Summary: America should lead the world in preparing for COVID-19. Instead, we are a laggard, as this briefing by WHO makes all too clear. Let’s catch up before we get a raging epidemic. It won’t happen unless we demand better and faster action.
America’s vast resources should make us among the best prepared of nations for the COVID-19 epidemic. Our large number of ICU beds plus our stockpiles of drugs and medical equipment (details here). Our massive wealth not just of money but also of talent and infrastructure in the health sciences. Our preparations for bioweapon attacks. And the weeks of warning provided by China. But we may have squandered these advantages. The mistakes by the CDC in rolling out the tests were crippling. But worse is the lack of leadership – the negative leadership of our tweeter-in-chief, Clown Trump.
That might have changed, starting with Trump’s appointment of Mike Pence to ramrod America’s response to COVID-19. Just in case it has not, we should read and take to heart these words from Thursday’s WHO briefing. They are said to the world, but (unfortunately) apply well to America. It would be sad if after all the mockery of WHO and China by Americans, we ignored WHO’s advice and China’s success (at containing the epidemic) – and as a result we suffered greatly.
WHO should be pointing to America as a leader for others to emulate, not warning us not to be a laggard. But fast action can change that. It will happen before a raging epidemic in America only if we demand fast and better action. And if we can muzzle the Left when the whine about civil liberties violations when the government takes the strong action necessary to contain the epidemic in America.
This briefing also provides answers to questions being asked by many people – and often answered with misinformation.
Excerpt from the WHO press conference on 5 March 2020
See the full transcript. Slightly paraphrased for clarity. Red emphasis added.
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO (TAG)
…Now to the numbers. There is now a total of 95,265 reported cases of COVID-19 globally. And 3,281 deaths. In the past 24 hours, China reported 143 cases. Most cases continue to be reported from Hubei province, and eight provinces have not reported any case in the last 14 days. Outside China, 2,055 cases were reported in 33 countries. Around 80% of those cases continue to come from just three countries.
We see encouraging signs from the Republic of Korea. The number of newly reported cases appears to be declining, and the cases that are being reported are being identified primarily from known clusters. Although a few countries are reporting large numbers of cases, 115 countries have not reported any cases. 21 countries have reported only one case, and five countries that had reported cases have not reported new cases in the past 14 days.
The experience of these countries, and of China, continues to demonstrate that this is not a one-way street. This epidemic can be pushed back, but only with a collective coordinated and comprehensive approach that engages the entire machinery of government. We’re calling on every country to act with speed, scale, and clear-minded determination. Although we continue to see the majority of cases in handful of countries, we’re deeply concerned about the increasing number of countries reporting cases, especially those with weaker health systems.
However, this epidemic is a threat for every country, rich and poor, and as we have said before, even the high-income countries should expect surprises. The solution is aggressive preparedness. We’re concerned that some countries have either not taken this seriously enough, or have decided there is nothing they can do. We’re concerned that in some countries the level of political commitment and the actions that demonstrate that commitment do not match the level of the threat we all face.
This is not a drill. This is not the time to give up. This is not a time for excuses. This is a time for pulling out all the stops. Countries have been planning for scenarios like this for decades. Now is the time to act on those plans. These are plans that start with leadership from the top. Coordinating every part of government, not just the health ministry. Security, diplomacy, finance, commerce, transport, trade, information, and more. The whole government should be involved. We need a whole government approach. …
We call on all countries to accelerate those plans, and we stand ready to work with them to do that. More funding is being made available to support countries that need it, and that have plans in place. As you know, The World Bank, The International Monetary Fund, have both made funds available to stabilise health systems and mitigate the economic consequences of the epidemic with a special focus on enabling access to critical supplies and equipment. …
We’re all responsible for reducing our own risk of infection, and if we’re infected, for reducing our risk of infecting others. There is something all of us can do to protect vulnerable people in our communities. That’s why we keep talking about solidarity. This is not just a threat for individual people, or individual countries. We’re all in this together. And we can only save lives together. I thank you.
Question: Do you have any evidence that coronavirus is seasonal. Thank you.
