The World Health Organization on Thursday declined to designate the ongoing outbreak of a novel virus in China a global health emergency, saying that, for now, health officials are sufficiently equipped to combat the outbreak there and in other countries and that the agency does not need the additional authorities that come from such a declaration.
Announcing a public health emergency of international concern, or PHEIC, grants the WHO director-general certain powers, including the ability to issue recommendations for how countries should respond. Declaring a PHEIC could also galvanize global attention to the need to address the outbreak, which has sickened hundreds and killed at least 17 people in China, and led to cases in countries including Thailand, Japan, South Korea, and, as of Tuesday, the United States.
Didier Houssin, the chair of a WHO emergency committee, said Thursday that members remained divided about the need for a PHEIC, but that overall, they decided it was too early to recommend that WHO Director-General Tedros Adhanom Ghebreyesus declare one. Houssin said that some members felt because there were so few cases outside of China and because Chinese authorities had implemented steps to try to contain the virus, the outbreak at this point did not amount to a global emergency.
“Make no mistake: This is an emergency in China,” Tedros said. “But it has not yet become a global health emergency. It may yet become one.”
The announcement came just a day after an initial committee meeting, after which Houssin and Tedros said they needed more information to reach a consensus on whether to declare a PHEIC. WHO officials stressed they were still responding rapidly to the outbreak and collaborating with national health authorities around the world even in the absence of a PHEIC.
Tedros said the world should be ready for additional cases and an evolution in the outbreak and that he could reconvene the emergency committee as circumstances changed. “It could be in a day, it could be in a couple, it could be any time,” he said.
The committee did recommend that WHO send an international mission of experts to China to assist the country’s investigation and response. Tedros accepted that suggestion, but China has to agree to it before a team can go.
Hundreds of cases of the virus, which is known provisionally as 2019-nCoV and has been determined to belong to a family called coronaviruses, have been confirmed in the central Chinese city of Wuhan, home to 11 million people and where the outbreak is believed to have started last month.
Infections have also started to crop up around China, with millions of people expected to travel around and from the country for the Lunar New Year holidays, which begin this week. In response, Chinese authorities have shut down transport from and within Wuhan, as well as the cities of Huanggang and Ezhou, essentially quarantining 20 million people.
Experts have questioned whether such a move will actually help with the public health response. Shutting down transit could limit medical supplies coming into the cities, and make it harder for people who are sick to get to clinics to get a confirmed diagnosis and for health officials to track the contacts of people who are sick. The decision could also stir distrust of the government’s efforts to stem the outbreak and divert resources that could go to the response. Plus, the travel ban started in Wuhan Thursday morning; that allowed time for people who had been infected with the virus to leave the city.
“There’s just a real fundamental question of efficacy here,” said Alexandra Phelan of Georgetown University’s Center for Global Health Science & Security. “Mass quarantines are typically considered not very effective.”
More specific restrictions called social distancing measures might have some benefit, Phelan said, slowing the spread of the virus but not stopping it. These steps include suspending school and mass gatherings, and possibly public transit as well.
“What we’re seeing here with Wuhan and the two other cities appears more than social distancing,” Phelan said. “It’s a bit like a sledgehammer.”
When asked if WHO backed the quarantine measures, Tedros said China as a sovereign nation could take the steps it wanted to control the outbreak.
Countries, including the United States, are screening passengers arriving from Wuhan for symptoms of the infection, including cough, fever, and shortness of breath, and informing travelers about the signs of the virus to encourage them to seek out medical care if they become sick. On Thursday, the U.S. Centers for Disease Control and Prevention said people should avoid nonessential travel to Wuhan.
Cutting off travel and trade with a country dealing with an outbreak is viewed as unlikely to stop disease spread and is likely to discourage countries from being transparent about outbreaks. The PHEIC designation would have enabled Tedros, as the WHO director-general is known, to urge countries not to close borders or limit trade, though countries do not have to comply.
Coronaviruses, which include SARS and MERS, typically spread to humans from an animal source. Many of the early cases of the novel coronavirus were linked to a seafood market in Wuhan that also sold animals for meat. But health authorities have confirmed that some infections have come through human-to-human transmission. They are still trying to determine whether spread among people is limited or whether it might be spreading in a sustained manner, meaning it easily passes from one person to the next and then onward.
Tedros said experts have not seen evidence of human-to-human transmission outside of China at this point, but emphasized all that remained unknown about the virus, including the source, how it is spread, and the full range of how it affects people it’s infected.
The seafood market in Wuhan was closed Jan. 1, the day after Chinese health officials reported to the WHO a strange spike in pneumonia cases in the city.
The emergence of a global coronavirus outbreak from China is reminiscent of the SARS outbreak of 2002 to 2003, which went on to kill nearly 800 people. The PHEIC designation (pronounced “fake”) was created following an update to the International Health Regulations after that outbreak.
The first PHEIC was declared for the 2009 H1N1 flu pandemic, and others have included the 2014-2016 West African Ebola outbreak and the Zika outbreak in 2016. The WHO set up an emergency committee to assess whether MERS should be declared a PHEIC, but it concluded after meeting several times that the disease did not constitute a global health emergency.
There are two active PHEICs: the ongoing Ebola outbreak in the Democratic Republic of the Congo and the continued transmission of polio.
Helen Branswell contributed reporting.