“Test, Test, Test” for COVID-19, Says WHO; Canada, EU & African Countries Introduce Sweeping New Travel Restrictions
Two workers screen people at a drive through COVID-19 testing center in New Rochelle, New York, USA

The World Health Organization issued an urgent call for countries worldwide to dramatically scale up COVID-19 testing, followed by stricter isolation of confirmed cases and contact tracing – saying that those steps are critical to getting the accelerating pandemic under control.

But there was far less clarity from WHO about the use of travel restrictions. This, despite Canada’s dramatic and unprecedented move to ban entry of all non-residents, with the exception of US citizens. Meanwhile, a host of low- and middle-income countries in Africa, eastern Europe and Latin America were also closing down their borders to travelers from the United States and western Europe, in order to contain the rapid virus spread – in a powerful reversal of patterns seen in previous epidemics such as SARS and Ebola.

“We cannot stop this COVID-19 pandemic if we do not know who is infected. So I have a simple message for all countries – Test, Test, Test,” said WHO Director General Dr Tedros Adhanom Ghebreyesus speaking at a press briefing on Monday.  

All countries should be able to test all suspected cases, they cannot fight this pandemic blindfolded, they should know where the cases are, and that is how they can take decisions,” said Dr Tedros

Dr Tedros said he had delivered that same message to European Ministers of Health, in a region which is now being overwhelmed by the surge in cases, and where large disparities have emerged in testing strategies. Some countries aggressively pursuing tests while others, such as the United Kingdom and Switzerland, have so far been more reserved. Switzerland is testing only people with serious symptoms or deemed to be at high-risk, a move which a group of leading scientists have protested is ill-advised.  The United Kingdom has undertaken an even more laissez-faire position, calling on older people to self-isolate while presuming that widespread infection of younger groups will occur and help build a “herd immunity” – a strategy opposed even more strenuously by other scientists and experts.

While refraining from calling out countries specifically, the WHO Director General said that testing needs to be prioritized more overall in order to combat COVID-19 more effectively.

“Social distancing measures can help reduce transmission…However, such measures are insufficient on their own,” said Dr Tedros, referring to the widespread closure of schools and commercial activities now being seen in Europe as well as in New York State and other US hotspots.

“The most effective way to reduce infection rates is to test, test test. Test every suspected case. If they test positive, isolate them and find out who they have been in contact with up to two days before they developed symptoms, and test those people too, and test these people too.”

“Test all cases – if you know all cases, you can follow up on all contacts. Going forward, my recommendation [to Europe] is that MoHs should be able to test ALL suspected cases.”

He also said that European countries should adopt more aggressive case quarantine and follow-up measures, including the potential hospitalization of mildly ill people in community centers, gyms or other public facilities – or carefully monitored home care with the observance of very strict isolation measures – in order to prevent further onward transmission.

“WHO advises that all confirmed cases, even mild cases, should be isolated in health facilities to prevent transmission and provide adequate care,” said Dr Tedros.

“But we recognize that many countries have already exceeded their capacity to care for mild cases in dedicated health facilities. In that situation, countries should prioritize older patients and those with underlying conditions. Some countries have expanded their capacity by using stadiums and gyms to care for mild cases, with severe and critical cases cared for in hospitals,” he said.  In that case, patients with mild disease should be isolated and cared for at home – with strict attention to WHO recommended protective gear for the caregivers, and separation of daily activities.

As for testing, so far WHO has distributed over 1.5 million tests to 120 countries worldwide, and now the Organization is looking at how to ramp up that capacity by expanding to multiple laboratories in countries that have the capacity to do testing at the molecular level, said Maria Van Kerkhove, WHO Emergencies Technical Lead.

“We are building on existing systems, on national influenza centres that exist across the globe,” she said, “and we trying to increase the number of labs that can test in individual countries, whether it is national, subnational or private labs.  We are also working on getting the physical tests out there.” she said. As new automated systems go online capacity can be ramped up further, WHO officials also noted, with reference to Friday’s announcement by Roche Pharmaceuticals of a US Food and Drug Administration Emergency Authorization for an automated COVID-19 test.

