said the virus probably peaked between 23 January and 2 February.

Tedros added, however, that “the sudden increase in new cases is certainly very concerning”.

Most worrying is the arrival of the coronavirus in Italy and Iran with no prior warning, presumably spread by people who were asymptomatic carriers. Italy now has 219 cases and seven people have died. The figures in Iran are disputed, but some reports claimed there had been 50 deaths in the city of Qom, which is a pilgrimage site.

Other experts said it was hard to believe that Covid-19 would not now spread worldwide.

“We now consider this to be a pandemic in all but name, and it’s only a matter of time before the World Health Organization starts to use the term in its communications,” said Dr Bharat Pankhania, from the University of Exeter Medical School.

“This gives us focus and tells us that the virus is now appearing in other countries and transmitting far afield from China. However, it doesn’t change our approach in monitoring the outbreak. In the UK, there’s no need to move towards mitigation strategies, as so far, our containment policies are working. We only have 13 cases, and they are contained and controlled. I expect we will continue with this containment strategy while it’s successful.”

“A pandemic means an infectious disease is spreading out of control in different regions of the world. We already have a Covid-19 epidemic in China and, more recently, large outbreaks in South Korea, Iran and Italy. If those outbreaks cannot be brought under control, then Covid-19 would fit the criteria of a pandemic,” said Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh.

“The immediate implication is that many different countries around the world may be sources of Covid-19 infections. This makes it much harder for any one country to detect and contain imported cases and trying to do so will place ever greater demands on national health systems.

Tedros said the new cases outside China reinforced the need for all countries to ensure they were ready for the arrival of Covid-19. “This is the time for all countries, communities and families and individuals to focus on preparing,” he said. “We do not live in a binary black and white world. It is not either/or. We must focus on containing while doing all we can to prepare for a potential pandemic.”

That would mean safeguarding the elderly and those with health problems and weakened immune systems, who are most vulnerable to the coronavirus.

Dr Michael Ryan, WHO’s director of emergencies, said a flu pandemic was more recognisable because of the knowledge scientists have of the way influenza viruses behave. “What we don’t understand yet in Covid-19 is the absolute transmission dynamics,” he said.

The Italian government has introduced stringent internal travel restrictions, closing off the worst-hit areas in the northern regions of Lombardy and Veneto. About 50,000 people in 11 northern Italian towns have been under lockdown since Friday night, with police patrolling the streets and fines being imposed on anyone caught entering or leaving outbreak areas.

Austria suspended train services over the Alps to Italy for about four hours late on Sunday before restarting them after two travellers tested negative for coronavirus. A train carrying about 300 passengers from Venice, in Italy, to Munich, in Germany, was halted on the Italian side of the Brenner Pass before being allowed to continue its journey after the two tested negative, authorities said.

France’s junior transport minister, Jean-Baptiste Djebbari, said on Monday that there was no need to close down transport borders between France and Italy.

“Closing down the borders would make no sense, as the circulation of the virus is not just limited to administrative borders,” he told BFM Business.

Sarah Boseley Health editor

• The Guardian. Mon 24 Feb 2020 18.43 GMT Last modified on Mon 24 Feb 2020 23.39 GMT:
https://www.theguardian.com/world/2020/feb/24/coronavirus-outbreak-a-pandemic-in-all-but-name-says-expert


Experts warn world ‘grossly unprepared’ for future pandemics

[September 2019 article]

Dire risk is compounded by climate crisis, urbanisation and lack of sanitation, says global monitoring board.

It sounds like an improbable fiction: a virulent flu pandemic, source unknown, spreads across the world in 36 hours, killing up to 80 million people, sparking panic, destabilising national security and slicing chunks off the world’s economy.

But a group of prominent international experts has issued a stark warning: such a scenario is entirely plausible and efforts by governments to prepare for it are “grossly insufficient”.

The first annual report by the Global Preparedness Monitoring Board [2], an independent group of 15 experts convened by the World Bank and WHO after the first Ebola crisis, describes the threat of a pandemic spreading around the world, potentially killing tens of millions of people, as “a real one”.

There are “increasingly dire risks” of epidemics, yet the world remained unprepared, the report said. It warned epidemic-prone diseases such as Ebola, influenza and Sars are increasingly difficult to manage in the face of increasing conflict, fragile states and rising migration. The climate crisis, urbanisation and a lack of adequate sanitation and water are breeding grounds for fast-spreading, catastrophic outbreaks.

“For too long, world leaders’ approaches to health emergencies have been characterised by a cycle of panic and neglect,” said Dr Gro Harlem Brundtland, former prime minister of Norway and co-chair of the board alongside Elhadj As Sy, the secretary general of the International Federation of Red Cross and Red Crescent Societies.

“It is high time for urgent and sustained action. This must include increased funding at the community, national and international levels to prevent the spread of outbreaks. It also requires leaders to take proactive steps to strengthen preparedness coordination mechanisms across governments and society to respond quickly to an emergency.”

The report acknowledges governments and international institutions have taken steps to increase preparedness for outbreaks in the five years since the Ebola crisis in west Africa, but concludes current preparedness is “grossly insufficient”. A growing lack of public trust in institutions in some countries, exacerbated by misinformation, hinders disease control, said the study.

The report’s authors contrast the current Ebola outbreak in the Democratic Republic of the Congo, where a lack of trust between communities and authorities has undermined response efforts [3], with Uganda, where public health authorities and community officials had a preparedness plan in place when it crossed the border [4]. Cases in Uganda were quickly isolated and detected, reducing further infections.

“The trust between communities and the institutions that serve them is at the core of an emergency response, but it is almost impossible to build trust in the middle of a crisis,” said As Sy.

“Community engagement and trust cannot be an afterthought, it has to be earned. Leaders and public health authorities must work as partners with communities to build that trust. We can’t just show up once a health crisis hits. We need to be there before, during and after.”

Outbreaks could emerge naturally, but there is also a risk of accidental or deliberate release by rogue actors, which could complicate an effective response, they said.

“Ebola, cholera, measles – the most severe disease outbreaks usually occur in the places with the weakest health systems,” said World Health Organization director Dr Tedros Adhanom Ghebreyesus. “As leaders of nations, communities and international agencies, we must take responsibility for emergency preparedness, and heed the lessons these outbreaks are teaching us. We have to ‘fix the roof before the rain comes.’”

The report noted some recent progress. As of July 2019, 59 countries had developed a national action plan for health security. But not one is fully financed.

The report outlined seven steps to ensure the world’s health system is better prepared for the next health emergency, calling on heads of states to increase funding and for international organisations to build preparedness into funding mechanisms.

“Poverty and fragility exacerbate outbreaks of infectious disease and help create the conditions for pandemics to take hold”, said Axel van Trotsenburg, acting CEO of the World Bank. “Investing in stronger institutions and health systems will promote resilience, economic stability and global health security.”

Karen McVeigh
@karenmcveigh1

Global development is supported by
Bill and Melinda Gates Foundation

• The Guardian. Wed 18 Sep 2019 16.08 BST Last modified on Thu 19 Sep 2019 13.36 BST:
https://www.theguardian.com/global-development/2019/sep/18/a-deadly-virus-could-kill-80-million-people-in-hours-experts-warn


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