Dr Maria van Kerkhove (MKV): So far we’ve only known about this virus for eight weeks or so. We don’t know much about what this virus will do over the course of a season. …We have no reason to believe that this virus would behave differently in different temperatures. We have no reason to believe that this virus would behave differently in different temperatures, which is why we want aggressive action in all countries to make sure that we prevent onward transmission, and that it’s taken seriously in every country. …
Dr Michael Ryan (MR): It’s important to explain that seasonality is driven by factors in the virus, its ability to survive in the environment, but it’s also driven by human factors, which are the coming together of humans. And influenza and other respiratory diseases can spread efficiently in winter, not necessarily because of the temperature, but because human beings come together in closed environments, and therefore transmission is more facilitated.
So we’ve seen this disease now in a number of different climates. Singapore is a very hot, humid climate, and the disease there has spread, it’s coming under control. So we will need to wait and see. Wait and see.
Question: Can you mention what countries are not taking this very seriously?
TAG: There are a good number of countries who have left the epidemics up to the ministry of health and the health emergency institutions. We’re saying that’s wrong. It needs whole government approach. That’s why my statement today was focused on advising all countries on Earth to trigger the whole government approach.
So all sectors in the government are involved, and this should be led by the principal, head of state or head of government, or the second person who has the mandate to coordinate all sectors. But governments alone cannot beat this virus. In addition to the whole government approach, the focus should be on mobilising everybody, all citizens, to take care of themselves, and to also take care of others, and to make significant progress in the fight. …
Question: Dr Marc Lipsitch, an epidemiologist at Harvard, {said on CBS on March 2} that as many as 40 to 70% of the world’s five billion adults could at some point contract coronavirus. Is it really that dire, in your perspective?
MR: We’ve had these numbers almost every week now for the last eight weeks. And we need to, as I’ve always said, take each prediction into account. We need to know what data that’s based on. This is usually based on modeling data, based on certain assumptions about transmission and some assumptions about control measures. …We will listen to all good science.
Having said that, there are obvious real things happening in the real world that contradict that. If we look at China, today, 20 provinces in China have today downgraded their public health emergency risk level. That’s 20 of 31 have actually gone in the reverse. That’s flying in the face of that prediction. I’m not saying which one is correct. …Yesterday, the last 24 hours, only four cases of confirmed COVID-19 infection outside Hubei in China. Most of those cases came from other countries. …
Question: Please tell us if surfaces could be a source.
MVK: So we know that this is a respiratory pathogen, and it spreads through droplets. And so these droplets that come out of our mouths and our noses, if we cough, we sneeze, will move some distance, and they’ll settle on surfaces. And there are some experimental studies that are currently underway that are looking at how long these viruses will survive on different types of surfaces.
In some preliminary results from that it looked like this virus acts and behaves similar to the SARS coronavirus. But those viruses can be inactivated with disinfectants. So cleaning of surfaces can clear those viruses away, and that’s important. The role of asymptomatic transmission is a very important question to us as well.
Question: Please tell us what you know about asymptomatic transmission.
MVK: We know that this infection with COVID-19 causes a wide range of symptoms, including people who don’t develop symptoms. What we understand is that because contact tracing is so strong, in some countries, cases that have not yet developed symptoms are being identified by being PCR positive. And so these are people who are pre-symptomatic. So it’s a few days before they develop symptoms.
Now the question is whether or not those individuals can transmit to other people. We know that that is possible, but we do not believe that that’s a major driver of transmission. And the reason we know that is because if we look at the actual epidemics and how these epidemics are unfolding, if they were a major driver of transmission it would have caused much larger numbers of cases.
The big question that we have right now is how many people have been infected overall, and how many people are truly asymptomatic. That is, how many people have been infected but don’t develop symptoms. Those studies are starting now. There are serologic assays that are in use right now. We are advocating for population-based sero-surveys to be conducted so that we can have a better understanding of which proportion of the population has evidence of infection, as detected through antibodies.
But we do not believe that asymptomatic transmission is a major driver of transmission. It’s still early days. It’s still a few weeks into this outbreak. We’re learning every day something new about this virus. That can change. As every statistic, everything that we say here. But based on the evidence, we’re an evidence-based organisation, we’re taking the evidence we receive from countries, we’re looking at all of the scientific papers that are coming out, and we’re looking at the evidence.
Question: Do you think any approaches {used in China} can be …adopted by other countries? Thank you.
MR: I think the DG has spoken to this many times. That was the whole purpose of having the joint WHO international team join our Chinese colleagues. I’ve been at this a long time. Nobody has ever responded to an epidemic perfectly. No one has ever responded in perfect time with the perfect response. This is the real world we live in.
