Summary: The daily WHO briefings are terrifying because they show what we should be doing to fight COVID-19 but are not doing. Let’s catch up before we get a raging epidemic. It won’t happen unless we demand better and faster action.
Fight ignorance about the epidemic with numbers
The total number of cases in a nation is a factoid, useful for scary headlines and little else. The epidemic’s impact results from the affected area’s number of cases vs. its population. These numbers are rounded and from WHO’s March 9 situation report.
- China has 81 thousand cases and 1.4 billion people. A small ratio, and they have it under control.
- But that’s still misleading, since 84% of those cases are in Hubei Province – 68 thousand cases in a population of ~60 million. And they have it under control.
- Italy has 7400 cases and 60 million people – 11% of Hubei’s cases with a similar population. Not yet under control.
- S. Korea has 7400 cases and 51 million people – a similar number of cases as Italy but with only 85% of its population. Yet they’re getting it under control.
- America has 200 cases and 327 million people. We’ll have the same proportion of cases as Italy does today when we have 40 thousand cases.
But we will have 40 thousand cases if the US government does not quickly act more aggressively, as explained in yesterday’s WHO briefing.
Excerpt from the WHO press conference on March 9
See the full transcript. Slightly paraphrased for clarity. Red emphasis added.
In red italics are my comments about America’s failure to prepare.
Dr Tedros Adhanom Ghebreyesus, Director-General of WHO (TAG)
As you know, over the weekend, we crossed 100,000 reported cases of COVID-19, in 100 cases. …Now that the virus has a foothold in so many countries, the threat of a pandemic has become very real. But it would be the first pandemic in history that could be controlled. The bottom line is, we are not at the mercy of the virus. The great advantage we have is that the decisions we all make, as governments, businesses, communities, families, and individuals, can influence the trajectory of this epidemic. …
Of all the cases reported globally so far, 93% are from just four countries. This is uneven epidemic at the global level. Different countries are in different scenarios, requiring a tailored response. It’s not about containment or mitigation, which is a false dichotomy. It is about both. All countries must take a comprehensive, blended strategy for controlling their epidemics and pushing this deadly virus back.
Countries that continue finding and testing cases and tracing their contacts not only protect their own people, they can also affect what happens in other countries, and globally. WHO has consolidated our guidance for countries in four categories. Those with no case, those with sporadic cases, those with clusters, and those with community transmission. For all countries, the aim is the same. Stop transmission and prevent the spread of the virus.
For the first three categories, countries must focus on finding, testing, treating, and isolating individual cases. And following their contacts. In areas with community spread testing every suspected case and tracing their contacts becomes more challenging. Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters. Depending on their context, countries with community transmission could consider closing schools, cancelling mass gatherings, and other measures to reduce exposure.
The fundamental elements of the response are the same for all countries. Emergency response mechanisms, risk communications and public engagement, case finding and contact tracing, public health measures such as hand hygiene, respiratory etiquette, and social distancing.
Laboratory testing, treating patients and hospital readiness. Infection prevention and control. And an all of society, all of government approach. …
Singapore is a good example of an all of government approach. Prime Minister Lee Hsien Loong’s regular videos are helping to explain the risks and reassure people.
Why isn’t Trump doing this? It worked for FDR.
The Republic of Korea has increased efforts to identify all cases and contacts, including drive-through temperature testing to widen the net and catch cases that might otherwise be missed.
Why is this not happening in the worst-affected areas of the US?
As you know, more funds are being made available for the response, and we’re very grateful to all countries and partners who have contributed. Just since Friday Azerbaijan, China, the Republic of Korea, and the Kingdom of Saudi Arabia have announced contributions. Almost $300 million US has now been pledged to WHO strategic preparedness and response plan. We are encouraged by these signs of global solidarity, and we continue to call on all countries to take early and aggressive action to protect their people and save lives.
Why isn’t the US on this list? If for no other reason than we should fund others to fight the epidemic in order to defend ourselves.
For the moment, only a handful of countries have signs of sustained community transmission. Most countries still have sporadic cases or defined clusters. We must all take heart from that. As long as that’s the case those countries have the opportunity to break the chains of transmission, prevent community transmission, and reduce the burden on their health systems. Of the four countries with the most cases, China is bringing its epidemic under control, and there is now a decline in new cases being reported from the Republic of Korea. …We’re encouraged that Italy is taking aggressive measures to contain its epidemic, and we hope that those measures prove effective in the coming days.
Let hope be the antidote to fear. …Let solidarity be the antidote to blame. Let our shared humanity be the antidote to our shared threat.
Question: Is there a light at the end of the tunnel here at all? Do we see an end to this thing even now? We know that the fundamental measures that are put in place seem to work in controlling the spread, but do we see a light at the end of the tunnel?
Dr Michael Ryan
I think we’re still very much in the beginning or middle of this fight. The disease has not run its course by any means in most countries. In fact, most of the countries infected have recently imported the disease. The spread of the virus now and its impact are more in the hands of us and society than they are due to the virus itself…
And there are things that may happen with temperature change. Not that the virus will change because of the temperature, but certainly human behaviour changes according to seasons, and the way in which humans mix and distance socially changes with the season. So we may see some natural changes in the incidence of the disease. But hope is not a strategy, and therefore when we look at this as being realistic we’re still very much in the up-cycle of this epidemic, and there are still a number of miles to go. …
The Director-General has said that the window of opportunity is closing and the spectre of a pandemic is rising. At the same time, another window of opportunity may be opening. The data from and the experience of some Asian countries shows that the application of measures across all of society, a systematic, government-led approach, using all tactics and all elements available, seems to be able to turn this disease around. Maria, you may have a more precise definition of where you think we are epidemiologically.
Dr Maria Van Kerkhove
One thing we never want to do is predict what will actually happen. It is in our hands. It is in the hands of how every country deals with this. I think in many countries it will get worse before it gets better, but in many others they only have one or two cases, or they haven’t had cases yet, and that is an opportunity to stop something before it begins. We’ve talked a lot about the four Cs of transmission: no cases, cases, clusters, community transmission. It’s difficult to answer that question on a global scale.
I think that’s important for each country to do on its own. What is the risk of importation to my country? What is the risk of transmission in my country? What is our capacity to deal with this? Where do we have gaps? And how do we address those gaps? Those are really critical questions for every country to be asking themselves, if they haven’t already.
Why are Trump and Pence not getting this information to the American public?
China has shown that they’ve slowed {the epidemic} tremendously, and in some they have stopped transmission. We’ve seen Singapore take drastic action and reduce its transmission. We’ve seen some countries not have any onward transmission. So in terms of what may happen and the light at the end of the tunnel, absolutely, we can see a light at the end of the tunnel. How quickly we get there depends on what countries do.