The World Health Organization on Thursday declared the outbreak of a novel coronavirus a global health emergency, an acknowledgement of the risk the virus poses to countries beyond its origin in China and of the need for a more coordinated international response to the outbreak.
In making the announcement, WHO leaders urged countries not to restrict travel or trade to China, even as some have shut down borders and limited visas.
Late Thursday, the U.S. State Department increased its travel warning for China, saying people should avoid going to the country. In a tweet, Secretary of State Mike Pompeo cited the emergency declaration and the ongoing spread of the virus for the decision, despite what WHO leaders said about travel policies.
“This is the time for science, not rumors,” WHO Director-General Tedros Adhanom Ghebreyesus said following a meeting of the agency’s emergency committee. “This is the time for solidarity, not stigma.”
Tedros, as he is called, stressed the decision was not meant to criticize the Chinese response to the outbreak, which he and other WHO officials have gone out of the way to praise. Instead, he said, the declaration of a public health emergency of international concern, or PHEIC, is meant to help support less developed countries and to try to prevent the virus from spreading in those places that are less equipped to detect the disease and handle infections.
“We don’t know what sort of damage this virus could do if it spread in a country with a weaker health system,” Tedros said.
Last week, the committee had recommended that a PHEIC not be declared yet because of limited spread of the virus outside of China. Tedros reconvened the committee this week because some other countries, including Japan, Germany, Vietnam, and, as of Thursday, the United States, had reported limited human-to-human transmission of the virus — a warning sign that the virus could start circulating more broadly outside China.
Members of the emergency committee had previously been divided over whether to recommend Tedros declare a PHEIC. Those opposed seemed to want to see if China’s efforts to control the outbreak could prevent broader worldwide transmission. Some 99% of the global cases have been in China, and the large majority of infections in other countries have been in people who picked up the virus while in China and then traveled to the other nations.
Didier Houssin, who leads the committee, said members on Thursday “almost unanimously” backed the PHEIC because of the rise in cases in China, the number of countries outside of China — now 18 — with cases, and what he called “questionable measures” taken by countries in their travel policies toward China.
As of Thursday morning, there have been more than 7,800 confirmed coronavirus infections around the world, all but 98 of which were in China. There have been 170 deaths, all in China. Infections caused by the coronavirus, provisionally called 2019-nCoV, were first reported in December in the central Chinese city of Wuhan, though it’s possible the virus was spreading among people there before then.
The declaration comes as individual countries have started to close borders and restrict trade to China, and as airlines have halted some flights. Experts say such measures are not effective in stopping the spread of a virus and may discourage countries experiencing outbreaks from being forthright. The PHEIC gave Tedros the authority to formally recommend that countries not limit travel and trade to China, though other nations do not have to comply.
Still, the PHEIC could rally some global coordination for a more unified response. Dr. Michael Ryan, the WHO’s emergency chief, told reporters Wednesday that 194 countries implementing unilateral trade and travel restrictions was an economic, political, and social “recipe for disaster.”
Tedros on Thursday said more important than the PHEIC declaration were the recommendations from the emergency committee, which included speeding the development of vaccines and therapeutics, combating misinformation, and supporting countries with weaker health systems.
“The only way we will defeat this outbreak is for all countries to work together in a spirit of solidarity and cooperation,” Tedros said. “We are all in this together and we can only stop it together.”
So far, there have been no confirmed cases of the virus anywhere in Africa. But public health experts worry that countries there may not be as equipped to detect cases and control the potential transmission of the virus as many countries with stronger health infrastructure. China has made huge investments in Africa in recent years, with increasing travel back and forth; experts fear that the virus could easily move to the continent from China.
Also Thursday, the WHO said it plans on provisionally calling the disease caused by the virus “2019-nCoV acute respiratory disease” until officials settle on a name.
WHO officials stressed that they and national health officials around the world had still mounted a wide-reaching and aggressive response to the outbreak. At a press conference Wednesday, they seemed to lament that so much attention was paid to the binary of whether something was a PHEIC or not a PHEIC. Tedros said he wished it was more like a stop light, with yellow serving as a warning.
It’s seen as “PHEIC, no PHEIC, either green or red,” Tedros said. “I think we have to revise that. It would be good to have the green, the yellow, and then the red, something in between. … There could be some intermediate situation.”
China has taken unprecedented steps to try to contain the outbreak, quarantining tens of millions of people in Wuhan and other cities by shutting down travel within, to, and from the areas. Experts, however, say, it’s not clear such massive efforts are likely to prove effective, given that the virus seems to be spreading in many locations in China and that the lockdowns could keep or drive people away from seeking care if they are sick.
There have been some questions about China’s response, including whether it was equipped for such an outbreak, it has documented all deaths from the virus, and it has been forthcoming about when the virus started spreading among people. But WHO officials have repeatedly lauded the country’s response. On Thursday, Tedros said that were it not for China’s efforts, “we would have seen many more cases outside China by now.”
In the United States, officials have been screening passengers arriving from Wuhan for signs of illness and informing them to call a health care provider if they start to get sick. (Officials from the Centers for Disease Control and Prevention have said the number of people arriving from Wuhan has dropped since China imposed the travel ban from there, but that they were continuing with their screening policies.) The CDC has also boosted surveillance at 20 entry points where officials are normally based in case an arriving traveler shows signs of a disease.
There had been five confirmed cases of the coronavirus in the United States, all related to travel to China. But just hours before the WHO declared the PHEIC, the CDC announced that one of those people — a woman in Illinois — had passed the virus on to her husband. U.S. officials had anticipated an incidence of such limited transmission and are working to prevent any broader spread of the virus.
WHO officials have said if sustained transmission of the virus occurs outside China, it becomes much harder to stop overall.
The virus can cause severe cases of pneumonia and milder cases of cough and fever, according to studies of early infections in Wuhan. It’s likely that authorities have not been able to keep track of many mild cases, including people who were not sick enough to seek care, and researchers have documented cases of the virus in people showing no symptoms.
It’s not clear if people need to be showing symptoms to pass the virus on, though even if asymptomatic people can spread the virus, they may be less likely to than people who are sneezing and coughing — routes for the virus to jump from one person to another.
Coronaviruses, a family that includes SARS and MERS, are thought to originate in bats and can jump from there or another animal to humans. Many of the early cases in Wuhan — though not all — were tied to a seafood market that also sold live animals for meat.
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 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.
Ahead of WHO’s decision Thursday, there were two active PHEICs: the ongoing Ebola outbreak in the Democratic Republic of the Congo and the continued transmission of polio.
This story has been updated with information about U.S. travel warnings for China.