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Insights into Editorial: Why is COVID-19 not a pandemic yet?

Coronavirus

Context:

The coronavirus outbreak came to light when on December 31, 2019, China informed the World Health Organisation of a cluster of cases of pneumonia of an unknown cause in Wuhan City in Hubei province. On January 9, 2020, WHO issued a statement saying Chinese researchers have made “preliminary determination” of the virus as a novel coronavirus. Since then the thousands of cases of the novel coronavirus have been reported from all the 31 provinces in China. The number of deaths due to the novel coronavirus now stands at 170. Cases have been reported from 15 countries, including India. The novel coronavirus has acquired the ability to spread among humans, with cases of human-to-human transmissions being reported first in Vietnam and Germany.

Symptoms of Corona Virus:

  1. Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
  2. In 2019, a new coronavirus was identified as the cause of a disease outbreak in China.
  3. Coronavirus symptoms can include fever, cough and shortness of breath.
  4. The illness also causes lung lesions and pneumonia. Milder cases may resemble the flu or a bad cold, making detection difficult.
  5. Chinese researchers have shared the whole genome sequence of the novel coronavirus, however apart from some basic details, not much is known about the virus in terms of its source, precise duration of incubation, severity, and what makes it quite easily transmissible.
  6. The severity of COVID-19 symptoms can range from very mild to severe.
  7. People who are older or have existing medical conditions, such as heart disease, may be at higher risk of serious illness. This is similar to what is seen with other respiratory illnesses, such as influenza.

When was the last time a pandemic was declared?

A pandemic is defined as the worldwide spread of a new disease. The last pandemic reported was the 2009 H1N1 flu pandemic, which killed hundreds of thousands globally. Unless it is influenza, WHO generally avoids declaring diseases as pandemics. This change came about after the lessons learned from the 2009 H1N1 experience. According to 2017 pandemic influenza risk management guidelines, the WHO uses pandemic influenza phases — interpandemic, alert, pandemic and transition — to “reflect its risk assessment of the global situation regarding each influenza virus with pandemic potential infecting humans”.

Have some countries contained the spread?

There are nine countries — Afghanistan, Pakistan, Egypt, Iran, Iraq, Kuwait, Lebanon, Oman and UAE — in the WHO Eastern Mediterranean Region that have reported novel coronavirus infections. Only five countries — Thailand, India, Sri Lanka, Nepal Taiwan — in the WHO South-East Asia region have reported SARS-CoV-2 infections. In the Americas, cases have been reported from only Canada, the U.S. and Brazil. All countries that have reported even one case should primarily focus on containing the spread of the virus, the WHO chief said. Fourteen countries have managed to contain the spread of the virus and no new case has been reported for more than a week. And nine countries, including India, Nepal and Sri Lanka, have not reported any additional cases in the last two weeks. This highlights that the virus can be stopped in its track if countries take appropriate and timely actions.

Since the virus has spread globally, will WHO declare COVID-19 as pandemic?

  1. WHO Director-General made it abundantly clear that WHO will not declare COVID-19 a pandemic at this moment.
  2. According to WHO, “We should not be too eager to declare a pandemic without a careful and clear-minded analysis of the facts.
  3. Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems.”
  4. It may also signal that we can no longer contain the virus, which is not true.
  5. We are in a fight that can be won if we do the right things. Of course, we will not hesitate to use the word pandemic if it is an accurate description of the situation.
  6. WHO not downplaying the seriousness of the situation, or the potential for this to become a pandemic, because it has that potential.
  7. On the contrary, we are saying that this virus has pandemic potential and WHO is providing the tools for every country to prepare accordingly.

What steps should countries take to stop the virus from spreading?

  1. The priority should be to detect cases early and isolate people who test positive for the virus.
  2. Once a case is detected, the focus should be to trace the contacts and treat them if already infected.
  3. Since the molecular test is not highly sensitive and can return false negatives, people who have returned to India or have come in contact with people who have tested positive should be made aware to seek immediate medical care once symptoms show up.
  4. Though the average incubation period is five-seven days, a few have shown up symptoms at the end of 24 days.
  5. Efforts should also be focussed on preventing outbreaks in hospitals and spread in the community. One way to stop the spread in the community is to avoid mass gathering in enclosed spaces.
  6. The Ministry of Health has advised people to avoid all non-essential travel to countries where community spread of the virus is reported, particularly Singapore, South Korea, Iran and Italy.
  7. According to February 13 release, the Health Ministry has been following up passengers travelling from China, Singapore, Thailand, South Korea and Japan for a period of 28 days.

Conclusion: Looking ahead:

Ultimately, the decision to declare a pandemic rest with the WHO’s Director General. That decision will be based on a range of factors including how fast the disease is spreading, which groups of people are most at risk and the effectiveness of treatments. That caution could stem, in part, from WHO’s handling of the H1N1 swine fever outbreak in 2009. Using criteria since abandoned, the WHO declared a pandemic. Later, when the disease proved less deadly than first feared, some accused the WHO of overreacting. Preventing unnecessary panic, of course, is key. The word pandemic “may also signal that we can no longer contain the virus, which is not true,” said the Director General. “We are in a fight that can be won if we do the right things.” WHO would not hesitate to use the word pandemic if it becomes “an accurate description of the situation”.