Georgetown Global Health Experts Comment on WHO’s Delayed PHEIC Decision and Wuhan Transportation Shutdown

Posted in News Release  |  Tagged 2019 Novel Coronavirus, coronavirus, global health, infectious disease

WASHINGTON (January 22, 2020) — This afternoon, World Health Organization Director-General Dr. Tedros Adhanom Ghebreyesus announced a delay in his decision on whether or not to declare the novel coronavirus (2019-nCoV) outbreak that began in Wuhan, China, a Public Health Emergency of International Concern (PHEIC). Also today, China announced a ban on transportation out of Wuhan starting Thursday. 

Georgetown global health and security experts react to these developing stories.

On WHO’s delayed PHEIC decision and the transportation shutdown in Wuhan:
“Dr. Tedros proclaimed that he required more information in order to make a determination on a Public Health Emergency of International Concern, and the vote within the emergency committee was split 50/50. The virus is clearly spreading around the world, and thus constitutes a public health risk to other countries through international spread and potentially requires an international coordinated response. The third condition for a PHEIC — if it constitutes an extraordinary event — is where there may be debate. Since the true case fatality is unknown and the dynamics of ‘super-spreaders’ and extent of human-to-human transmission are still being determined, it may be too soon to make the declaration.
 
“In the interim, China has taken aggressive action to issue a travel ban on all public transportation out of the city of Wuhan and within. This is an extraordinary move, given the size of the population and the amount of travel expected during the Lunar New Year. There is fear that such a move will only push people to take action to avoid authorities and leave the city via other means, and possibly incite panic. Professor Houssin, chair of the emergency committee, noted that the decision by the Chinese to institute this travel ban will be considered by the emergency committee during the deliberations on Thursday.”
 
– Rebecca Katz, PhD, MPH, is professor and director of the Center for Global Health Science and Security at Georgetown University. Follow her on Twitter at @RebeccaKatz5.

On WHO’s delayed PHEIC decision, the transportation shutdown in Wuhan, and legal obligations of countries:
“This decision to defer and reconvene tomorrow after gathering more information overnight is unprecedented and reflects the limitations of the data the Emergency Committee was trying to work with. It is essential that the WHO is working with the most accurate information, given the pace that new cases and deaths are being reported, international spread of the novel coronavirus, and the very real risk that countries will begin to impose unnecessary and detrimental travel restrictions, it is essential that WHO take the necessary leadership as required by the IHR.

“China’s decision to shut down travel from Wuhan is incredibly concerning, particularly given the timing before Lunar New Year. As we learned during SARS, heavy-handed quarantines may make outbreaks worse as people will find ways to leave, may panic, and mistrust authorities, making public health measures more difficult to implement.

“It is critical that Director-General Tedros makes clear why mass quarantines may endanger public health — as was learnt during SARS — as well as the importance of a human-rights based approach to health.

“Tomorrow’s Emergency Committee will be important for highlighting that all countries have international legal obligations to avoid unnecessarily interfering with travel and trade, and must respect the human rights of travelers, including only imposing the least restrictive measures necessary to protect public health.”

– Alexandra Phelan, SJD, LLM, LLB, is a faculty member of Georgetown’s Center for Global Health Science and Security and is an adjunct professor at Georgetown Law. Follow her on Twitter at @AlexandraPhelan.

On emergence of the virus in the U.S.:
“The emergence of new viruses is not an unexpected phenomenon. The global health community expects it and has put systems, governance structures and plans in place to address the emergence of just this type of virus. That being said, all public health is local, which means that local public health departments and clinicians will be following CDC guidance to be on the lookout for new cases, take recommended precautions and institute mitigation strategies. Vigilance is important, and the U.S. has extraordinarily talented and dedicated public health and health care professionals working to protect thepublic.”

– Rebecca Katz, PhD, MPH, is professor and director of the Center for Global Health Science and Security at Georgetown University. Follow her on Twitter at @RebeccaKatz5.

On obligations of WHO:
“WHO must work with China to beef up surveillance and contact investigations. Failure to do so will place the region and the world at great risk.

“Despite early reassurances from China, we now know there is human-to-human transmission, with potential ‘super-spreader’ events, which are key elements of an emerging epidemic. There are also vital facts we don’t know, such as the efficiency of human transmission and whether it is sustained, and the precise animal vector.

“The international community must prepare wisely. It is unlikely border screening will work, as it was shown to be ineffective during SARS and other outbreaks. The best way to prepare is through solid surveillance and contact tracing, public health education, and investing in vaccines and treatments. Governments must be honest and transparent, giving full cooperation to WHO.”

– Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law. Follow him on Twitter @LawrenceGostin.

On virus transmission:
“If the virus that has emerged in Wuhan City follows the same pattern as SARS, we could see a rapid uptick in the number of infected health workers, and exposures by ‘super-spreaders’ who have the potential to infect large numbers of people in the absence of prevention measures. China has shared the sequence of 2019-nCoV, which will aid development of diagnostic tests and interventions, and help experts predict how the virus is likely to behave.

“The most urgent question concerns the dynamics of virus transmission:  the first reported cases appear to have been transmitted directly to humans from (presumably) an infected animal, with human-to-human transmission to household contacts and health care workers following.”

– Julie Fischer, PhD, is director of Georgetown’s Elizabeth R. Griffin Program in the Center for Global Health Science and Security. Follow her on Twitter @Julie_E_Fischer.

General guidance for reducing spread:
“The medical and public health community are working rapidly to learn more about the virus. In addition, diagnostic tests are being developed and mobilized and efforts are just beginning, drawing on lessons from studies of other coronaviruses including SARS to develop and test potential candidate vaccines and therapies.

“While we wait to learn more about this virus and how it is spread, like other respiratory viruses such as flu, spread through contact with sick patients and their cough and other secretions is most likely. Wash hands frequently. If sick with cough or fever, cover your cough by coughing into you sleeve and stay away from work and public places. Also, while it won’t protect against this novel coronavirus, if you haven’t yet had this year’s flu shot, it’s not too late to reduce your risk of flu, which causes similar symptoms and could be confused with coronavirus. If you have traveled to affected areas and become sick, or have had contact with someone who has or is under investigation for coronavirus, let your health care provider know, but be aware the virus may spread rapidly to additional countries and locations. Many clinics prefer that, if possible, you call ahead if you have a respiratory illness so they can take steps to avoid the spread of infection in health care facilities.

“CDC’s guidance for health care providers includes the importance of heightened awareness at this time, obtaining travel histories from patients, and the use of rigorous infection control measures, including hand washing as well as use of gowns and appropriate respiratory protection when caring for suspect patients with lower respiratory infections.”

– Jesse Goodman, MD, MPH, professor of medicine and director, Center on Medical Product Access, Safety and Stewardship

To arrange an interview with any of the professors above, please contact Karen Teber at km463@georgetown.edu.