In particular, one of those factors was sustained duration of the outbreak. My understanding is we finally crossed the time threshold for declaring this a Pandemic.
Declaration of official pandemic means world bank pandemic relief fund program gets activated as long as many other clauses in different contracts and agreements. There is an influence on WHO and the people behind it didn't want pandemic to be declared too soon. If it was declared 3-4 weeks earlier there could be many lives saved in countries like Iran, what is happening in Africa is not known at all due to no testing but situation is probably bad.
https://www.theverge.com/2020/3/11/21156325/coronavirus-pand...
I suspect The WHO declared this a pandemic, based upon the article, out of concern for what they perceive to be insufficient government activity.
EDIT: I was wrong, here is the chart: https://www.who.int/influenza/resources/documents/pandemic_p...
that is, sustained community outbreaks in multiple WHO regions.
For someone like the WHO, you'll either be criticized for sounding the alarm for no reason or not sounding it fast enough.
My reaction to this push alert today was "wait, they hadn't called it a pandemic yet??"
If anything, African states are going to be hit the hardest. South Africa for example, a country I am in, has the world's highest HIV cases. Pneumonia is a death sentence for HIV patients. Also, our infrastructure to manage a spike in infected arriving at state hospitals is abysmal. Right now, we sit with 7 infected (officially) but these are all index based with vectors from recent visits to Italy. If this changes to non-index based vectors, and this disease spreads to the townships, we are done for. If anything, COVID-19 is likely going to hammer Africa the hardest.
Sedentary lifestyles enabled by modern lifestyles as opposed to a hunter-gatherer lifestyle can contribute to decreased overall health but thats not the issue here since almost nobody is a hunter-gatherer anymore.
When it comes to new viruses, all of us are in the same boat immunity-wise.
To take you at your intent, all humans will be exposed to this virus with more or less the same chances of suffering. I imagine there may be pockets of resistance within certain gene pools, but it's a crap-shoot who and where.
those liking scifi: Asimov explored the idea in one of his novels. "Spacers" vs "Earthers" in the novel "The Caves of Steel"
Why isn't Africa innately resistant to HIV then?
Much, much better than the alternative.
H1N1 was serious and compared to this, well handled.
An extreme and early response, can turn a disease into a trivial event. Which raises questions about whether such an aggressive response is necessary.
It can be, in many ways, like using an umbrella in a rainstorm. You get to the destination, and you're totally dry, so what was the point of the umbrella?
With these disease outbreaks, there's no counterfactual we can run to see what would have happened if we didn't respond early.
The current COVID-19 epidemic caused by SARS-CoV-2 is many times more fatal than the 2009 H1N1 epidemic. The current epidemic has similar a fatality rate to the 1918 Spanish Flu.
COVID-19 currently has a 3.4% case fatality ratio according to the WHO last week -
https://www.who.int/dg/speeches/detail/who-director-general-...
But this is in the middle of the pandemic and is likely to be revised downward as many cases are undiagnosed.
The 2009 H1N1 outbreak had a inital case fatality ratio of 0.4%, but revised downwards to 0.026% afterwards due to new evidence of more spread than thought -
This number will likely go down to below 1% because:
- S. Korea have implemented large scale tests on asymptomatic cases and their death rate is 0.77%
- the "Princess Diamond" cruise, which can be considered a closed experiment, has had a 1% death rate for people that were not ventilated
- in China if you exclude the Hubei province, the mortality rate is 0.88%
In Italy the mortality rate is 6% but the explanation is quite simple — they stopped testing asymptomatic cases, even people with fever are sent home without a test and instructed to return in case the fever doesn't go away in a few days and they are overwhelmed. At this point they are only admitting people that have trouble breathing.
And northern Italy has really good hospitals, so the only reasonable explanation for the huge disparity is that they have more than 10 times the reported total cases.
In other words, the virus has infected many more people than official numbers.
Remember that those "total cases" are cases that have been discovered via tests, it does not include people that stayed at home and weren't tested, either because the symptoms were too mild or because they were sent home.
Edit: A Hong Kong national from the ship died on 6 March which is being included as the 7th death. So, this may simply be fragmented rather than explicit exclusions.
https://www.worldometers.info/coronavirus/#countries
They are saying 7 deaths and 32 critical.
As far as I can tell Australia has 3 deaths including 1 from the cruse ship. https://www.abc.net.au/news/2020-03-08/coronavirus-related-d...
This is the most dangerous misinformation I’ve heard spread about this disease, and it’s getting repeated everywhere.
There is no mountain of undiagnosed asymptomatic cases. It doesn’t exist.
WHO has looked. China has looked. South Korea has looked.
