Novel Coronavirus Outbreak Is Not a Public Health Emergency of International Concern

Tedros Adhanom Ghebreyesus, PhD, director-general of the World Health Organization (WHO) hs decided to not declare the Wuhan Coronavirus outbreak a Public Health Emergency of International Concern (PHEIC). The news was announced today in a press conference.

The recommendation to not declare the outbreak a PHEIC was made during a meeting by a panel of the International Health Regulations Emergency Committee at the United Nations’ Geneva Headquarters.

This committee convened to assess the situation on Wednesday, January 22^nd but with an overwhelming amount of information to discuss and new developments in the situation, the decision was made to push the decision to Thursday, January 23^rd.

The decision was made based on the fact that public health efforts are being implemented to try to contain the disease and a low number of case counts overall.

“Make no mistake, this is an emergency in China. But it has not yet become a global health emergency. It may yet become one,” director-general Ghebreyesus said.

According to the director-general, "as it was yesterday, the emergency committee was divided" on whether to make the declaration. Yesterday, Didier Houssin, MD, chairperson of the International Health Regulations Emergency Committee, stated that the split among the 16 committee members was "50/50, even."

Contagion® spoke to Krutika Kuppalli, MD, vice chair of the Infectious Diseases Society of America's Global Health Committee about her opinion on the committee's decision.

“I am surprised that the WHO did not declare a PHEIC after the Emergency Committee convened today as it appears the criteria of the IHR have been met," Kuppalli, who is also an affiliated assistant clinical professor at Stanford Healthcare said. "I remain concerned given the rising number of cases, growing number of individuals that have died or who are critically ill, reports that isolation wards in Wuhan are full and health care workers are becoming infected."

"According to the WHO, 25% of those infected have developed severe disease and most of those who have died have had co-morbidities such as hypertension, diabetes, or coronary artery disease," Kuppalli continued. "As Dr. Tedros mentioned this is an emergency in China and all of Asia is at high risk, which puts the entire world at risk given our increasingly mobile and connected society."

>>READ: Clinical Characteristics of the First 2019-nCoV Cases in Wuhan, China>>READ: CDC Confirms First US Case of Wuhan Coronavirus

The decision to not declare a PHEIC comes just 2 days after the US Centers for Disease Control and Prevention (CDC) announced the first Wuhan coronavirus case in the United States.

CDC has also raised its travel advisory to alert level 3, indicating a recommendation to avoid nonessential travel to Wuhan, China. The decision came after Chinese officials announced they would shut down all transportation in and out of Wuhan, where the outbreak originated.

"Although China has instituted lockdowns in an attempt to contain this outbreak, they will likely be counterproductive and will drive cases underground, causing spread of disease, and panic," Kuppalli said.

In the press conference communicating the decision not to declare a PHEIC yet, director-general Ghebreyesus announced that 584 cases had so far been reported to WHO, including 17 deaths. 575 of the cases and all deaths have taken place within China.

The outbreak was originally tied to a seafood market in Wuhan, but new infections are no longer confined to the city.

WHO has also confirmed cases in Japan, Thailand, South Korea, and the United States.

China notified the WHO of a pneumonia outbreak of then-unknown etiology on December 31, 2019. On January 9, WHO released a statement explaining that Chinese scientists had discovered a new coronavirus responsible for the outbreak.

Clinicians should gather travel history information in any suspected patients.

The WHO case definitions include standards for patients with severe acute respiratory infection as well as acute respiratory illness.

A suspect case applies to patients with severe acute respiratory infection when there is no other etiology which fully explains clinical presentation and travel to or residence in Wuhan, or no other etiology and status as health care worker in an environment where severe acute respiratory infections of unknown etiology are being cared for.

A suspect case also applies to patients with any acute respiratory illness and close contact with a confirmed or probable case of novel coronavirus, working in an animal market, or working in a health care facility with reports of novel coronavirus in the 14 days prior to onset of symptoms.

Probable cases are defined as suspect cases where novel coronavirus testing is inconclusive or testing was positive on a pan-coronavirus assay. Confirmed cases are defined by laboratory confirmation of novel coronavirus infection.

"Since there still is much we still do not know about the 2019 novel coronavirus, such as the source, how easily it spreads, or the range of clinical severity I believe we will continue to see cases globally," Kuppalli commented.

"As the situation continues to rapidly evolve I hope Dr. Tedros does not hesitate to reconvene the Emergency Committee of the WHO to reassess the situation again very soon," Kuppalli concluded. She also noted that clinicians can use IDSA resources to monitor the situation.

For the most recent cases in the novel coronavirus outbreak, visit the Contagion® Outbreak Monitor.