Dr Tedros at WHO’s Monday press briefing on COVID-19

WHO Officials Sidestep Issue of Travel Restrictions – Even as More Countries Shut Or Limit Border Crossings 

Unlike the call to testing, Dr Tedros and other top emergency team leaders avoided comment on the travel restrictions now being seen across the globe as a pandemic response.

Asked by one journalist, whether along with the lack of aggressive testing, European free movement policies, have now boomeranged, Mike Ryan, who had in the past staunchly opposed travel bans at all, said:

“The epidemics of different countries are in different stages of development. Europe is a multi-country partnership.

“Many countries are attempting lockdown, but relying on travel measures is not enough,” he added. “It may have an impact, but it is not sufficient. Let’s talk about solidarity and how countries can work together instead of comparing them – although lessons learned in China, in Singapore, in Japan are now being transferred in Europe. And hoping we can accelerate that in the coming days.”

Said Dr. Tedros.  “The rule now is how to live with globalization.”

Still, African countries — whose citizens often have to provide an update on their health status just to get a visa to travel to Europe — were now moving to stop or limit arrivals from both Europe as well as the United States, noted The Intercept.

Among those, Uganda and the Democratic Republic of Congo have now imposed quarantine measures on travelers from Italy, France, China and Germany and in the case of Uganda, from the United States as well.  Ghana and Kenya became the first two African nations to set down forceful travel restrictions, in the case of Ghana on arrivals from countries with more than 200 coronavirus cases.  Rwanda, Uganda, Mali, and others have imposed similar quarantine measure for European travelers, while across the continent, passengers are screened for their temperature at international airports.  After restricting travelers from high-risk countries to quarantine, Mauritania deported 15 Italian tourists and Tunisia deported 30 other Italians for violating theirs. A Cameroonian news outlet reported higher arrivals from Italy due to people trying escape their coronavirus-infected country.

Active cases of COVID-19 around the world as of 6:13 PM CET 16 March, Numbers change rapidly.

In Europe, meanwhile, European Union Commission President Ursula von der Leyen announced on Monday a temporary restriction on non-essential travel into the European Union’s Schengen passport-free zone for 30 days in order to slow the spread of the virus. The ban on entry would cover all non-essential visits from third countries, with exemptions for Schengen area long-term residents, family of EU nationals and diplomats.

The announcement follows a span of individual European countries shutting down borders to nationals from other European countries deemed to be hotspots, as COVID-19 cases accelerated across the continent, to a total of 51,771 cases and 2,316 deaths on Monday afternoon.

Germany, with the third highest case-load in Europe at 7174 cases, became the latest country to restrict border crossings by visitors from neighboring France, Austria and Switzerland, along with closing eateries, entertainment venues and places of worship. That followed similar moves by Austria, the Czech Republic, Denmark, Hungary, Poland, and Switzerland to partly or completely close borders as well. Italy, with 14,991 confirmed cases and Spain, with 9428 cases, had already restricted travel into and out of the country as the two countries with the highest number of cases in the European epidemic.  After declaring a state of emergency on Saturday, Spain announces also announced it a series of other sweeping measures including requisitioning the private healthcare sector and shutting all but essential services on Monday.

Switzerland also announced that it would close down all schools, commercial centres, leisure establishments as of Monday and until April 19, leaving only essential services such as banks, health care facilities, pharmacies, food stores and take-away. Hotels and transport facilities would also remain open. French President Emmanuel Macron followed soon after with even more extreme measures, asking French citizens to remain at home except for essential errands.

Meanwhile, Prime Minister Boris Johnson of The United Kingdom, which has been an outlier in approaches to fighting the virus, called on Britons to adopt a series of voluntary measures, including the voluntary seclusion for 12 weeks of people over the age of 70, and other at-risk groups.

“It looks as though we are now approaching the fast growth part of the upward curve and without drastic action, cases could double every five or six days,” said Johnson in a televised address on BBC.

He also called for a shift to teleworking, and said people should also avoid crowded pubs, clubs and theatres – although no closures of any establishments were announced. Johnson also said that schools would remain open for the moment. Rather than aggressively testing, the UK has said that anyone with a persistent cough or fever should stay home for 14 days, along with other members of their household. The moves, which treat spread of the virus as inevitable and attempt to create a herd immunity effect first among healthier parts of the population, have left him open to criticism from some health experts.

