When was the world given official notice about the novel coronavirus’s human-to-human transmission and high infection rates?
Wasn’t it already too late by 12 Mar 2020 when WHO declared the COVID-19 outbreak a pandemic? Did backroom geopoliticking lead WHO’s Director-General Dr Tedros Adhanom Ghebreyesus to delay warning the world? Did this timing mean that WHO and Tedros were responsible for wrong-footing nations across the world in preparing for the COVID-19 crisis? Did the world lose precious weeks when it should have been readying defenses against the coronavirus outbreak at least since January?
While the word “pandemic” catches the public imagination, that 12 Mar declaration actually carried little significance for international policy-making.
Instead, what really mattered was the earlier 30 Jan 2020 Public Health Emergency of International Concern (PHEIC) declaration. It is PHEIC that bears implications for international acts in health ministries and agencies across nations. So the right sequence of events to study for WHO and national responses is that around WHO’s PHEIC Declaration.
In late January a week before declaring PHEIC, WHO had called two meetings of its International Health Regulations (2005) Emergency Committee, one on 22 Jan 2020, and then the next the day after. The IHR Emergency Committee advises WHO’s Director-General on, among other things, the determination of PHEIC. These 22–23 Jan meetings included representation from the US, China, Japan, Thailand, France, the Netherlands, Canada, Australia, Thailand, and Singapore, among elsewhere. By implication, therefore, all these nations and likely others were already fully apprised of the COVID-19 situation.
At the 23 Jan 2020 meeting China presented to the IHR Emergency Committee data on death rates, the rise in confirmed cases, and the provinces affected by the novel coronavirus. The Committee noted both human-to-human transmission and a preliminary $R_0$ estimate of 1.4–2.5. But Committee members disagreed on whether PHEIC declaration was warranted, primarily because of the latter’s restrictive, binary nature. The Committee suggested WHO might consider a more nuanced system that could reflect varying levels of alertness and severity, rather than just PHEIC / no PHEIC. The outcome, however, was that, based on the evidence presented, the divided Emergency Committee gave no clear direction to the Director-General. By some accounts, it would have been highly inappropriate for Dr Tedros and WHO to override this advice for circumspection given them by the Committee.
The following day, 24 Jan 2020, The Lancet — among the world’s oldest and best known of general medical journals — published a coronavirus article by Chinese scientists carrying three important features. The publication (1) described pandemic potential; (2) reported high mortality with evidence of efficient human transmission, and (3) recommended testing upon suspicion and personal protective equipment for healthcare workers.
To summarise the evidence, first WHO’s IHR Emergency Committee, comprised of national representatives from around the world, were apprised of the dangers due to the novel coronavirus, and failed to recommend PHEIC declaration; second, an article in The Lancet presented scientific evidence on the novel coronavirus that pointed to an imminent global health situation fraught with danger.
Some nations (Singapore for one) began to take precautionary measures immediately. But most others did not.
WHO called another IHR Emergency Committee meeting a week later. At this 30 Jan meeting the decision was taken to declare PHEIC. With hindsight, observers might fault WHO for not earlier setting aside instruction from its own IRH Emergency Committee. If WHO had done so, there might have seven days more of warning the world had. However, if we denote 30 Jan 2020’s PHEIC Declaration as day 0, many nations did not exactly try to make up for that lost week:
- Day +1: Italian government suspended all flights between Italy and China, and declared a state of emergency to last six months.
- Day +2: Trump announced travel restrictions on people coming from China; the US declares a public health emergency.
- (Over a month passes, then …)
- Day +41: India’s Health Ministry said the coronavirus “is not a health emergency”.
- Day +43: Trump declared national emergency. UK described its strategy of herd immunity (reversing it only over that next weekend).
- Day +46: Spain declared state of emergency.
- Day +47: France declared strict national lockdown.
- Day +49: COVID-19 deaths in Italy first exceeded those in China. Taiwan closed its borders to nonresidents.
- Day +52: Germany issued strict social distancing measures but not lockdown.
- Day +54: Modi announced on TV at 2000h that from midnight all of India would be under lockdown; all markets, closed; all transportation disallowed.
What PHEIC does, according to the WHO website:
The role of the International Health Regulations (2005) IHR Emergency Committee: