The war against COVID-19

Starting with a few cases in Wuhan, Hubei province in China in December 2019, the Coronavirus (COVID-19) outbreak rapidly spread within then outside the country. Recently, a significant number of new cases was observed notably in South Korea, Iran, Italy and Japan. Furthermore, screening and quarantine measures are being implemented by an increased number of States, in particular for people coming from most affected countries.

On 30 January 2020, the World Health Organization (WHO) declared the outbreak a public health emergency of international concern and raised its global risk assessment for the novel coronavirus to "very high". As of March 4th, globally, there are 92,943 confirmed cases and 3,160 deaths. In the past 24 hours, China reported 120 cases. Most cases continue to be reported from Hubei province. Outside China, 2075 cases were reported in 35 countries. According to the WHO the transmission is relatively high while the mortality rate remains low.

Worldwide: Total confirmed cases: 118,322 Deaths: 4,292

China: Total confirmed cases: 80,955 Deaths: 3,162

 Outside of China: Total confirmed cases: 37,367 Total deaths: 1,130 Countries/territories/areas: 113

WHO Director-General in his regular media briefing (11.03.2020) stated that WHO has been assessing this outbreak around the clock and is deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction. WHO therefore has made the assessment that COVID-19 can be characterized as a pandemic.

“All countries can still change the course of this pandemic.

If countries detect, test, treat, isolate, trace, and mobilize their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.

Even those countries with community transmission or large clusters can turn the tide on this virus.

Several countries have demonstrated that this virus can be suppressed and controlled.

The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same – it’s whether they will. 

Some countries are struggling with a lack of capacity.

Some countries are struggling with a lack of resources.

Some countries are struggling with a lack of resolve.

We are grateful for the measures being taken in Iran, Italy and the Republic of Korea to slow the virus and control their epidemics.

We know that these measures are taking a heavy toll on societies and economies, just as they did in China.

All countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights.

WHO’s mandate is public health. But we’re working with many partners across all sectors to mitigate the social and economic consequences of this pandemic.

This is not just a public health crisis, it is a crisis that will touch every sector – so every sector and every individual must be involved in the fight.

I have said from the beginning that countries must take a whole-of-government, whole-of-society approach, built around a comprehensive strategy to prevent infections, save lives and minimize impact.

Let me summarize it in four key areas:

1st Prepare and be ready.

2nd Detect, protect and treat.

3rd Reduce transmission.

4th Innovate and learn.

I remind all countries that we are calling on you to activate and scale up your emergency response mechanisms;

Communicate with your people about the risks and how they can protect themselves – this is everybody’s business;

Find, isolate, test and treat every case and trace every contact;

Ready your hospitals;

Protect and train your health workers.

And let’s all look out for each other, because we need each other.”

“The world is not ready to manage this virus on a large scale and must do it as quickly as possible,”—Bruce Aylward, lead of the WHO China joint mission on COVID19 (report available here) said on Tuesday 25th of February. The virus is knocking on the door of countries that are not China and the measures being taken are not enough. An example is Iran, the Coronavirus has already killed at least 15 people. The authorities try to contain the progress of the virus by asking citizens not to go outside. The origin is believed to be in the holy city of Qom, a place of pilgrimage of Shia Muslims, from which the coronavirus is spreading in the middle east, through nine countries. The majority have decided to close borders and suspend flights with Iran, whose Minister of Foreign Affairs has called for regional cooperation to curb its progress. At the national level, concerts, football matches, classes at schools have been cancelled... The fact that this region welcomes some 12 million refugees and displaced persons in conditions of precariousness, of already weakened systems, of lack of hygiene and sanitation or lack of medical attention, which would be a breeding ground for the transmission of the disease among the most vulnerable. The elderly and people with previous pathologies are at greater risk than with the flu because there is still no vaccine against the coronavirus.

We should not underestimate this infection, but we should not be drastically alarmed either. Tests should be done and, if possible, with scientific criteria.

