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With New Hotspots, Coronavirus on Verge of Pandemic

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Editor's Note: For the latest updates on the 2020 coronavirus outbreak, see our news coverage.

Feb. 24, 2020 -- The World Health Organization (WHO) said today that while new fronts had opened up in the battle against COVID-19, the rapidly spreading infection was not yet a pandemic.

“For the moment, we’re not witnessing the uncontained global spread of this virus. We’re not witnessing large-scale severe disease or deaths,” says WHO Director General Tedros Adhanom Ghebreyesus.

While reports of new cases have slowed down in China, recent clusters with hundreds of cases have been reported around the South Korean city of Daegu and in northern Italy near the Lombardy region.

As of Feb. 24, South Korea had reported 833 cases, and many of those reportedly had ties to the Shincheonji Church of Jesus and a local hospital. Italy had reported 230 cases and 5 deaths.

Iran has officially reported 64 cases around the city of Qom, though that number may be an underestimate because the confirmed death rate from COVID-19 is thought to be around 1%-2% of cases. Iran has reported 12 deaths, which suggests a higher number of undetected or unreported illnesses. Because it takes a few weeks to die of the infection, reporting this many deaths also suggests the outbreak in Iran is more advanced than currently known.

China has the majority of cases with more than 77,000 and nearly 3,000 deaths.

“Does this virus have pandemic potential, absolutely, it has. Are we there yet? From our assessment, not yet,” Tedros says.

A pandemic is the worldwide spread of a new disease, according to the WHO. The organization no longer follows a specific process for declaring a pandemic. Tedros says they have already declared COVID-19 a Public Health Emergency of International Concern, or PHEIC, their highest level of alert.

Pandemics are more severe than outbreaks or epidemics. It’s a term that signals that a disease is a threat to the entire world. While public health officials seemed to downplay the significance of attaching the word to COVID-19, there’s no doubt about its importance in public messaging.

Tedros says that though significant hotspots had flared up in recent days, they should be considered separate epidemics affecting each country in different ways. He says each outbreak needs its own tailored response.

He says a WHO team has landed in Italy to assist there. Another team of experts is on its way to Iran.

Infectious disease experts say they respect the WHO’s caution, but they say a pandemic seems almost inevitable.

“There are currently ongoing chains of transmission in South Korea, Japan, Northern Italy, Iran, and these are the ones that we know of,” says Isaac Bogoch, MD, an infectious disease researcher at the Toronto General Hospital Research Institute.

“You can see the pendulum swinging much closer to greater global transmission of this infection,” Bogoch says.

Mike Ryan, MD, executive director of the WHO’s Health Emergencies Programme, says they are being cautious about declaring a pandemic with COVID-19 because there are still so many unknowns.

He says it is easier, for example, to tell when the flu reaches a pandemic level because the flu is better understood.

“We’ve had previous pandemics, and we know with influenza that when there’s highly efficient community transmission…, as we see with seasonal flu, and that the disease does spread around the world. So it’s much easier to say when a pandemic will occur in an influenza situation,” he said.

Ryan says some of the biggest questions about COVID-19 revolve around exactly how it spreads through communities.

“Look what’s happened in China,” he says. “We’ve seen a significant drop in cases. Huge pressure was placed on the virus, and a sequential decrease in cases. That goes against the logic of pandemic. Yet, we see, in contrast to that an acceleration of cases in places like Korea.”

“We’re still in the balance,” he says.

Ryan stresses that countries and individuals should still be getting ready.

“It is time to do everything you would do in preparing for a pandemic,” he says.

For countries, Ryan says, those steps were preparing to detect and treat cases, preparing to follow contacts of known cases, and preparing to put containment measures in place.

People should be prepared to stay home from work or school -- the so-called self-quarantine. Tedros says the WHO’s study of the infection in China shows that people with mild cases could expect to recover within 2 weeks, while critical or severe cases recover in 3 to 6 weeks.

 

WebMD Health News Reviewed by Arefa Cassoobhoy, MD, MPH on February 24, 2020

Sources

World Health Organization, press briefing, Feb. 24, 2020.

Mike Ryan, MD, executive director, Health Emergencies Programme, World Health Organization, Geneva, Switzerland.

Isaac Bogoch, MD, clinical investigator, Toronto General Hospital, Toronto, Canada.

Tedros Adhanom Ghebreyesus, director general, World Health Organization, Geneva, Switzerland.

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