In what is a rapidly evolving health crisis in Italy, Prime Minister Giuseppe Conte announced that the whole country would be placed on lockdown effective Tuesday, March 10. People would be allowed to travel for work or family emergencies, but sporting events and large gatherings would be prohibited. Police and the military will enforce the bans. Alarmingly, the number of cases has increased to 9,172, with the death toll now standing at 463. Within a 24-hour period, 97 people have died. Though the northern Lombardy region has been hit the hardest, all 20 Italian provinces now have cases.
Italy is now considered the worst-hit country after China, but all indications are that the epidemic is growing exponentially internationally. Global deaths have already surpassed 4,000, while more than 114,000 people have been infected. France, Spain, and Germany have confirmed more than 1,000 cases. Germany recently reported its first fatality. The United States has added 83 new cases, with 624 people infected in at least 34 states. Presently, 26 people have died. Those at highest risk of hospitalization and death are people over 60 with existing medical conditions.
At yesterday’s press briefing in Geneva, World Health Organization Director General Dr. Tedros Adhanom Ghebreyesus emphasized that the world has come close to losing effective control over the spread of the virus. However, he also voiced a note of optimism that its spread could still be stemmed. “The bottom line is that we are not at the mercy of the virus,” he stated. “The decision that we all make as governments, businesses, communities, families, and individuals can influence the trajectory of this outbreak globally.”
Highlighting their evaluation of China’s response to the outbreak over the last eight weeks, WHO reaffirmed its belief that the epidemic could still be contained if all countries implemented a comprehensive and blended strategy of containment and treatment. Out of 80,000 cases of Covid-19 in China, 58,600 people, or 70 percent, have recovered and been discharged.
The existing definition of recovery from Covid-19 has been established as two polymerase chain reaction (PCR)—a medical research process which allows scientists to amplify a very small sample of DNA in order to study it in detail—confirmed negative tests in 24 hours. In China, they are also utilizing clear lungs on a CT scan as a definitive clinical criterion. It is worth noting that under the heading of mild to moderate symptoms (expected in 80 percent of those that have become infected) this includes mild pneumonia and respiratory distress. Most people who recover may require up to six weeks to return to full health.
The WHO optimistically noted the fact that 93 percent of all cases have occurred in only four countries. Most affected countries have less than 10 people infected. Many countries, including Singapore, have been able, with government engagement, to retard or halt the further spread of the infection within their borders. WHO cited these achievements as evidence that the present epidemic can still be brought under control.
WHO has divided countries into four categories: those with no cases, sporadic cases, clusters, or evidence of community transmission. For the first three categories, it has recommended focusing on finding new cases through extensive testing, isolating those that are infected, and pursuing leads on contacts diligently. For the last group, WHO stressed that action must be focused at community levels to manage new clusters of cases. Additionally, more considerable containment efforts, including school closures, the cancellation of mass gatherings, and other social distancing efforts, must be implemented. China and South Korea have brought the epidemic under control through extensive testing and containment efforts and have been able to reduce the number of new infections drastically.
There are no clear-cut or concrete criteria by which a pandemic can be defined. The essential aspect of a pandemic is that its spread can no longer be controlled. The seasonal influenza is such a case, where it is not considered possible to prevent its spread so instead methods to minimize its impact are taken, such as vaccine programs, public health advice and supportive care.
Though the ability to control Covid-19 is still within reach, WHO emphasized a collaborative international response was essential. It also noted significant concerns that many nations that manufacture protective material had imposed restrictions on their exports. One of the WHO’s primary functions is the distribution of necessary medical supplies and protective equipment to various countries throughout the globe. It warned against hoarding, price gouging, or manipulation which undermine the ability of healthcare workers on the ground to get access to personal protective equipment.
Germany has banned the export of such gear to avoid supply shortages in its own country. Russia, Turkey, and France have implemented such restrictions as well. The US has also threatened to implement such measures and has asked domestic manufacturers to ratchet up production.
In an emotional but sober plea to reporters at the press briefing, WHO Director General Tedros said, “If anything is going to hurt the world, it’s moral decay. And not taking the deaths of elderly and senior citizens as a serious issue is one of the moral decays. Any individual, whatever their age, any human being, matters. It pains us to see, actually, in some places they want to move into mitigation because the virus kills seniors or older people only. That’s dangerous.
“Whether it kills a young person or an older person, or a senior citizen, every country has an obligation to save that person. That’s why we are saying no white flag. We don’t give up. At the end of the day, it’s a human life … we can’t say we care about millions if we don’t care about an individual person. For all countries, a comprehensive approach, a blended approach, an approach that can help contain this outbreak, is very important because the death rate from this outbreak is very high.”
On closing their press brief, WHO officials emphasized that a critical aspect of these efforts is the prevention of the spread of infection in healthcare facilities. Some 2,000 health care workers were infected in China. Most of them were exposed during the initial phase of the outbreak, when lack of information and protective equipment made their work dangerous. WHO also stressed that the sustained wearing of protective equipment can be psychologically stressful and contribute to the onset of exhaustion. Chinese health care workers had to work eight-hour shifts, for example, without being able to use the bathroom.
Michael Ryan, the head of WHO’s Health Emergencies Program, concluded, “The minimum we can give those frontline workers is the personal protective equipment, the training, and the management to help them manage their stress and fatigue. Most countries are moving to that. In the coming days and weeks, the real tragedy will be the moral hazard and dilemma health workers may face if they have Covid-19 patients in front of them who need help, and they don’t have the protective equipment to protect themselves.
“Would you like to be those healthcare workers? Would you like to be that doctor or nurse having to treat a patient, knowing full well that you are not protected? That’s an awful dilemma that no healthcare worker in the world should have to face. And that is the massive responsibility of governments at the national level and at an international level and to have the solidarity to fix that.”