China has contained an epidemic that could worsen soon. If the number of patients affected by coronavirus are high in China, it is because they are treated in the hospital for two to six weeks. There are still more than 50,000 people admitted and most of them are from when the highest peaks of the disease were recorded. Therefore, deaths from COVID-19 could be higher in other countries. The world is not prepared: in developing countries because they lack the means to have specific centers that detect and treat the disease. In the West there would be several factors for this mortality: 1) It is higher in the elderly and Europe has an aging population. In addition, the mildest cases of the disease are not being sought, which are the ones that spread the virus. Serious cases go to the hospital too late and are therefore more likely to die. 2) We have to be prepared and collaborate, wash our hands every hour, keep them clean to stop the spread of the disease. Countries must change their mentality and face the first case in their territory as a prelude to the worst scenario, that of the pandemic.

How to deal with the virus? Having beds for the patients of COVID-19, facilities for quarantines and isolation, defining how to transfer the patients, having mechanical ventilation and oxygen for the most serious cases and the availability of laboratory taxis for the detection of infection. It is clear that cases are increasing and, as soon as infections begin to be added, we must be prepared to control them on a large scale, as if the virus were to appear tomorrow.

We must turn to the experience of China, they are containing the virus on a large scale. We need to learn how to manage the virus, not only achieve zero cases. New barriers are being built between other countries and China, while we need to learn from their commitment, investment, solidarity, resilience, readiness planning, capacity-building and rapid-response thinking to help people survive this disease.

We need to be ready to stop its transmission:

Patients – Healthcare workers – Community

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Patients ----------------------------------------

Children are not in the contagion chain or in risk groups because this disease is not a flu, although it is more severe. Most infections occur not in hospital centers, but in neighborhoods. It is recommended that patients affected by the coronavirus do not come into contact with other hospital patients because, for them, coronavirus could be fatal.

What has China done?

China has carefully approached a brand new virus, never seen before, quite frightening. Very basic public health tools are being applied with rigor in contaminated areas. An innovative, systematic and pragmatic approach on a scale: case finding, contact tracing, social distancing, movement restrictions and used that approach to try to stop a new emergent respiratory born pathogen. To do so, China realized immediately that the intensity of transmission of the virus was not the same in different parts of the country: identification of zero cases, sporadic cases, clusters of cases or community transferred cases. What is the correct mitigation approach? There is an international mobilization of a phenomenal collective action and cooperation to this response. Passion, commitment, interest, responsibility, accountability and an individual sense of duty (it’s our duty to stop this virus). Everyone has a role in the prevention and control task force that answers straight to the State Council and President.

Technology response: data and AI is being used to find every case, trace every contact across vast areas. Hospitals repurposed for the response of COVID19 separated from regular hospitals in a very orderly manner. Everyday life: keep the food, medicines and other essential products moving though deliveries. How science driven and agile the response is? How to take care of the severely sick patients guide. Speed of turnover to stay on top of the learnings on the COVID19 response. They applied the rigor, discipline, a differentiated approach, collective action, repurposed machinery of government to make it work, technologically powered and science driven. They applied to what was an escalating, with an exponential growth, disease within and outside of China.

This is a rapidly escalating epidemic that we have to tackle super-fast to prevent a pandemic. 5G platform will be used to make the connectivity with the areas where we can run the virus response in real time. Together, countries can try to sort out the transmission worldwide.

The course of the outbreak has changed because its exponential growth has slowed down. Anytime we pull down the force of the infection from the epicenter, we are going to reduce the probability of the virus to go elsewhere. There is an extraordinary mobilization to implement health principles.

What’s the real trend of the outbreak ? Important issues to be considered:

Fever clinics, isolation centers, massive facilities for COVID-19 infected patients.

How do we, operationally, run a response? How do we run the containment at a global scale? How much transmission is going on in communities? Who / How / Where are people getting infected? There’s not a wider transmission beyond what we see clinically. The global response has to be informed with evidence:

The symptoms of coronavirus are: fever (88%), dry cough (68%), infection (4%), fatigue, myalgia, general un-wellness, pneumonia, respiratory insufficiency, multi-organ failure. They affect more aggressively patients with hypertension and prone to suffer from heart diseases.

