As the number of novel coronavirus infections rose again on Thursday – to 28,060 confirmed cases in China and 225 abroad – a US Centers for Disease Control official raised the possible spectre that the epidemic could become a global “pandemic” – if countries fail to take assertive action now.

“While unclear how the situation will evolve, we are preparing as if it were the next pandemic – while hoping that it is not,” said Barbara Marston, head of the International Coronavirus Task Force, speaking at a US State Department teleconference for foreign press about the epidemic currently raging in Hubei Province, China.

Her remarks followed a statement Wednesday by US Senator Chuck Grassley, who said that while “not yet a pandemic, there are signs that it could develop into a worldwide threat.” Grassley spoke after receiving a classified briefing by the Department of Health and Human Services.

US Calls For WHO Technical Guidance On Travel Restrictions – WHO To Convene Global Research Forum 

In Geneva, the US meanwhile called upon the World Health Organization to provide more advice to countries about protective measures countries could take to protect themselves from new cases of virus arriving with travelers from China.

Speaking at WHO’s Executive Board meeting Thursday, the US representative asked WHO to “provide technical advice to member states as to how they can implement appropriate travel restrictions consistent with the International Health Regulations (IHR) to minimize the spread, and complement the travel restrictions that China has put in place.”

WHO has generally opposed travel restrictions by countries outside of China – saying that the disease first needs to be attacked at its source in Wuhan and Hubei province, where tens of millions of people remain under lockdown.

Even so, some 22 countries have put in place measures ranging from cancellation of flights and visas to the temporary quarantine or barring of entry to people arriving from China.

In an afternoon press briefing WHO’s Emergencies Head Mike Ryan responded saying that, “Under the IHR, where countries have exceeded or appear to have exceeded those recommendations, we are bound to ask the country for the rationale,” he said, speaking in an afternoon press briefing. “The IHR does not deny or prevent a country from taking measures, but requires to justify the risk assessment. This is a very important balance.

“All risk assessment is local, so local dynamics and local capacity are important. Sometimes you have a limited toolkit and you have to use it in a certain way.  Sometimes you have to make decisions based on communities’ perceptions of fear.

But he added that travel measures such as quarantine, are generally too expensive and complex for low-income countries to undertake, and investments would better be spent in preparing clinicians and laboratories to handle the virus.

As compared to travel restrictions, he said WHO’s outreach has been focused on preparing health systems in low income countries to detect and diagnose the disease, if and when cases arrive, as well as to take appropriate infection control measures.

“High-impact quarantine measures are some of the most expensive measures to implement. Low-income countries have choices to make, and the real point of entry to a country [for a new infection] is a poorly equipped emergency room or  doctors’ clinic.

“We do support screening [at point of entry], but to have disease arriving to untrained health workers and unprepared in a clinical setting thats the worst thing. And we are focusing on weaker countries with weaker health systems to support the key parts of their health system… the last thing we need is the front-line health workers becoming victims.

“Where countries have more resources they can put in place more expensive measures.  You can argue about the value.. we want to extract the most from every dollar invested.”

Against the more dire predictions of a possible pandemic, Ryan also voiced one cautious note of optimism.

He noted that the overnight increase in new cases in China between Wednesday and Thursday of 3,697 confirmed infections had been slightly less than the whopping 3925 new cases recorded between Tuesday and Wednesday.

“Today is the first day that overall new confirmed cases dropped,” said Ryan, noting that the large 24-hour increase nonetheless remained a cause for significant concern.  The epidemic has so far claimed 564 lives in China, while there has been only 1 death abroad, officials also note, an indication that infection spread to other countries is so far being contained.

WHO To Sponsor Research Forum On Coronavirus Next Week

Meanwhile, WHO Director General Dr Tedros Adhanom Ghebreyesus said that the Organization would convene a global research and innovation forum next week, 11-12 February, to respond to the novel coronavirus (2019-nCoV).

He noted that currently there are no effective treatment tools or vaccines for the virus – and with tens of thousands of people ill, those are desperately needed.

“We don’t know the source of the outbreak. We don’t know what its natural reservoir is, and we don’t properly understand its transmissibility or severity. We have no vaccine to prevent infections and no therapeutics to treat them,” said Dr Tedros, at the Thursday press briefing.

