“We have to do everything we can to prepare for a potential pandemic.” The CEO of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, assumed this Monday that it is probable that what is today an epidemic of Covid-19, caused by the Wuhan coronavirus, become something greater. “We cannot paralyze the world and it is not realistic to say that transmission between countries can be stopped. There will probably be epidemics in several, but they can be contained,” added Michael Ryan, director of the international organization’s emergency program.
The scene has changed rapidly in a few days. It has gone from contemplating how cases in China seemed to be contained and how in the rest of the world infections were extremely rare to uncontrolled outbreaks in Italy, South Korea and Iran. Ghebreyesus has insisted that they can be contained and that the scenario continues to be one of epidemic, both in terms of number of cases and deaths outside, but at the same time has asked countries and communities to prepare for the spread of the coronavirus: “No it is a matter of black and white, yes or no. Each country has to make its own risk containment plan. The priorities are to protect health workers, that communities mobilize to take special care of the elderly and with pathologies [entre ellas se han producido más del 80% de los fallecimientos hasta ahora] and protect the most vulnerable countries by containing the epidemic where they can. “
The situation that opens up is a pure unknown and every minute counts. The simple fact of being able to delay the arrival to the northern countries for a few weeks can be a great relief, said Ryan, since the seasonal flu will be declining and health systems will be more freed from this burden to be able to care for possible patients with Covid-19. “We cannot know what is going to happen, if it is going to be stopped, to become a seasonal disease or a full-blown global pandemic,” he added.
Whether or not it is a pandemic is more of a semantic debate. Declaring it or not is the consequence that it affects a good number of countries, that the majority of humanity is potentially exposed to the virus, something that is not happening at the moment. Not even the WHO experts themselves are clear when this term could be spoken of. “When there are flu pandemics, we know how the virus behaves, how many people it has affected in other years, its transmission pattern … In the case of Covid-19 we don’t know anything about this. In China, for example, we see a significant drop in infections, which goes against the very logic of a pandemic, but at the same time it is growing in Korea. On the other hand, we see that there are countries that are successful in containing it, “said Ryan. We speak of a pandemic, for example, to refer to HIV, a disease that, although only a small percentage of the population suffers from it, is present practically in every corner of the world: there is no country where risk does not exist.
And although health authorities have insisted that the pandemic scenario can still be avoided, the message is that you have to be prepared. What does this mean? Act as if it were just around the corner, that health systems around the world are ready to detect cases, to follow the trail of people with symptoms, to take containment measures that prevent the spread of the disease.
In the almost daily appearance that the top officials of the WHO offer the media to report on the latest details of the virus, they have also explained the results of the expedition of experts who have been in Wuhan, the epicenter of the outbreak. The good news is that the situation there has not gotten out of hand. The genetic sequence of coronavirus remains stable, the recovery time ranges from two weeks for the mildest patients to between three and six weeks for the most severe. The percentage of deaths is currently between 2% and 4% in Wuhan and around 0.7% outside.
This has several explanations. Fernando Simón gave them a few days ago, director of the Center for Coordination of Health Alerts and Emergencies of the Ministry of Health: “When a health system is saturated, as has happened in Wuhan, it is normal that health services are not sufficient and there may be higher mortality. In addition, at the beginning of an epidemic with an unknown pathogen, the first cases that are detected are serious and it is not clear how to treat them. In the rest of the world there are much fewer infections, much greater attention can be paid to each one, they are treated much earlier, since they are detected earlier and they go to the doctor sooner, which reduces mortality ”.
Experts insist on remembering the novelty of the virus and the uncertainties that this opens up. Until practically a month and a half ago the pathogen was unknown. From there he began a race against the clock to decipher its mechanisms of action, its contagion capacity, its lethality. And the information is in continuous progress. Although at first it was thought that it could not be transmitted between humans, it was soon discovered that this was not so. Now it is crucial to unravel to what extent asymptomatic people can transmit the disease; recent studies have shown that around 20% do so, which tremendously complicates prevention. Also the incubation periods, which although in most cases do not exceed 14 days, they have sometimes exceeded them.
And if it is early to draw conclusions about the coronavirus and all that it may imply in China itself, it is much more so in the countries where it has just begun to spread. “In each country the dynamics are different,” said Ryan. The expert points out that while in China It has been seen that most of the infections occurred between relatives, in Korea they have occurred in religious gatherings, something that may also be happening in Iran. The WHO has sent a team there to study the situation, which will arrive on Tuesday. This Monday he will land in Italy.