Pandemic Finally Declared, One Month Late
COMMENTARY: Fearing fear itself, the world’s top health official renders the term useless
The World Health Organization (WHO) today declared the global epidemic of coronavirus outbreaks a pandemic, something several health officials have expected for more than a month and which some say is long overdue. The thing is, there’s no agreement among global and national health officials over how to define the word or when to use it, and language from WHO’s director-general today suggests “pandemic” either needs to be seriously redefined or stricken from the viral-disease lexicon.
One infectious disease expert used the P-word exactly five weeks ago.
“To me, it appears we are currently in the early stages of a mild pandemic with cases in over two dozen countries and sustained human-to-human spread established by this virus,” Dr. Amesh Adalja, an infectious disease expert at the Center for Health Security at Johns Hopkins University, told me on Feb. 5.
Today I asked Adalja if the declaration came too late and if that had any impact on precautions taken.
“Most persons believed this to be a pandemic for some time and were taking the actions required for a pandemic response,” Adalja said. “I do think that diagnostic testing scale-up might have occurred quicker with less emphasis on travel history if a pandemic had been declared earlier.”
I also asked Adalja if the term “pandemic” needed redefining. “A pandemic refers to an infectious disease being present and spreading throughout the globe,” he said. “When that is present, there should be no controversy in declaring a pandemic.”
What happened in 5 weeks
By Feb. 5, 24,554 cases of COVID-19, the disease caused by the new coronavirus, had been confirmed, with 491 deaths, according to the WHO. All but 191 of those cases were in China. But the virus had already spread to at least 24 countries on multiple continents, including at least 11 cases in the United States.
Two days earlier, on Feb. 3, Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention (CDC), said this: “We are preparing as if this were the next pandemic.”
A day earlier, on Feb. 2, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease (NIAID), said the disease “almost certainly is going to be a pandemic.”
But until today, the World Health Organization repeatedly refrained from using the P-word. “What we see are epidemics in different parts of the world,” WHO director-general Dr. Tedros Adhanom Ghebreyesus said Feb. 24. On Feb 26 he added: “Using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralyzing systems. It may also signal that we can no longer contain the virus, which is not true. We are in a fight that can be won if we do the right things.”
Tedros appears to have been wrong about the degree to which governments around the world would react.
Aided by inaction, misinformation and super-spreaders who pass the disease along even when they don’t have symptoms, the deadly coronavirus has now infected more than 118,000 people in at least 100 countries, killing more than 4,200.
“WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,” Tedros said today. “We have therefore made the assessment that COVID-19 can be characterized as a pandemic.”
But… nothing changes?
Tedros went on today to describe the new designation as being hollow, however.
“Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus,” he said. “It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”
So what is a pandemic, what’s the word for, and when should it be used?
WHO’s own documentation defining pandemic is thin and arguably not very helpful. It reads: “A pandemic is the worldwide spread of a new disease.”
But according to the U.S. National Center for Biotechnology Information, the WHO has in the past laid out a clearer definition. In part, WHO has stated that a pandemic may be declared when human-to-human spread of a novel disease causes outbreaks in at least two countries that aren’t in the same region. (There are six regions, roughly equating to the Americas, Africa, the Middle East, Europe, Southeast Asia, and the Western Pacific, mainly Australia.)
By the justification Tedros laid out today, however, whether the term is used depends in part on whether governments are reacting sufficiently. In essence, he deployed it as a scare tactic — exactly what he said on Feb. 26 that he did not want to do.
Tedros was quick to defect blame today.
“WHO has been in full response mode since we were notified of the first cases,” he said. “And we have called every day for countries to take urgent and aggressive action. We have rung the alarm bell loud and clear.”
That is true. But perhaps embracing the word “pandemic,” actually defining it clearly for the public and for health officials, and using it earlier (maybe thereby instilling a little fear in governments and health officials around the world) would have been the responsible thing to do.
This commentary is based on facts, but the opinions belong to the writer and the two should not be confused.