• 80% of the cases are mild, 30% are severe and 6% are grave.
• 15 % of the cases change from mild to severe.
• 15 – 20 % of the cases change from severe to critical.

The survival rate is extremely high in mild cases.

TCM, Traditional Chinese Medicine has shown its effectiveness in 90% of the cases, especially in mild cases (lowers anxiety and has anti-inflammatory and anti-fever effects).

Handling of dead bodies (see technical guide, WHO recommendations).

Vaccine, resources and data analysis are needed for the containment of the virus: better tools, right diagnosis, therapeutic tools, do the right studies. Get organized, wisely used time and research save lives.

WHO Director-General's opening remarks at the mission briefing on COVID-19 - 26 February 2020 (source: WHO).

Coronavirus disease (COVID-19) advice for the public Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing. (Source: WHO).

Coronavirus disease (COVID-19) technical guidance – country readiness, patient management, risk communication and community engagement, points of entry/mass gatherings, surveillance and case definitions, infection prevention and control, disease commodity package, naming COVID-19, laboratory guidance, early investigations, reduction of transmissions from animals to humans. – (source WHO).

Coronavirus disease (COVID-19) travel advice (source WHO).

How COVID-19 Spreads (source: CDC).

Coronavirus Map: Tracking the Spread of the Outbreak (source: NYT).

Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control (training provided by WHO).

Transmission of the COVID-19 by animals: Coronaviruses are zoonotic, meaning they are transmitted between animals and people. While animals are the source of the virus, this virus is now spreading from one person to another. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.  WHO Situation report 32: The new COVID-19 is caused by the virus SARS-CoV-2. The most likely ecological reservoirs for SARS-CoV-2 are bats, but it is believed that the virus jumped the species barrier to humans from another intermediate animal host. This intermediate animal host could be a domestic food animal, a wild animal, or a domesticated wild animal which has not yet been identified. Coronaviruses are thermolabile, which means that they are susceptible to normal cooking temperatures (70°C). Therefore, as a general rule, the consumption of raw or undercooked animal products should be avoided. Raw meat, raw milk or raw animal organs should be handled with care to avoid cross-contamination with uncooked foods.

Symptomatic and asymptomatic transmission: Common signs of infection include respiratory symptoms, fever, cough, shortness of breath and breathing difficulties. In more severe cases, infection can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death.

Management of dead bodies: "There is no evidence to suggest that the coronavirus can spread during preparations of the body for burial," Ronald St John, former director-general of the Centre for Emergency Preparedness and Response at the Public Health Agency of Canada who managed Canada's response to the 2003 SARS outbreak, told Al Jazeera.

 Recommendations given by Dr. Bruce Aylward:

a) Think that the virus will show up tomorrow.

b) Be ready (in terms of capacity and rapid response) to manage the spread of the virus.

c) Wash your hands, wear masks and hats.

d) Talk with people who are already responding to the outbreak, don’t stigmatize nor build barriers with infected people.

WHO: COVID-19 Updates provided by Dr. Michael J. Ryan – Executive Director, WHO health emergencies programme, Dr. Maria van Kerkhove – Technical lead, WHO Health emergencies programme, and Dr. Tedros Adhanom Ghebreyesus – WHO Director General:

"Time is a window of opportunity to act aggressively to prevent this virus and save lives. Advice: we should move swiftly and contain it.

COVID-19 spreads very fast if it is not adequately contained. With right measures it can be contained. Evidence shows that there’s not wide spread community transmission before the virus gets a foot hole. We advocate for a comprehensive approach.

 First case, cluster, evidenced community transmission. Preparing for all the scenarios at the same time. No country should assume it won’t get cases. The virus does not respect borders. Not distinguish between ethnicities, development level.

