COVID-19 Versus Public Health: New Test Grounds Are Iran, Italy & Korea
Health checks at the “Guglielmo Marconi” airport in Bologna, Italy

With spiraling outbreaks of COVID-19 in 3 countries, Iran, Italy, and Korea, WHO officials warned Monday of growing risks that the epidemic could become a full-fledged pandemic – although Dr Tedros Adhanom Ghebreyesus stepped back from the brink, telling a press briefing on Monday: “Does this virus have pandemic potential? Absolutely it has. Are we there yet? Not yet.”

“We have hope, courage and confidence that this virus can be contained,” he added, speaking at a daily press briefing. “We are not witnessing the uncontained global spread of the virus with significant deaths.”

In a visit to Geneva, UN Secretary General Antonio Guterres called on UN member states to “do everything they can to contain the disease” warning that if even a few countries fail, the epidemic will veer “out of control, with dramatic consequences to global health and global economy.”

According the latest official Chinese data, the trend showing a decline in new cases in China continued on Monday, with only 423 fresh reports of infection over the past 24 hours, leaving a total of 77,269 cases, and 2,596 deaths. Abroad, however, the story was of a percolating  crisis with 2,281 cases and 32 deaths reported as of Monday afternoon.

Italy, Iran and Korea – New Virus Test Grounds

In Italy, one of the newest epicenters, some 230 cases and six deaths were reported as of Monday afternoon. That was as compared to 16 cases on Friday according to the Ministry of Health.

Some 11 towns – 10 in the Lombardy region just south east of Milan, Italy’s financial nerve center, were under a strict quarantine. Schools were shut, train service suspended, and police barricaded main roads around the communities where at least 163 people were infected. The Ministry of Health on Sunday expanded strict measures region to Italy’s Veneto region too.

Austria temporarily suspended train service from Italy on Sunday, and announced that the country was reconsidering the reintroduction of border controls. But Switzerland and other neighboring European Union countries left their borders open. European Union Health and Food Safety Commissioner Stella Kyriakides told reporters Monday that the WHO had not recommended imposing travel restrictions across the EU’s open “Schengen” “zone . The European Centers for Disease Control meanwhile announced  that a group of European experts were being sent to Italy to assist in the response and further develop recommendations for coordinated action.

Said Kyriakides, “We all need to take this situation very seriously, but without giving in to panic, even more importantly, to disinformation.”

Iranian officials, meanwhile, were still scrambling to determine the chains of transmission behind the cases in the country, even as the outbreak spilled over into neighbors. At least 10 countries tightened border controls and enacted travel restrictions in response to the Iranian outbreak, where at least 61 cases and 12 deaths have now been reported, according to WHO’s Eastern Mediterannean Regional Office. The outbreak has left Iran with the highest death toll from the virus of any country outside of China.

Commuter in Iran wears face mask as COVID-19 cases climb (Photo Credit: Farsnews)

Many of the 10 countries that had imposed travel restrictions  tightened border controls after confirming their own cases of COVID-19, linked not to travel in China, but to travel in Iran. Just Monday morning, Oman also suspended flights to and from Iran indefinitely after the country’s first two COVID-19 cases were confirmed in two Omani women who had recently returned from Iran.

Meanwhile the South Korean government raised the level of the response to “red” – the highest possible level – as cases quadrupled from 204 infections Friday to 833 confirmed cases and 7 deaths as of 8:00AM CET Monday, according to the Korean Center for Disease Control.

Among the new Korean cases confirmed over the weekend, 18 people had just returned from an eight-day religious pilgrimage to Israel on 16 February. That left Israel scrambling to identify local contacts of the pilgrims for followup, while also turning back all but 11 of 188 passengers on board another Korean airliner that landed in Tel Aviv on Sunday, due to infection fears. The return of the Korean passenger plane triggered diplomatic protests from Korea.

In Korea’s Daegu, where an explosion of cases was linked to the Shincheonji Church, Korean authorities have obtained an entire list of the church’s membership for follow-up, and to encourage members to self-quarantine.

Mixed Messages on Outbreak Containment Measures

WHO and other UN officials, however, continued to project mixed messages about what containment measures countries should follow – praising tough Chinese steps as effective, on the one hand, but also discouraging other countries from taking similar measures.

The praise came at a press briefing in Beijing. There, a group of WHO-convened international experts led by WHO’s Bruce Aylward, who had been on a weeklong mission, expressed support for the country’s unprecedented containment efforts.

Those measures effectively put Wuhan, the city of 11 million people at the epicentre of the outbreak, under quarantine, as  mass events and meetings were canceled, commercial and entertainment centres were closed, and the movement of millions more across the country was restricted.

Even in Tianjin and Shanghai, far from the epicentre, some apartment complexes are under virtual lockdown, with only one family member allowed to leave the complex per day to buy food, local sources have told Health Policy Watch. 

