There have been major developments since January 23 which makes it almost certain that the WHO after today’s meeting will announce the novel coronavirus as public health emergency.
“Yes, all the criteria for a ‘Public Health Emergency of International Concern’ have been met, including a serious outbreak, a novel pathogen, international spread, and impacts on travel and trade,” Prof. Lawrence O. Gostin, Director, World Health Organization Collaborating Center on National & Global Health Law in Washington, DC, U.S. said in an email sent to me a few days ago. In the email sent before local transmission could be reported outside China, he said: “There has been international spread [and] that is all that matters. I think it is only a matter of time until we see local transmissions.”
When is PHEIC declared
According to WHO, the term PHEIC as defined in 2005 is an “extraordinary event which is determined, as provided in these regulations — to constitute a public health risk to other States through the international spread of disease, and to potentially require a coordinated international response”. This as per WHO “implies a situation that is serious, unusual or unexpected, carries implications for public health beyond the affected State’s national border, and may require immediate international action”.
If not on January 22-23 when the emergency committee first met to decide if the novel coronavirus outbreak in China constituted a public health emergency, all of these and more have been met in the last few days both within and outside China.
Human-to-human transmission in three countries outside China and its potential to spread further globally, according to Director-General of WHO Tedros Adhanom Ghebreyesus, was the main reason why he asked the committee to reconvene on Thursday. Local transmission outside China is just one of the important developments that have happened since the last meeting that has turned the situation grave.
First among them, is the accelerated spread of the virus within and outside China. On January 23 when the committee decided not to declare public health emergency, there were only 584 cases and 17 deaths reported to WHO from across the globe. Of them, 575 cases and all deaths were from China and the remaining nine cases were from six countries — Japan, South Korea, Thailand, the U.S. and Vietnam.
In just six days since the meeting, the number of cases and deaths both within China and in other countries has multiplied manifold. As on January 30, mainland China reported 7,711 cases and 170 deaths. The virus has now been reported from all the 31 provinces.
The number of novel coronavirus cases from other countries/regions too has increased sharply since January 23. As on January 30, 117 cases have been reported from 21 countries/regions, including India, Tibet, Finland, Philippines, and UAE. At 14, Thailand has the most number of cases outside China followed by 12 in Japan and 10 each in Hong Kong and Singapore.
Local transmission outside China
In addition to the increase in the number of cases and deaths, local transmission has been reported in Vietnam, Germany and Japan. No local transmission outside China was reported before January 23. This alone is very likely to push the WHO into declaring the novel coronavirus as public health emergency. There were fourth generation cases in Wuhan and second-generation cases in China outside Wuhan even before January 23.
Spreading during incubation period
Third, the virus seems to have the ability to spread even during the incubation period. This we know from the admission by China’s National Health Commission Minister that the novel virus might be spreading even during the incubation period when symptoms do not show up. This was seen in the case of a man in Germany who was infected by a colleague visiting from China. The colleague began to feel sick only on her journey back home. The ability of the virus, like in the case of common cold, measles and chicken pox, to spread even before symptoms show up will make it very difficult to stop the global spread of the virus.
It is for this reason that even thermal screening at all 20 airports in India might not be able to detect all cases at the point of entry. People returning from China or who were in contact with infected people or people who had recently returned from China can show up with symptoms few days later.
Four, unlike SARS, people may harbour the virus even when they do have overt symptoms. Alarmingly, more asymptomatic cases are being reported in the case of the novel coronavirus. Besides a reported case of a child in China being asymptomatic, the WHO has reported three other such instances outside China. It is not clear how well the asymptomatic cases who have sub-clinical manifestation of the disease would transmit the virus and infect others.