Every emergency response is dotted with missed opportunities, and unfortunate delays, and sometimes decisions that have to be made on limited data that subsequently turn out. You look back and you think, you know what, if we knew that now, then what we know now, we might have done something differently. So we need to be really careful on the one hand to learn the lessons, and on the other hand not to say that exactly what happens in China needs to now happen exactly the same everywhere else.
The lessons we’ve learned from China and Singapore are – To break down your problem. Understand where you have just sporadic cases. Understand where you have clusters. Understand where you have community transmission. Adapt your response to those needs. Distribute your resources according to priority. Be persistent, be consistent, be coordinated, be joined up. These are the things we need to see.
Command, control, coordination, coherence. And that, the DG has been speaking to, an all of government approach. Community, society, public sector, private sector, and government coming together to work together. And in weeks. And it’s been shown. It can be turned around in weeks if that is what people are prepared to do.
There are no guarantees with that approach. There are no guarantees that that can be achieved. But at the very least that will significantly slow down the spread of this virus, allowing our health systems to catch up. And I think all of you have seen that health systems, even some health systems with a very small number of cases, have already struggled. They’ve already struggled to deal with the small caseload. So we need to get our health systems stronger. And one of the ways of doing that is to slow down the spread of this disease. …
MVK: We’ve learned that the fundamentals work. The fundamentals of public health work. The fundamentals of identifying your cases, identifying your contacts. I’m an epidemiologist. This is epidemiology at its core. You need to look for your cases aggressively. You need to find all of those contacts, and find those contacts. You need to mobilise your population.
One of the things I was most touched by in China, was the absolute drive of every single person we met. Every person of the population knew what their role was in this outbreak. They knew what they needed to do. They knew how they had to protect themselves, how they could protect their families, and what they needed to do collectively to bring this under control. …
TAG: There is a common factor for all countries. Which we call political commitment or political intervention. As you know, political intervention is like surgical intervention. It brings a paradigm. And meaning if the highest level of the government, the head of state or head of government, starts to lead and coordinates all sectors that brings qualitative change in the way that we respond to the epidemic.
That can be done by any country on Earth. That can bring a new paradigm in each and every country. That’s why in my statement today we focused on whole government approach. No government, no country has an excuse, because each and every country has a government. That’s what we’re asking for. Take it to a higher level. This is not up to the ministers of health only. This is the responsibility of the head of state, the head of government, and it should be coordinated from the top, and all sectors should be involved.
This virus is touching everything in the country. It will. In those countries that are not there. So that’s why it’s going to touch everything, if it’s going to touch the politics, if it’s going to touch the social fabric of the country, if it’s going to touch the economy, then no sector is immune or untouched. That’s why we’re saying we have to raise it up, and then the political commitment is at the centre. The political intervention is at the centre, because that’s the surgical intervention. That brings paradigm.
I was encouraged to get a call from President Sebastián Piñera of Chile. Calling on his own initiative to discuss the situation. Globally and in his own corner. And exchanging ideas on how we can really beat this virus. And not only that, we had a very good discussion, this was the day before yesterday, with President Sebastián Piñera, but today with the prime minister of Sweden. Another excellent discussion on the global situation, on the importance of whole government approach. By the way, he was just coming out of a meeting with his cabinet, discussing this issue, mobilising all sectors. …
These are the approaches we’re saying are the right ones, and these are the approaches we’re saying are going to mobilise the whole government. But not only the whole government, but that whole government should mobilise the whole society. And making the response to every citizen’s business. If we do that, we can push back on this virus. We can be successful in the containment strategy.
Some people, you’re following the media, are saying it’s already the pandemic, there is nothing we can do now, we should move into mitigation. And containment may not work. We don’t think that containment should be abandoned. Because I have already said many countries are succeeding in that strategy, in containment strategy, and containing the virus. But we’re not saying just follow containment strategy. What we’re saying is, in addition to aggressive containment strategy, please also prepare for any eventualities.
There could be crises in our hands, so let’s prepare for any eventualities. But we should not give up on the containment strategy. The worst thing that can happen to any country, or even any individual, is giving up. Don’t give up. Don’t surrender. Use a comprehensive approach. Don’t use dichotomy. Let’s use a comprehensive approach. Everything that we can do to contain it. If not, we will see it {spread}. Then we will have the other strategies at hand, because we are saying, let’s prepare for the rest too.
This kind of approach, comprehensive approach, cannot be sustained without sustainable political commitment at the highest level. Coordination at the highest level.