If shutting down huge cities of 11 and seven million inhabitants is unprecedented, the WHO supporting such a measure is shocking. It goes against the grain of what WHO has always stood for — not restrict travel even when public health emergency is declared.
In a bid to curb the spread of the novel coronavirus that emerged in the city of Wuhan in Hubei province in early December last year, China took a drastic and unprecedented step on Wednesday to shut down the city thus preventing its 11 million inhabitants from leaving. All modes of transport — planes, trains, buses, subways and ferries — have been suspended to prevent residents from exiting the city. Later in the day, authorities planned to shutdown more cities — Huanggang, a city of seven million, shut rail stations in Ezhou city with one million inhabitants, and impose travel restrictions on two the smaller cities — Chibi and Zhijiang.
The move comes in the wake of increasing number of people getting infected and even dying. As per the January 22 update by China’s National Health Commission, the number of infected people in China stands at 571 and deaths at 17. The city of Wuhan, the hotspot of the disease outbreak, has reported nearly 80% of all cases and all the 17 deaths.
Spread of the virus
Besides the huge number of cases reported from Wuhan, the virus has spread to 24 provinces within the country and exported outside the country as well — three cases in Thailand, two cases in Vietnam and one case each in Japan, South Korea, Taiwan, United States, Hong Kong, Macau, and Singapore.
That the virus has already acquired the ability to spread from one person to another has been confirmed by the World Health Organization. Besides close contacts such as in families of an infected individual, 16 health-care workers have been infected. The WHO now sees possible evidence of sustained transmission — the ability of the virus to spread beyond just clusters of patients.
The decision to shut down the city comes on a day when WHO’s Emergency Committee was deliberating whether the novel coronavirus in China should be declared as a “Public health emergency of international concern”. With a split verdict and not enough information available to make a decision, the emergency committee is reconvening Thursday for further deliberations.
WHO’s stand is shocking
The chair of the committee had taken note of the travel ban and said that it is an “important information and will certainly be useful for the reflection of the members of the committee”. The WHO Director-General himself had taken note of China’s decision and said that the travel ban is a reflection of the significant measures taken by China to minimise the spread of the virus.
Speaking to reporters during a conference call after the meeting on Wednesday, Director-General Tedros Adhanom Ghebreyesus answering a pointed question about China imposing travel ban in Wuhan, said: “What they [China] are doing is very strong measure and with full commitment. Based on the situation, taking action that is appropriate is very important. We stressed to them that by taking a strong action not only will they control the outbreak in their country but will also minimise the chances of this outbreak spreading internationally.”
He then added: “They recognise that. And they are doing both — for their own country but at the same time China should play a bigger role in global health. So they are taking more and significant measures to limit or minimise international spread. So as long as it is tailored to the problem, the commitment that we see we comment their actions.”
What the WHO always stood for
These observations run counter to the stand the WHO has always taken even when it announces public health emergency. While announcing the Ebola virus disease outbreak in the Democratic Republic of the Congo as a public health emergency last year, the WHO had stated unequivocally that it is “essential to avoid the punitive economic consequences of travel and trade restrictions on affected communities”.
On announcing Zika as a public health emergency on February 1, 2016, the WHO did not impose any travel restricts. It said: “There should be no restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission. Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites.”
Even in the case of holding the Olympics in Brazil in 2016 after Zika was declared as Public health emergency, the WHO had said: “Based on current assessment, cancelling or changing the location of the 2016 Olympics will not significantly alter the international spread of Zika virus. Brazil is one of almost 60 countries and territories which to date report continuing transmission of Zika by mosquitoes. People continue to travel between these countries and territories for a variety of reasons. The best way to reduce risk of disease is to follow public health travel advice.”
How then can one justify travel restrictions in Wuhan and other cities? Even if the restrictions limit the spread of the virus outside the cities, it is puzzling how the shutdown can prevent human-to-human transmission inside the cities. Shutting down entire cities go beyond the normal practice of quarantining infected people and might backfire.