The window of opportunity to contain novel coronavirus is narrowing as the number of cases with no clear epidemiological link, such as travel history to China or contact with a confirmed case is increasing in many countries, WHO chief cautioned.

With a spike in the number of new confirmed cases in ‘many countries with no clear link with China, World Health Organization Director-General Tedros Adhanom Ghebreyesus on February 21 warned that the “increasing signs of transmission outside China show that the window of opportunity we have for containing coronavirus is narrowing”.

For weeks the WHO head has been emphasising that there is a “window of opportunity” to contain COVID-19 even as the number of cases and deaths in China kept increasing. But on Friday he said for the first time that the window of opportunity to contain the disease is narrowing.

The WHO head stressed that the number of cases outside of China still remained “relatively small”, but raised concern about the “number of cases with no clear epidemiological link, such as travel history to China or contact with a confirmed case.”

“We must not look back and regret that we failed to take advantage of the window of opportunity we have,” he said. “The data from China appear to show a decline in new cases. This is welcome news, but it must be interpreted very cautiously. It’s far too early to make predictions about this outbreak.”

“If we do well within the narrowing window of opportunity, we can reverse or avert any serious crisis. If we squander the opportunity, then there will be a serious problem in hand” he cautioned. “Our biggest concern continues to be the potential of COVID-19 to spread in countries with weaker health systems.”

“We are concerned with the increasing number of cases in Iran” he said. As on Friday Iran had reported 18 cases and five deaths. And there is a case in Lebanon linked to Iran.

Cases spike in Iran, South Korea

Till February 19, no confirmed case was reported from Iran. But in a matter of three days, Iran has confirmed 28 cases and five deaths. There have also been cases of travellers from Iran testing positive.

Similarly, in South Korea, the numbers have been increasing sharply in the last couple of days. With 433 confirmed COVID-19 cases, South Korea has the most numbers outside China. There have been three deaths as well. Most of the cases (231) are restricted to people belonging to a religious group in Daegu and 111 cases a hospital psychiatric ward in Cheongdo county.

Local transmission growing in a few countries

Singapore with its gold-standard surveillance has so far reported 89 confirmed cases. At least seven not been traced to a known transmission chain. Japan confirmed 14 more cases on February 22 has a similar problem. Italy has reported 39 cases with local transmission and became the first country in Europe to report deaths; two have died so far. Ten towns have been shut down after a cluster of cases emerged on February 21.

According to an AFP report, Italian Health Minister Roberto Speranza said Italy is now seeing the same sort of cluster of cases that Germany and France have seen.

The Princess Diamond ship in Japan waters has the biggest cluster of cases outside China with 634 cases and two deaths.

Is this the tip of an iceberg?

The number of cases reported outside China may still be the tip of an iceberg if the analysis by the Imperial College London study is anywhere close to reality. According to the analysis, two thirds of COVID-19 cases exported from mainland China is yet to be detected globally. If true, this could potentially result in “multiple chains of as yet undetected human-to-human transmission outside mainland China”. This is despite the travel restrictions from Wuhan City and other cities across China.

Though the number of cases outside of China has still remained “relatively small”, there have been a “number of cases with no clear epidemiological link, such as travel history to or contact with a confirmed case”. How the COVID-19 would play out in the coming weeks and months depends on how seriously countries strive to prevent the spread of the virus.

UPDATE – Feb 23

The number of cases in South Korea shot up to 556, while the number of deaths increased to four.