“We are shadow boxing, we need to bring this virus out into the light so we can attack it properly.  So on February 11 and 12, we are convening a global research forum.  This will be a meeting of scientists from all over the world, including China, both in person and virtually. The aim of the meeting is to fast track development of effective diagnostic tests, vaccines and medicines.”

Human Rights Watch Protests Wuhan Lockdown

Meanwhile, Kenneth Roth, Executive Director of Human Right Watch, an advocacy group, took China to task over its handling of the coronavirus epidemic- on both public health and rights grounds, and noted apart from its welcomed prompt public genetic sequencing of the virus, China’s reaction has been a cover-up.

The criticism came just as one of the first doctors to sound the alarm about the new disease, 35-year old ophthalmologist Li Wenliang, tragically passed away from a battle with the novel coronavirus on Thursday night. Li was detained by police and asked to sign a statement swearing he would “not spread rumors” after he tried to warn members in a group chat about cases of a potential “SARS-like” illness in December. Li is survived by his pregnant wife and young child, according to tributes to the doctor circulating on Weibo, China’s Twitter equivalent.

“It may be good for political self-preservation but its a disaster for trying to contain the epidemic,” Roth told reporters at a news conference in Geneva Thursday.

Asked about China’s handling of the information surrounding the outbreak, especially on social media, the veteran HRW chief said, “There has been an enormous amount of information put out on social media but there’s also an active government effort to suppress it. The government does seem determined to limit the flow of information about the coronavirus outbreak. Particularly, criticism of its response to that.”

Roth, a harsh critic of China’s rights record, argued, “When push comes to shove, do you allow open information, open debate, and indeed criticism of governmental conduct in the face of something threatening the Chinese public, or do you try to cover it up to preserve the power of Beijing. It’s always official power that is the priority.”

Turning to China’s massive quarantine efforts- to try and contain the spread of the virus- Roth declared: “There are major questions about this, besides the nature of the quarantine. A quarantine of this sort, and magnitude, has never been attempted. Only an autocratic government, like China, could try that. Quarantines of this sort, normally do not work.”

He critically observed the quarantines that public health officials advocate, are much more targeted.”They’re aimed at people who have been identified as having the virus, and they’re put in a place where they can receive treatment, as well as food and housing, and then that is a way of avoiding infecting others.”

Roth said the idea of a quarantine of Hubei province – a region of 60 million – has never before happened and pondered ” it’s utterly unclear whether it’s going to be effective. People need to be housed, they need to get treatment, and there are huge gaps in the Chinese government’s response to individual needs.”

“So, this is not a rights-oriented approach to public health. This is treating public health with a sledgehammer, and public health officials will tell you this is not an effective way to proceed…” he added.

Concerning the large number of countries that have notified the WHO of the restrictive measures they’ve taken – which appear to go against the grain of WHO’s recommendations – and some countries, such as the U.S., holding classified briefings on the outbreak, Roth said, “There’s no place for secrecy in fighting an epidemic.”

” I think it’s broadly understood that you need total and complete transparency to effectively fight an epidemic. You need to know where it’s breaking out, you need to know in real-time where medical energies have to be focused. And so, this is not a time for secrecy, it’s not a time to suppress criticism of governments’ reaction. It’s a time for total transparency, even if it’s embarrassing. ”

Executive Board Raises Concerns About WHO Emergencies Contingency Fund & Staffing

In a morning discussion on Emergency Preparedness at WHO’s Executive Board, Japan asked whether WHO’s emergency contingency fund had assurance of sustainable funding, while Germany, speaking on behalf of the European Union, underlined the need for WHO to support countries in measures to guarantee the safety and security of health workers and health facilities – to create “resilient health systems able to withhold the shock of health emergencies.”

Singapore stressed the need to examine more deeply the increased global health risks faced due to increased urbanization, more and more densely populated cities, where viruses can be easily transmitted in crowded spaces, both public and private.

China, meanwhile, called on the global community to react in a “rational manner” to the crises and “refrain from panic.”  But it also asked WHO why some 30% of posts in the Organization’s Health Emergencies Department were vacant, as of November 2019.

Ryan, in response to the query, said that vacancies were largely due to budget shortages.

Image Credits: HPW/Catherine Saez, Fletcher/HPW, John Zarocostas.