In Latin America, Colombia and El Salvador have also banned all foreigners from entering the country. Guatemala has banned the entry of citizens of the United States, Canada, South Korea, Italy, France, the United Kingdom, China and Iran.

In the US, meanwhile, the governors of New York State, New Jersey and Connecticut, on Monday announced a “regional approach to combating COVID-19” – pointedly noting that it was “amid a lack of federal direction and nationwide standards.”

The Tri-State strategy, which is the basin of commuter traffic in and out of New York City, calls for a limit on social and recreational gatherings to 50 people effective at 8 p.m. Monday evening. The move, the governors stated, followed upon updated guidance from the Centres for Disease Control and Prevention, calling for the postponement or cancellation of in-person events of 50 people or more.  As the total number of COVID-19 cases in New York State climbed to nearly 1000 cases, New York City’s Mayor Bill de Blasio on Saturday announced that public schools would be moving to remote learning, and on Sunday ordered the closure of all leisure and entertainment venues, as well as restaurants, with the exception of take-away food services, followed by a similar move in Los Angeles.

“These places are part of the heart and soul of our city. They are part of what it means to be a New Yorker. But our city is facing an unprecedented threat, and we must respond with a wartime mentality,” de Blasio was quoted as saying.

More than US$19 Million Secured For WHO COVID-19 Response  

In one bright spot, Dr Tedros said that he was confident of meeting the WHO goal of raising some $US 675 million for the organization to fight the epidemic, noting that in just the last few days over $US 19 million had been secured from private and public donors for a COVID-19 response fund co-launched with the UN Foundation on Friday.

He also praised the United States for coming forward with more funds to fight the pandemic; this was despite pre-pandemic proposals for sweeping cuts in allocations to WHO from the US Federal Budget for 2020.  The United States had pledged in early February up to US$100 million for COVID-19 response. On March 2, the U.S. Agency for International Development (USAID) made its first concrete commitment of $37 million in financing from the Emergency Reserve Fund for Contagious Infectious Diseases – monies destined to 25 of the countries most affected by the novel coronavirus or at high risk of its spread.

“It’s not just the funding, it is the human spirit that we see fighting this virus.  When there is unity and solidarity of spirit, the resources can come. I am really encouraged over the spirit of solidarity that I see,” said Dr. Tedros.

That spirit of solidarity was less evident in unconfirmed reports that the administration of US President Donald Trump had attempted to gain exclusive rights to an experimental COVID-19 vaccine under development by the pharmaceutical firm CureVac in Germany.

The allegation, first reported on Sunday in German media, and then widely circulated in The New York Times, Washington Post and elsewhere, centered on the suggestion that the Trump administration sought to strike a deal with CureVac, a drug maker that is based in the city of Tübingen but that also has operations in the United States.

CureVac issued a statement on Sunday rejecting the “rumors”, while key shareholders, including the Bill and Melinda Gates Foundation and private investor Dietmar Hopp said the rights would not be sold to any single country. Hopp said he wanted the vaccine to “help people not just regionally but in solidarity across the world. I would be glad if this could be achieved through my long-term investments out of Germany,” Reuters reported.

However the report, which followed upon other moves by the German government to restrict the export of personal protective equipment for health workers, has sparked debate around the dangers of nationalizing and stockpiling of essential drugs and supplies that could hinder global cooperation and solidarity in the face of the pandemic, STAT News reported.

While avoiding reference to the controversy in his briefing, Dr. Tedros observed that “Crises like this tend to bring out the best and worst in humanity.

“Like me, I’m sure you have been touched by the videos of people applauding health workers from their balconies, or the stories of people offering to do grocery shopping for older people in their community,” he said referring to the nightly scenes that began in Italy of urban dwellers signing, clapping and playing instruments from their balconies at 6 p.m. every evening to boost morale and voice appreciation.

“This amazing spirit of human solidarity must become even more infectious than the virus itself. Although we may have to be physically apart from each other for a while, we can come together in ways we never have before.”

 

 

 

Image Credits: U.S. Army National Guard/Sgt. Amouris Coss), Johns Hopkins CSSE.