It’s not there. The mortality rate is presently 6.01% and fluctuating, making this virus about twice as deadly as the Spanish Flu
People in Italy are only admitted in hospitals if they have difficulty breathing by themselves. People that only have a fever or other mild symptoms are sent home, with no test administered. When the outbreak started they were testing asymptomatic cases, trying to be proactive in identifying infected people, but they stopped doing that once things have gotten out of control. And we will see this pattern repeating.
What's dangerous is spreading nonsense like a 6% death rate, which is factually not true.
South Korea have a lot of early stage cases in those numbers (haven’t died, haven’t recovered), and a very young population on the whole. An undetermined number of those cases will die rather than recover.
Multiple sources have looked for these large majorities of asymptomatic cases and did not find them. There is no evidence other than our collective hunches that these cases exist in significant numbers.
Taking Johns Hopkins numbers (at time of me writing this):
125,108 confirmed cases 4594 deaths 66,682 recoveries 71,276 outcomes
4,594 / 71,276 = 6.45% have died (deaths / outcomes)
At least 80%-85% of all Covid-2019 cases have mild symptoms. We are not talking about completely asymptomatic cases, we are talking about a majority of cases that could pass for a mere cold or flu.
Many of those will not go to a hospital or be tested, especially if the system is overwhelmed.
Italy could easily have more than 10 times the number of reported cases because they stopped testing proactively. Only people with difficulty breathing are now tested and these represent a small minority of cases.
I gave S.Korea as an example because AFAIK they are the only ones doing large scale testing of the population and they aren't China (whom we may or may not trust to be transparent).
The data we have points to a mortality rate that's less than 1%.
When you see a mortally greater than that it is because people aren't tested unless they reach the ICU.
The 80-85% mild cases comes from confirmed cases that we know about. They’re included in the current 6.45% death rate from the JH data.
China may or may not be transparent, but if they have an incentive to hide anything, it would be a higher death rate rather than a lower one.
The data is the data. In any case it’s now global and the 6.45% is actually higher than it was before the virus started growing exponentially outside of China (it was 5.7% from this dataset then).
https://en.wikipedia.org/wiki/Coronavirus_disease_2019#Epide...
Taking Johns Hopkins numbers (at time of me writing this): 125,108 confirmed cases 4594 deaths 66,682 recoveries 71,276 outcomes 4,594 / 71,276 = 6.45% have died (deaths / outcomes)
Basically we are counting every case severe enough to cause death, but only some of the cases that aren't very severe, and that latter group is already a much bigger piece of the pie even among confirmed cases.
The table in the "comparisons to other pandemics and epidemics" section gives a point estimate for the case fatality rate of 0.03%. If we assume that the final rate for covid-19 is somewhere in the 1-2% range that's what I last heard, that would mean that "10X as fatal" is an understatement - more like 30-70x as fatal.
The mortality rate is presently 6.01% and fluctuating, making this virus about twice as deadly as the Spanish Flu.
Taking Johns Hopkins numbers (at time of me writing this):
125,108 confirmed cases 4594 deaths 66,682 recoveries 71,276 outcomes 4,594 / 71,276 = 6.45% have died (deaths / outcomes)
Data from the China CDC suggests 20x as fatal: https://www.businessinsider.com/coronavirus-compared-to-flu-...
I for one lean towards nipping things in the bud and have been experiencing ever-increasing anxiety since I started watching Covid-19 in late January.
Look at the situation with vaccines. Your grandparents getting vaccines was a no-brainer. They heard stories of people getting polio or the measles and it was serious shit. Three generations later we have conspiracy theories about vaccines, I think because so few iminently deadly diseases have gotten a vaccine lately. We are down to the tricky ones, and cultural memory of the others is starting to crack.
AFAIK, scientists are still trying to develop a covid-19 vaccine candidate. And after they have one, there will be many months before millions of doses can be produced and distributed.
https://canoe.com/news/world/who-no-longer-uses-pandemic-cat...
Modeling the causal impact of their criteria in light of data from the COVID-19 pandemic could reveal how different messaging strategies applied at different thresholds impact the spread of the virus.
The leadership could have done this months ago and estimated how proactive versus inactive quarantine efforts would impact morbidity. They have to know their role in persuading the public and government officials.
You don't have to stick to a rigid and inflexible criteria when thousands of human lives are at stake. When you define the criteria, you can also change them.
Labeling this a pandemic would have given cover to organizations that wanted to be more cautious but were afraid of "looking stupid".
Other than their censorship in China (they give different advice on their website served to China, even on English-language pages, involving the effectiveness of traditional Chinese medicine against the virus), I think they're doing a mostly okay job so far, from what I can see in the current reporting.
1) There are no objective criteria for calling something a pandemic.
2) They did not feel they knew enough about the propagation pattern to make the subjective call.
3) They were deeply worried that calling it a pandemic would switch government strategies from containment to mitigation, resulting in higher contagion and loss of life.
They especially emphasized the last point. The only question in my mind is whether (1) they decided containment was no longer viable or (2) they decided not calling it pandemic would be seen as unserious, even if containment could still potentially have benefits.
