On Sunday, President Moon Jae-in put South Korea on Red Alert. Confirmed cases of novel coronavirus Covid-19 had surged thirteen-fold in a week, topping out at 736. The sudden swell means South Korea has the highest number of infections outside of China.
Meanwhile, some 50,000 citizens across the Veneto and Lombardy regions in Italy have been put on lockdown as authorities restrict traffic in and out of towns. Italy emerged over the weekend as one of the nations with the highest number of cases in the world: 157, the most outside of Asia.
With infection numbers ballooning worldwide, media is speculating that the World Health Organization (WHO) will declare the outbreak an official pandemic soon.
But instead of sticking to a strict vocabulary to define the outbreak, WHO is sending mixed signals: spokespeople say the agency no longer uses a ‘pandemic’ designation, while its leaders publicly speculate whether the outbreak has met ‘pandemic’ criteria yet.
The last pandemic
The last time the WHO declared a global pandemic was the outbreak of H1N1, otherwise known as swine flu, in 2009. At the time, swine flu had infected close to 30,000 people across 74 countries. As of Tuesday morning, for comparison, Covid-19 had infected over 79,000 people across 28 countries, with 2,069 cases reported outside of China.
Labelling H1N1 a pandemic was controversial, however. The WHO defined the term simply as a “worldwide spread of a new disease.” Critics later noted that WHO officials lowered the organization’s criteria for defining a pandemic shortly beforehand.
Previously, a viral outbreak’s mortality rate had to reach a certain level—in addition to contagion going international—for it to qualify for the pandemic label. Facing a lack of consensus on the proper definition of the word, the WHO appears to have done away with the word “pandemic” altogether, at least in its official terminology.
“The WHO does not use the old system of 6 phases—that ranged from phase 1 (no reports of animal influenza causing human infections) to phase 6 (a pandemic)—that some people may be familiar with from H1N1 in 2009,” a WHO spokesperson based in Manilla said in an email, adding that the WHO recognizes that the current situation has “outbreaks and clusters of cases in multiple countries.”
According to WHO director general Tedros Adhanom Ghebreyesus, who spoke during a press briefing on Monday, the “highest level of alarm” the WHO has on hand is to declare an outbreak a Public Health Emergency of International Concern (PHEIC). The WHO called the Covid-19 outbreak a PHEIC on January 30, but, confusingly, WHO officials—including Tedros—are still considering whether to use the word pandemic to describe the current situation.
“Our decision about whether to use the word ‘pandemic’ to describe an epidemic is based on an ongoing assessment of the geographical spread of the virus, the severity of disease it causes and the impact it has on the whole of society,” Tedros said. “Does this virus have pandemic potential? Absolutely. Are we there yet? From our assessment, not yet.”
What’s in a name?
Despite no longer implementing an official sliding scale of zero-to-pandemic, the WHO continued to issue guidance on pandemic influenza preparation as recently as 2018 and, in June last year, published a report on the preparedness of member states to cope with pandemic influenza. (Covid-19 is a coronavirus, not influenza, although its symptoms and transmission are similar.)
A second spokesperson for the WHO said the organization “may or may not use the word pandemic, but [doing so] does not trigger any extra action.”
At least that latter point is clear. Even the World Bank, which raised $320 million in funding for the Pandemic Emergency Financing Facility (PEF) through a bond sale in 2017, doesn’t need the WHO to declare a pandemic before paying out. The fund channels resources to affected economies if a series of stringent conditions are met.
To fulfill the World Bank’s criteria for a pandemic, an outbreak has to be 12 weeks old, have resulted in 250 deaths in its country of origin and at least 20 deaths in a second country. With over 2,500 deaths in China and reports of 50 deaths in Iran—which the Iranian government denies—it seems only a matter of time before the PEF is deployed. But many experts in the field already consider the Covid-19 outbreak pandemic.
“If we go by the definition of a pandemic—which means a virus has become epidemic in many different places—then yes, this is a pandemic,” said Eng Euong Ooi, a professor of emerging infectious diseases at Singapore’s Duke-NUS Medical School.
According to Ooi, the definition of an epidemic is the appearance of a number of cases in excess of what is typically expected. That creates a very low threshold because the number of typical cases for a novel disease such as Covid-19 is zero so, technically, the Covid-19 outbreak has been a pandemic for weeks already.
Whether the WHO calls the coronavirus outbreak a pandemic, however, is somewhat moot because the measures taken to prevent its spread and treat its infection remain the same no matter the label.
Ooi said: “It’s important to focus on the control measures, like finding a vaccine, rather than waiting for a word that can just trigger a lot of unnecessary panic.”
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