An emergency committee for the World Health Organization (WHO) today had a tie vote on whether to recommend sounding the loudest alarm available in response to the outbreak of a novel coronavirus that has spread from Wuhan, China, throughout that nation and to at least four other countries.
At a late evening press conference in Geneva, WHO Director-General Tedros Adhanom Ghebreyesus, chair of the committee, and other WHO officials explained that half the committee decided there were still too many unknowns to a declare Public Health Emergency of International Concern (PHEIC), a designation that can affect travel and the movement of goods. The decision came hours after Wuhan authorities revealed that the city will shut down all transportation from the city of 11 million people on 10 a.m. local time on Thursday.
Didier Houssin, an adviser to France’s top health agency and chair of the committee, said half the committee still had questions about whether the patterns of transmission of the disease and its severity warranted a PHEIC. “The committee felt it was a little too unprecise to very clearly state that it was time” to recommend declaring a PHEIC, Houssin said. The committee, which advises WHO’s director-general, will meet again tomorrow to review whether fresh data tip the scales one way or another.
Alexandra Phelan, a lawyer at Georgetown University who specializes in global health policy and listened in on the press call, says based on Chinese government and media reports, she thinks the criteria for a PHEIC have been met. But the committee is focusing on a “level of granularity” not in the International Health Regulations, the treaty that allows WHO to declare a PHEIC, Phelan says. “It really came down to their interpretation of what is ‘international spread,’” Phelan says. If all known cases outside China were in people who had traveled from China, some might argue that it does not count as international spread, she says. But the available data may not be clear enough to know whether that’s the case.
Phelan, who has lived in China, says the reports of Wuhan restricting transportation are “particularly concerning from a public health perspective” as they could backfire. “You want people to have trust in public health officials if they are sick, and these sorts of heavy-handed decisions make people scared and mistrust authority.”
To date, there have been 555 confirmed cases of infection with the virus, temporarily dubbed novel coronavirus 2019, and 17 deaths. About 80% of the cases are in Wuhan, where the first patient sought care on 12 December 2019 and a cluster initially was linked to a large animal market there. Health officials suspect that an infected animal for sale at the market initially transmitted the virus to humans, but human-to-human transmission has since occurred in family members and health care workers who had close contact with confirmed cases.
The exact origin of the virus, which is similar to one that causes sudden acute respiratory syndrome and is most closely related to one found in bats, remains a mystery. Animals sold in the market are being tested for the virus, and environmental samples are also being analyzed.
Mike Ryan, executive director of WHO’s Health Emergencies Programme, said an official from China’s National Health Commission today gave the committee a “very deep presentation” that underscores how many questions remain. According to the Chinese data, 72% of the cases were more than 40 years old, and 40% had underlying diseases like diabetes, high blood pressure, and cardiovascular disease, Ryan said. “If the disease more severely affects older people because of underlying conditions, that doesn’t mean there aren’t infections in other age groups,” he said. “It just means that the visible infections of very sick people are in those older age groups.” Many of the fatal cases had “significant underlying conditions,” Ryan added.
No cases have yet been detected of what’s known as a third-generation transmission: a human infected by a human who was infected by a human. If transmissions occur for three generations or more, there’s a much greater threat of a virus rapidly spreading through communities.