We should not only be worried about the prevention of cases arriving to other countries, but about what will we do when these cases arrive. We shouldn’t be hopeless. We can all do something: detect cases early, quality clinical care, prevent hospital transmissions and community transmissions.

Are we ready for the first case? Do we have isolation units ready to go? Do we have enough oxygen, ventilators…vital equipment? Do States:

- Have reporting system facilities being used?

- Have the right training and equipment to stay safe?

- Take samples correctly to help patients?

- Test patients who are sick at airports?

- Are ready to treat patients with several or critical diseases?

- Have the right system to prevent infections?

 Do we know what’s the right information?

- 90% cases: fever

- 70% cases: dry cough

Are we ready to fight rumors? Are we able to have people on our side to fight the outbreak?

These are the questions that can prepare us. The difference between one case and 100 cases in the coming days and weeks.

If an answer to any of these questions is no, the virus can explode.

 This virus has pandemic potential.

We are providing equipment to countries and health workers to prevent, detect and manage cases. We have developed KPIs, estimated resources needed to prepare for and respond to up to 100 cases. WHO stands ready to support every country to develop its national plan

This is time for talking action to prevent infections and save lives. Fear and panic don’t help.

People can be worried, but we need to calm down and do everything possible to fight and stop the virus.

The continuous number of affected countries are of concern. Epidemiologists are monitoring the cases continuously. The assessment shows that the risk of spread is very high at global level. There is a chance of containment of this virus: early action must be taken. The key is to break the chain of transmission.

 What can we do?

1. Wash your hands regularly: regularly and thoroughly clean your hands with an alcohol-based hand rub or wash them with soap and water. Clean surfaces with disinfectant soap.

2.. Maintain social distancing: at least 1 meter (3 feet) distance between yourself and anyone who is coughing or sneezing.

3. Access reliable sources of information to learn more about COVID-19. Stay informed and follow advice given by your healthcare provider

4. Avoid travelling if you have a fever or cold. Avoid touching eyes, nose and mouth

5. If you have fever, cough and difficulty breathing, seek medical care early.

6. Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze. Then dispose of the used tissue immediately.

7. If you are prone to suffer cardiovascular diseases, respiratory difficulties, you have a higher risk of being infected.

8, If you feel unwell, stay at home an contact doctors, inform them of who did you have contact with.

9. If you are sick, isolate and make preventive decisions to avoid infecting others.

10. Don’t feel anxious. Find out what you can do in your community, workplace, school or place of worship.

Surveillance measures can help the containment. Knowing and understanding the disease is the first step to defeat it. We have never seen before a respiratory pathogen of such community transmission (clusters of transmission with family members and other close contacts), but that can be contained with the right measures. We need to analyze which scenarios countries are in (1st Case, 1st Cluster, 1st Evidence of community transmission).

Containment is feasible and must remain the top priority for all countries. Early aggressive measures of containment save lives.

At WHO we are still debating if it’s a pandemic or not. We are analyzing the data and monitoring cases every minute. We need to see the evidence in perspective: more than 130 countries have not detected any cases yet. Some just received their first cases yesterday. Some countries have declining epidemics and have not reported a case for more than 2 weeks.

No matter what country you are in, this disease will stretch your health systems.

We can push this virus back. Our actions will determine the course of the outbreak in each country.

As humanity, we should stand together

DRC: 2 weeks without a single reported case of Ebola, no patients receiving treatment. Good news for the whole world.

COVID-19 is becoming incredibly complex:

The newly affected countries should take precautions to manage these cases.

COVID19 is a threat we don’t clearly understand, but data shows:

It is not SARS, not MERS, not influenza. It is unique. Both COVID-19 and influenza cause respiratory difficulties and spread the same way (droplets from someone sick). Differences:

1. COVID19 does not transmit as efficiently as influenza (major drivers of transmission not identified).
2. No symptoms within 2 days.
3. We encourage all countries to do studies and share their data.
4. COVID19 spreads faster than flu, transmission is not driven by people not sick, it causes more severe cases than influenza.
5. No one has immunity to COVID19.
6. 3,4% of reported COVID-19 cases have died. There is no vaccine, nor specific treatment yet. Medicaments are being developed.

