A crisis management cell at the United Nations Secretariat level is being created to support global management of the novel coronavirus outbreak, World Health Organization officials said this evening.

In a late evening briefing Tuesday to WHO member states attending this week’s 146th Session of the Executive Board, WHO officials laid out their war plan for combatting the virus that originated a month ago in Wuhan, China – and which now includes 20,471 confirmed infections and 23,314 suspected cases inside China – but only 176 cases abroad.

“99% of the cases are in China, while in the rest of the world we have only 176,” underlined Dr Tedros Adhanom Ghebreyesus, in the briefing. “That doesn’t mean it won’t get worse, but for sure we have a window of opportunity.

“Concern and worry should be supplemented by action now while we have a window of opportunity… because of the measures that China is taking at the source.”

The WHO Director General said that WHO had sent 250,000 tests for identifying the new virus to more than 70 reference laboratories globally. Masks and gowns, as well as other basic equipment for creating isolation wards, are also being shipped from WHO warehouses in places such as Accra, Ghana – closer to countries that may need the most WHO support.

Laboratories in low income countries are also being trained in the conduct of rapid tests, WHO officials said.

“As of Friday, countries will have the capacity and the training to test and make the diagnosis in less than a week,” said WHO head of emergencies Mike Ryan, noting that the actions were underway in coordination with regional bodies such as Africa CDC. “We are not helpless and it is not hopeless,” he added.

Epidemic Response Cost Likely To Be High 

However, fighting the epidemic will come with a high price tag, the WHO officials warned.

The unit cost of responding for three months to just 10 imported cases from China could be an estimated US $ 1.5 million, while 100 cases involving some local transmission would cost about US $ 10 million, and 1000 cases of community transmission would cost over US $ 53 million, said Scott Pendergast, Director, Strategic Planning & Partnerships in WHO Health Emergencies.

He estimated that the overall cost of scaling up epidemic response in low income settings for the coming months would be about US $ 675 million, while WHO has immediate needs of about US $61.5 million.

Ryan said that WHO was exploring with the World Bank and other partners how to release global emergency and pandemic funds to low-income countries and fragile states for their response.

“We are looking at how that can be activated as well,” said Ryan. “We have our own contingency on epidemics and we have been using that to set up regional platforms. But if we need to go to scale with multiple countries having a thousand cases the cost of this will escalate rapidly.”

“Many, many countries in Africa are experiencing similar epidemics.. the addition of another novel coronavirus is another burden and a great worry,” Ryan said.

To help countries cope, WHO on Tuesday held a briefing with all 150 WHO country offices worldwide, Dr Tedros said.  From now on, the agency will also conduct daily media briefings about new developments in the emergency.

He said that he was also writing to all ministers of health worldwide to request faster sharing of data about exported cases.

“Of the 170 cases reported outside of China so far, only 38% have been fully reported,” he said, “and some of the high-income countries are behind in sharing this data with WHO.

“Without better data, it is very hard for WHO to assess how this outbreak is evolving or what impact it could have.  The commitment to global solidarity starts from sharing information.”

Travel and Trade Restrictions

Some 22 countries have now imposed travel and trade restrictions on the entry of people who recently were in China, the WHO Director General also said. But he said that such restrictions can also increase fear and stigma, which could even impede response efforts.

“We call on countries not to impose restrictions contrary to the International Health Regulations,” he said, referring to the binding treaty between WHO member states that governs emergency response efforts. “Where restrictions are created, we request that they are short in duration,” he said.

Said Pendergast, WHO was developing a public health strategy to help countries to prepare for and control the outbreak. It would focus on so called “high risk countries – low income countries.

“What we are mostly concerned is countries at the lower end of the preparedness scale where there are countries at a high risk of imported cases, but cases are not being detected and reported.”

Infection Transmission & Severity

So far, about 14% of the cases of the novel coronavirus, dubbed 2019-nCoV,  have been severe, and an additional 2% being fatal, said Maria Van Kerkhove, head of emerging diseases at WHO. Most of the fatal cases have been in people who are 60 years or older, or have pre-existing conditions, she said.

She said that the upper limit of the incubation period was 14 days, and that the virus is transmitted via droplets from an infected person, or touching surfaces contaminated by such droplets.

She said that WHO had created guidance on management of the virus, and would soon be updating that with advice on the use of protective masks in the community, during home care and in health care settings.

Image Credits: Flickr: Lei Han, WHO dashboard for 2019-nCoV, WHO.