Because a novel coronavirus has spread throughout China and jumped to a dozen other countries, the world is on red alert. But the World Health Organization (WHO) today, to the surprise of many global health experts, decided the outbreak does not merit the loudest siren it can sound, a declaration called a Public Health Emergency of International Concern (PHEIC). “It has not yet become a global health emergency,” WHO Director-General Tedros Adhanom Ghebreyesus said at a press conference in Geneva this evening. “It may yet become one.”
The decision by Tedros reflected a recommendation from an emergency committee, which over the past 2 days carefully reviewed information about the outbreak. The committee expected to issue a recommendation yesterday but it was so evenly divided on whether to declare a PHEIC that it requested this second day to review the most current data. Today, its chair, Didier Houssin, said opinions remained split. Those against a PHEIC declaration, Houssin said, contended that too few cases have surfaced outside of China—nine of 584 confirmed infections—and also rejected the declaration “because of the efforts presently made by Chinese authorities in order to contain the disease.”
According to an update that Chinese health officials gave to the emergency committee, 25% of the cases to date have had life-threatening disease and 17 people have died. But critical questions still remain about the severity of the infection with what’s now dubbed 2019 novel coronavirus (2019-nCoV). Researchers suspect that 2019-nCoV jumped from an animal to a human, but no animal source has been identified. Tedros also stressed that human-to-human transmission has occurred, but only within China.
Tom Inglesby, director of the Center for Health Security at the Johns Hopkins University Bloomberg School of Public Health, was part of a loud chorus that immediately questioned the decision to hold off on declaring a PHEIC. “This is clearly an extraordinary and novel event that poses risks to [other countries] through international spread and which requires a coordinated international response,” he told ScienceInsider. A PHEIC declaration, he said, “should be a means of increasing support for China’s response, not something that would in any way impair it.”
Inglesby and many others also sharply criticized China for restricting travel for people in Wuhan, where the outbreak surfaced last month, and several surrounding cities. In one of several tweets, Inglesby wrote, “Serious concern that large scale quarantine for nCoV will be ineffective and could have big negative consequences.” He warned that the restrictions could hamper efforts to move medical supplies and personnel—and also scare infected people away from seeking care.
Tedros sidestepped questions at the press conference about China’s travel restrictions, underscoring the sensitive political nature of coordinating international responses to outbreaks of novel, dangerous pathogens such as 2019-nCoV. “WHO’s role is to provide rational and science-based public health recommendations to countries,” Tedros said. “But at the end of the day, a sovereign country has the autonomy to do what it thinks is right.” He said he hoped the transportation restrictions were effective and “short in duration.”
Houssin said China’s announcement of the travel restrictions yesterday took the emergency committee by surprise, adding that the restrictions were initiated by the city of Wuhan. “It was not directly related to the specific epidemiology in the city,” Houssin said.
Michael Ryan, head of WHO’s Health Emergencies Programme, thanked China for providing WHO with detailed epidemiological information about cases that it has not yet made public. “In many of these situations in the past, countries haven’t been prepared to share that detail of data, quite frankly,” Ryan said. Based on the data, he says the outbreak is evolving. “We’re not in a position to say the epidemic has peaked,” he said.
Tedros said WHO is now working to help researchers develop new diagnostics and lay the groundwork to test therapies and vaccines. “The situation is serious,” Tedros said. “We’re completely committed to ending this outbreak as soon as possible, and I will not hesitate to reconvene the committee at a moment’s notice.”