Prevent infections save lives. Containment is possible. A comprehensive approach is recommended.

Gloves, medical masks, respirators, goggles… We can’t stop COVID without protecting our health workers. Supplies can take months to deliver. Stocks are often sold to the highest bidder. Protective equipment save lives. WHO estimates that more than 89 million, 76 million gloves and many goggles will be needed to respond.

Almost 90% of those cases are from just three countries. WHO now has a team on the ground in Iran to deliver supplies and support the government in the response. WHO is advising countries on actions they can take for each of the “three Cs” scenarios – first case, first cluster, and first evidence of community transmission. Our message to all countries is: this is not a one-way street. We can push this virus back. Your actions now will determine the course of the outbreak in your country.

We see encouraging signs from the Republic of Korea. The number of newly-reported cases appears to be declining, and the cases that are being reported are being identified primarily from known clusters.

It’s certainly troubling that so many people and countries have been affected so quickly. Now that the virus has a foothold in so many countries, the threat of a pandemic has become very real. But it would be the first pandemic in history that could be controlled. The bottom line is, we are not at the mercy of the virus. The great advantage we have is that the decisions we all make, as governments, businesses, communities, families, and individuals, can influence the trajectory of this epidemic.

Solidarity. All of us must work together to ensure that all countries can protect as many people as possible”.

Scam Alert (!) Beware of criminals pretending to be WHO

For targeted health information and myth busters visit WHO EPI-WIN

As the media coverage of the Coronavirus (COVID-19) outbreak dominates the media all over the world, the International Federation of Journalists (IFJ) has urged the media to report responsibly and avoid creating any unjustified panic that could worsen the situation.

“In the light of the emergence of new coronavirus infections across the world, the IFJ believes the media’s role is to provide citizens with verified, accurate and factual reporting and avoiding sensationalist reporting that could lead to general panic and fear. Respect for the facts and for the right of the public to truth is the first duty of the journalist.

Journalists and media must report on facts and reliable scientific sources, avoiding speculation. Fear-inducing vocabulary that could create a state of alarm that does not correspond to reality should be avoided. Journalists should also be especially sensitive with the privacy of affected people.

Accordingly, the IFJ also calls on public authorities and medical institutions to provide timely and transparent information so that journalists have access to all the information.

IFJ General Secretary, Anthony Bellanger, said: The journalist's responsibility towards the public takes precedence over any other responsibility. Media can increase public awareness of the situation regarding the Coronavirus through reporting that educates, warns and informs properly on the problem. That way they can also be part of the solution. It’s in this kind of context when we have the opportunity to again demonstrate to citizens the value of quality, ethical journalism”.

Situation reports: Every day, there are “WHO: COVID-19 Updates” live on United Nations TV at 4pm (GVA time), here.

WHO Update on Coronavirus disease 2019 (COVID-19), situation report 51 (Bolivia, Jamaica, Burkina Faso and Democratic Republic of the Congo have reported cases); situation report 50 (Brunei Darussalam, Mongolia, Cyprus, Guernsey and Panama have reported cases); situation report 49 (Bangladesh, Albania and Paraguay have reported cases); situation report 48 (Bulgaria, Costa Rica, Faroe Islands, French Guiana, Maldives, Malta, Martinique, and Republic of Moldova); situation report 47 (Colombia, Holy See, Peru, Serbia, and Togo); situation report 46 (Bhutan, Cameroon, Serbia, and South Africa) have reported cases); situation report 45 (Bosnia and Herzegovina, Gibraltar, Hungary, Slovenia, and occupied Palestinian territory have reported cases);

