Weaker health systems particularly at risk from coronavirus: WHO

Doug Hendrie

31/01/2020 3:28:34 PM

Urgent action is needed to stop the new virus from emerging as a true pandemic.

Global map of coronavirus cases
India and the Philippines have both reported their first confirmed cases of the virus, joining fellow developing nations Sri Lanka, Cambodia, Thailand, Vietnam and Nepal.

Countries with weaker health systems are at significant risk from the rapidly spreading coronavirus, the World Health Organization (WHO) has warned.
WHO Director-General Dr Tedros Adhanom Ghebreyesus this week declared the sixth-ever global public health emergency due to concerns over the spread of the virus into 22 countries and regions outside of China.
‘I am declaring a public health emergency of international concern … not because of what is happening in China, but because of what is happening in other countries,’ he said.
‘The greatest concern is the potential for the virus to spread to countries with weaker health systems which are ill-prepared to deal with it.’
India and the Philippines have both reported their first confirmed cases of the virus, joining fellow developing nations Sri Lanka, Cambodia, Thailand, Vietnam and Nepal.
The declaration represents a shift to greater concern from the WHO, which had previously chosen not to declare a public health emergency. Previous global emergencies have been declared for swine flu, ebola, Zika virus and polio.
Coronavirus – which the WHO has given an interim name of 2019-nCoV acute respiratory disease – has now passed the number of SARS cases in around one-third the time, according to the former director of the US Centers for Disease Control, Dr Tom Frieden.

‘Countries with the least resources are most at risk. Places without systems to detect and respond to outbreaks are like rooms that lack smoke alarms and sprinkler systems,’ Dr Frieden wrote in The Washington Post.
‘We’re all connected by the air we breathe, the food we eat and the planes we fly in. When other countries are stronger, we’ll be safer.’
Almost all coronavirus cases are so far in China, but human-to-human transmission has now occurred in four other countries. The death toll in China is now at least 213.
China has undertaken sweeping efforts to contain the virus, banning mass transport from the afflicted city of Wuhan and neighbouring areas. More than a dozen airlines have suspended flights to mainland China, according to Quartz.
While more developed nations such as Australia have the capacity to detect and quarantine people with the virus, newsGP has reported on concerns that conflicting information and a lack of resourcing for GPs means not all potentially affected people are being detected.
Australian virologist Dr Paul Horwood has echoed the WHO’s concerns over lower-income nations, and praised the decision to declare a global public health emergency.
‘In countries where the health system is weaker, the concern is being able to ensure people are isolated and quarantined, and that there are the necessary facilities to ensure healthcare workers are not exposed,’ he told newsGP.
‘These more resource-constrained countries may not have capacity for epidemiology and screening, which means there could be a silent spread.’
Dr Horwood said low-cost techniques can still be effective in containing the virus, such as encouraging self-quarantine, as well as handwashing and masks for people arriving from affected areas in China.
The James Cook University expert in zoonotic tropical diseases said previous major outbreaks saw a great deal of spread in hospitals.
‘We saw super-spreader events in hospitals [with SARS and MERS], so being able to control the spread there is a real concern in these countries,’ he said. ‘This coronavirus does seem to be different.
‘With SARS, people were not actually infectious until they were quite sick, so there wasn’t a great deal of spread in the community. This new Wuhan coronavirus seems to spread while incubating. We’re certainly seeing it spread faster than SARS did.’
‘At this stage, though, we’re still not seeing a lot of that community spread, which is fortunate. It means that hopefully we can still bring it under control.

‘In countries where the health system is weaker, the concern is being able to ensure people are isolated and quarantined,’ virologist Dr Paul Horwood said.

‘There is certainly reason to be concerned because viruses can mutate and evolve. We need to be alert, but not alarmed. We’re not panicking. The international health community can get this virus back under control.’
Dr Horwood predicted the actual number of cases is likely to be substantially higher than reported, because milder cases would not be seen by hospitals.
‘The more severe cases and fatalities have tended to be older people, so we can assume a lot of younger people have had it without showing these more severe symptoms,’ he said.
But Dr Horwood said it is not too late to stop a global pandemic.
‘We can put the genie back in the bottle, but it will require a lot of effort,’ he said. ‘It is spreading quickly, but not quickly enough that we give up hope of stopping it.
‘There is a chance.’
The virus has been estimated to have a reproduction number (R0) of between two and three.
‘That’s similar to influenza, which means it certainly has the potential to spread globally,’ Dr Horwood said.
Both earlier coronavirus outbreaks have been effectively stopped from spreading into the human population from their respective animal reservoirs of bats (SARS) and camels (MERS).
Dr Horwood argues China’s temporary ban on live wildlife markets should be made permanent to reduce the chances of other zoonotic diseases.
‘It’s a good move to ban the sale of wildlife, but it needs to be permanent,’ he said.
‘Many of these outbreaks are linked to live animal markets. They’re breeding grounds for novel viruses and have great potential to act as reservoirs. They don’t just threaten the countries where they are, but act as a global threat.
‘There’s a theory that as a virus becomes more transmissible, it loses some of its lethality. But I don’t believe that theory. It’s just that we haven’t yet had a highly pathogenic virus sweep through humans yet.
‘It has happened in animals that a virus with high lethality can wipe out whole populations.’
Dr Horwood pointed to African swine fever as a key example. The haemorrhagic virus has a mortality rate as high as 100% and has decimated pigs, affecting almost 80% of the world’s farmed pigs. 
‘Even Spanish flu had a mortality rate of only around 3%,’ he said. ‘That was a lot higher than other influenza viruses, but it killed around 50 million people because it infected nearly everyone around the planet.’
Estimates of mortality rates for the new coronavirus are 2–4%.
But Dr Horwood cautioned that current rates may overestimate its lethality.
‘We’re seeing the severe cases – they’re the ones being counted, by turning up to hospital. We’re not seeing the mild cases,’ he said.
‘That means the mortality could be lower. It remains to be seen.’
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