Amidst reports of an even tougher crackdown in China, including door to door visits by Wuhan public health authorities to identify people infected with the novel COVID-19 coronavirus and place them in mass quarantine facilities, WHO’s Emergencies Head Mike Ryan defended the tough government measures at a press briefing on Tuesday.

“Door to door surveillance, going around and doing active surveillance, this is a very good public health measure,” Ryan said. “Right now, the strategic and the tactical approach in China is the correct one.”

He noted that a slow reduction in the number of cases in China had created space for public health authorities to take more active measures in the Wuhan, Hubei epicentre of the epidemic, as well as in other cities such as Beijing, where new rules require residents returning to the city to isolate themselves for 14 days.

“While they are getting the success in putting out one fire, they don’t want the first to start somewhere else,” he said. “Now, you can argue whether those measures are excessive or restrictive on people, but there is an awful lot at stake here in terms of public health, and in terms of not only the public health of China, but all of the peple in the world.”

As of 5 p.m. Tuesday Central European Time, China was reporting a total of 72,532 cases in China, and 1872 deaths, 1,888 more than the day before. Abroad, there were 897 cases and 3 deaths reported across 25 countries. Of the more than 200 new cases outside of China, 99 of them were concentrated on the Princess Diamond cruise ship moored in Japan’s Yokohama harbour, where a total of 542 of the ship’s original 3,600 passengers and crew have tested positive for the virus.

House To House Surveillance in Wuhan, China

In Wuhan, authorities tightened their grip even further on residents that have been under lockdown already for several weeks, seeking to round up and quarantine anyone with the infection, including people with mild cases.

The Wuhan Health Commission announced a system of “closed management” of all apartment blocks and neighborhoods in the city of 11 million people, with 24/7 surveillance, and even stricter controls on those allowed to exit than had been in place previously.

Chutian Daily, a Wuhan newspaper was cited saying that 10 new quarantine centres with 11,400 beds were being set up across the city for people showing mild symptoms of infection, identified through house to house surveillance. Anyone suspected of having the virus would face mandatory testing.

Outside of Wuhan, other communities in Hubei province were also being sealed off. placed under around-the-clock “closed-off” management, in effect putting them under lockdowns.  The actions came as a prominent Wuhan doctor, Liu Zhiming, had reportedly died from the virus on Tuesday at the age of 51.

While COVID-19 can be very mild for younger people, deaths such as that of Zhiming, illustrate the way that the virus can hit much harder at older people, even when they are presumably in good health.

“Clearly there has been an apparent drop in the fatality rate,” said Ryan, pointing to results from a newly published paper by China CDC reviewing some 44,672 cases in China.  The findings indicate a case fatality rate of about 2%, somewhat lower than the 3% fatality rate of the very first patients who fell ill in Wuhan in January.  About 80% of those infected have only mild symptoms and quickly recover, the paper also found, although others become severely ill.

“We need to be careful that sometimes this is projected as a mild disease,” Ryan said. “That is true, but there is a significant number of people, 20 percent of people, who get this are severely or critically ill.”

Notably, average hospitalization time for the severely ill has been about 20 days. “If you have lots and lots of people in hospital for a very long time, requiring intensive care, it requires takes a huge effort from the health system,” Ryan observed. “We must remember that there is an at-risk group which is 40-79 years and older, and they can have a very severe course of disease, and we must be aware of that, if the disease is imported to a third country….”

Strengthening Weaker Health Systems

To that end, WHO has continued its efforts to bolster the preparedness of weaker health systems for the potential arrival of the virus, said WHO Director General Dr Tedros Adhanom Ghebreyesus, also speaking at the press briefing. “By the end of this week, some 40 African countries and 29 countries in the Americas will have the ability to detect COVID-19,” he said.

“Many of these countries have been sending samples to other countries for testing, waiting several days for results. Now they can do it themselves, within 24 to 48 hours.

“DRC is leveraging the capacity they have built to test for Ebola to test for COVID 19,” he said, noting it as a “great example” of how health system strengthening generates knock-on benefits. “Namibia, Timor Leste and Nigeria are running workshops and workshops with the media.”

A number of Asian and African countries have also stepped up their monitoring at ports of entry, including Bangladesh, Cambodia, Ethiopia, Pakistan, and South Sudan, Dr Tedros added.

And WHO has recently released new guidance related to management of ill travellers at international points of entry as well as interim guidance on planning and preparing for mass gatherings, in the context of the COVID-19 emergency.

Ryan confirmed that WHO was also in the process of shuttling supplies to test for the virus to DPR Korea, as well as meeting with North Korean officials in Geneva’s mission on risks the country might face due to its close ties with China. So far no cases have been reported in the country, however, he added.

China API Shortages May Boost Indian Drug Prices

Meanwhile pharma observers were nervously eying the crisis in terms of potential interruptions it might create in the Chinese supply of active principle ingredients (APIs), to the global drug market.

Reportedly, Chinese firms supply some 80-90% of the world’s APIs for basic drugs such as antibiotics, which undergo final manufacture as patented or generic drugs elsewhere.

While India’s pharma industry may be able to ramp up capacity to cover some of the shortfalls, India also procures almost 70% of its APIs from China, including for many generic drug formulations which help keep the world’s drug prices low.

Many suppliers had stocked up on API’s ahead of the Chinese Lunar New Year, so the shortages may not be felt immediately.

However, Daara Patel, secretary general of the Indian Drug Manufacturers Association, which represents over 900 of the country’s drug producers,  told Reuters that he could project supply disruptions beginning in April, if the crisis continues.   He said that antibiotics would likely be among the hardest hit as India is a major global generics producer.

Other international pharma companies are also watching the situation with concern.

However,  Thomas Cueni, head of the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), which represents most of the large patent drug producers said that currently the epidemic was not expected to create the same level of  interruptions in the patent drug market.

“Generic companies operate on tight margins, with often with procurement based on the lowest price, this does put pressure on companies for treatments such as antibiotics,” Cueni said.

“As a rule, the innovative pharmaceutical industry have tried and tested business continuity plans with alternative suppliers.…At this moment, the novel coronavirus outbreak isn’t causing problems for innovative medicines supply.

“The companies are continuously monitoring and proactively handling the situation as it’s developing and do not expect any long-term impact on the availability of medicines and vaccines, unless disruption due to the novel coronavirus outbreak is sustained over the next several months.  That being said, we (IFPMA and its innovative pharma member companies) are far from complacent and are monitoring the coronavirus situation in China closely.

“R&D biopharmaceutical companies are working to prevent and mitigate potential shortages through close coordination with national regulatory authorities and other global stakeholders, including the World Health Organization.”

Image Credits: Wikimedia Commons: Painjet.