• WHO COVID-19, Situation report 44 (Argentina, Chile, Poland and Ukraine have reported cases).
• WHO COVID-19, Situation report 43 (Andorra, Jordan, Latvia, Morocco, Portugal, Saudi Arabia, Senegal, and Tunisia reported cases).
• WHO COVID-19, Situation Report 42 (Armenia, Czechia, Dominican Republic, Luxembourg, Iceland, and Indonesia reported cases). 
• WHO COVID-19 situation report 41 (Azerbaijan, Ecuador, Ireland, Monaco and Qatar reported cases).
•  WHO COVID-19 situation report 40 (Mexico and San Marino reported cases).
• WHO COVID-19 situation report 39 (Belarus, Lithuania, Netherlands, New Zealand, and Nigeria reported cases).
• WHO COVID-19 situation report 38 (Brazil, Denmark, Estonia, Georgia, Greece, Norway, Pakistan, Romania, and North Macedonia reported cases).
• WHO COVID19 situation report 37 (Algeria, Austria, Croatia, and Switzerland reported cases).
• WHO COVID-19 situation report 36 (Afghanistan, Bahrain, Iraq, and Oman reported cases).
• WHO COVID-19 situation report 35
• WHO COVID-19 situation report 34
• WHO COVID-19 situation report 33
• WHO COVID-19 situation report 32
• WHO COVID-19 situation report 31
• WHO COVID-19 situation report 30
• WHO COVID-19 situation report 29
• WHO COVID-19 situation report 28
• WHO COVID-19 situation report 27
• WHO COVID-19 situation report 26
• WHO COVID-19 situation report 25
• WHO COVID-19 situation report 24
• WHO COVID-19 situation report 23
• WHO COVID-19 situation report 22
• WHO COVID-19 situation report 21
• WHO COVID-19 situation report 20
• WHO COVID-19 situation report 19
• WHO COVID-19 situation report 18
• WHO COVID-19 situation report 17
• WHO COVID-19 situation report 16
• WHO COVID-19 situation report 15
• WHO COVID-19 situation report 14
• WHO COVID-19 situation report 13
• WHO COVID-19 situation report 12
• WHO COVID-19 situation report 11
• WHO COVID-19 situation report 10
• WHO COVID-19 situation report 9
• WHO COVID-19 situation report 8 (Patients with 2019-nCoV infection, are presenting with a wide range of symptoms. Most seem to have mild disease, and about 20% appear to progress to severe disease, including pneumonia, respiratory failure and in some cases death).
• WHO COVID-19 situation report 7 (37 cases identified outside of China. Current estimates of the incubation period of the virus range from 2-10 days).
• WHO COVID-19 situation report 6 (29 confirmed cases have been reported outside of China in ten countries).
• WHO COVID-19 situation report 5 (23 confirmed cases have been reported outside of China in nine countries).
• WHO COVID-19 situation report 4 (846 confirmed cases, first case in Vietnam).
• WHO COVID-19 situation report 3 (reported in Thailand, Japan, Hong Kong Special Administrative Region, Taipei Municipality, China, Macau Special Administrative Region, United States of America and the Republic of Korea; All had travel history to Wuhan;WHO COVID-19 situation report 2 (314 confirmed cases have been reported for novel coronavirus (2019-nCoV) globally).
• WHO COVID-19 situation report 1 (WHO China Country Office was informed of cases of pneumonia unknown etiology -unknown cause- detected in Wuhan City, Hubei Province of China).

Latest IFRC communication messages and assets:

WHO has not declared this outbreak to be a pandemic, but they are strongly advising that countries prepared for this distinct possibility. There have also been some troubling incidents of racially-motivated violence and abuse, most notably an attack in Ukraine on buses carrying returnees from Wuhan. IFRC, UNICEF and WHO are developing community-based guides and global campaigns to thwart the effects of stigma on people and the COVID-19 response. 

Risk communication guides and assets (also available on the CommunityEngagement Hub):

• A guide to preventing and addressing social stigma
• Risk communication and community engagement: Guidance note (2 Feb 2020) EN FR ES AR RU PT 
• Key tips and discussion points for community workers, volunteers and community networks (with messages and FAQ) (23 February 2020) EN
• General key messages - 25 February 2020