Aylward highlighted that new cases had dropped so low in China that a Chinese researcher had trouble enrolling new patients into a clinical study for remdesivir, the only antiviral that “may have real efficacy” against the new virus.

The WHO team’s assessment has been that the measures taken in China averted the more rapid spread of the disease elsewhere. Guterres echoed those remarks in his Geneva briefing today, telling reporters that the world owes a debt of thanks to the Chinese:

“My message to all of those in China, who are deprived of a many aspects of a normal life, is a message of gratitude because it is the sacrifices of those who are deprived of those positive aspects of life, so as to avoid the propagation of the disease, who are rendering a service to humanity,” Guterres said, speaking in French.

He added, “All countries must do everything to be prepared, and all countries must do everything – respecting naturally the principle of non-discrimination, without stigmatization and respecting human rights – do everything they can to contain the disease.”

“This disease is still possible to be contained but if some fail, if some do not do everything that is needed, this can still become out of control, with dramatic consequences to global health and global economy.”

However, an hour earlier at a WHO press briefing, Emergencies head Mike Ryan was more ambivalent about the degree to which other affected countries, such as Italy and Iran, should imitate China’s tough measures – which have included the mass cancellation of public events, as well as the strict curtailment of entertainment, business and commercial activities, even in lesser affected cities, such as Shanghai.

“The natural transmission dynamics if you look at most cases, including in China are in family clusters,” said Ryan. “That has been driving the epidemic. Then there are very then particular circumstances… We need to understand the exact dynamics of what has been happening in Iran. Clearly there have been gatherings for religious festivals, people coming and moving on afterwards.

“We are reaching out to all affected countries to ensure that they have the necessary technical  assistance.  But I caution everybody, please don’t extrapolate from one individual country experience, each country is different.”

As for the outbreak in northern Italy, Ryan expressed strong opposition to travel restrictions, saying. “The European Union and Switzerland and other countries have been working together to maintain their open borders and to manage this risk collectively.”

He added, “There is no zero risk. This is about good risk management. It’s about good communication between states.  It’s about management and early detection of cases and their appropriate isolation and treatment.  It’s not about shutting borders; it’s about coherent coordinated public health actions of of a number of member states that share borders to manage the public health consequences.”

Iranian officials are still scrambling to determine the chains of transmission behind the cases in the country, even as the outbreak spilled over into neighboring countries. At least 10 countries have enacted travel restrictions for people transiting through Iran, reaching 61 cases and 2 deaths according to data from WHO’s Eastern Mediterannean Regional Office.

The 10 countries with travel restrictions on Iran include Turkey, Georgia, Jordan, Saudi Arabia, Lebanon, Iraq, Egypt, Kuwait, Bahrain, the United Arab Emirates, Afghanistan, and Pakistan. Many of the same countries tightened border controls after confirming their own cases of COVID-19, linked not to travel in China, but to travel in Iran. Oman became the latest country, suspending flights to and from Iran indefinitely after the country’s first COVID-19 cases were confirmed in two Omani women recently returned from Iran.

Trucks pile up at Bazargan, Iran border crossing, closed by Turkey since early Monday morning due to coronavirus fears.

Donors Dramatically Step Up Funding Support

With the virus accelerating on European shores, the EU today announced a €232 million package for the coronavirus emergency, one-third of the US $675 million requested by the WHO to fund the global response.

France, Germany, and Sweden have also contributed funding to the global response efforts. Germany today announced a €3 million infusion for the response today, following on Sweden’s commitment of SEK 40 million (3.8 million) earlier Monday.

In terms of the EU commitment:

  • €114 million will support the World Health Organization (WHO), in particular the global preparedness and response global plan. This money would boost public health emergency preparedness and response work in countries with weak health systems and limited resilience. Part of this funding is subject to the agreement of the EU budgetary authorities.
  • €15 million would be allocated directly to African institutions, including to the Institut Pasteur in Dakar, Senegal to support strengthened capacity for undertaking rapid diagnosis and epidemiological surveillance.
  • €100 million will support development of new health products and tools, including up to €90 million in funds to public-private partnerships with the pharmaceutical industry and €10 million directly spent for research on disease epidemiology, diagnostics, therapeutics and clinical management of containment and prevention.
  • €3 million will be allocated to the EU Civil Protection Mechanism for repatriation flights of EU citizens from Wuhan, China.

Guterres, at the WHO briefing called on countries worldwide to step up to the bat regarding WHO’s appeals for funding to confront the outbreak.

“If there is something stupid one can do in today’s world it is to not fully fund WHO appeals,” he said. “My appeal to all donors is to make sure that WHO appeals in relation to this virus, but also to other commitments around the world are fully funded.”

Image Credits: Dipartimento Protezione Civile, Farsnews.com, Twitter: @IrnaEnglish.