Source: https://youtu.be/OJQTM4QbTsg
Whether the WHO uses the term "pandemic" is honestly just semantics. You should direct the majority of your criticism at short-sighted governments who have prioritized the economy (or, even worse, markets) over health.
It was incumbent on local authorities to take the WHO's message seriously, especially after their expedition to China released its report.
It's akin to people not caring about a major hurricane barreling towards them because they've heard the doomsday scenarios before and nothing has happened.
They have to be careful, and that they were.
... why?
I mean, it's not like the word of the WHO is a binding thing, where anyone is mandated to take action on any level because of a binary designation in a taxonomy. This whole this is just bureaucratic wheels turning; everyone who needs to take action has all the information they need to do so.
This is just the WHO doing what it does best -- having committees meeting endlessly to decide whether to apply a certain meaningless designation and then announcing the conclusion of that exercise.
Their actual job, of collating and disseminating information and trying to coordinate any large-scale responses, is actually hard, so nobody wants to do it, but having a meeting to decide IS IT A PANDEMIC is an easy bikeshedding meeting that all the MBAs and ex-McKinsey people can attend and offer their stupid opinion on what the definition of a word is.
EDIT: I said "everyone who needs to take action has all the information they need to do so", and that could be interpreted as saying that we know enough to determine what actions to take. But what I mean is that we have enough data to start to make a range of predictions and bound the uncertainty to some degree; having a more precise metric for any aspect of COVID-19 should not affect the response since those metrics are essentially made up and not comparable even on a per-hospital level, much less a per-country level or even a per-test-kit-type level. Uncertainty is part of the game here, and understanding the risk profiles is how people and organizations and governments have to tune their response.
And leaving aside the immediate difficulties...let's save this kind of retrospective criticism for after, when we're closer to being out of the woods.
If you have prospective criticism -- what should be done now and going forwards -- that would be worthwhile.
Here is a neat video that helps put things in perspective for most any viewer. https://youtu.be/Kas0tIxDvrg
It already looked pretty bad mid/late January when China started construction of hospitals. Were there any reasons to think it would no go global?
Wouldn't it be better if the WHO actually helped prevent the pandemic in the first place?
WHO is merely declaring matter of fact about the virus's spreading. Which is kind of it's primary function, to declare things and publish reports so the governments can act on them. They can't really do much beyond that.
Thanks for clarifying, I thought the WHO was more like a global CDC.
There's no particular reason to assume it would take the same path in other countries took some sort of action, even if the actions weren't nearly as forceful as a complete lockdown. Especially since that lockdown was basically a blind and desperate shot in the dark based on incomplete and dubious information.
So: no, there was no objective reason to think it would not go global, but it was faaaar away...
I believe the pandemic label is when containment has failed and governments need to go into mitigation mode. Seeing as it had been relatively contained in China, South Korea, Singapore, Hong Kong, Taiwan, etc., it seemed reasonable that taking measures would be sufficient to prevent further escalation.
[1]https://www.who.int/csr/disease/swineflu/frequently_asked_qu...
Perhaps the 'doomsday clock' was right all along but didn't see this one coming.
The only mass media where I've seen that was in a BBC television report from a soccer stadium, and that was only last night.
No; what we call the flu is caused by the influenza virus. What we call the common cold is sometimes caused by a coronavirus (about 25% of cases). And while actual mortality rates are unclear, even the most optimistic figures (South Korea, for instance), are far more than 200% normal seasonal flu rates.
I know the South Korean government took that exact position because of their pro-China stance. They tried really hard to downplay the dangers of the virus simply because of its Wuhan origins. knowing that the Trump administration is on the other side of the fence regarding China, what do they have to gain by dismissing the situation?
They genuinely believe that it's a non-issue. That it will go away and that it's simply a trivial virus that isn't worth worrying about.
Asymptomatic cases are extremely rare, if they infects multiple others, they will likely be identified through retrospection. Overall, I'd say those cases are unlikely to result in significant difference in the estimate.
This is likely exacerbated by many countries not having ready access to flu vaccines and/or proper hospitalization for those that need it.
Compare this to America-specific numbers, where 34,000,000 – 49,000,000 Americans catch a flu-related illness each year, yet only 20,000 – 52,000 result in death [2].
[1] https://www.cdc.gov/media/releases/2017/p1213-flu-death-esti...
[2] https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...
So, 1.3-1.9 million US deaths.
Do you expect politicians to actually think? Especially when they can point at the "fakenews WHO." (I don't know how Trump would actually say it but you get the picture.)
If the WHO declares a pandemic early, they _do_ save lives. But they take the political beating because "nothing happened."
If the WHO declares a pandemic late, they don't save lives. They take a mild wrist slap because "they were late to declare it," which will not be remembered in about a month.
Sure, those classic alt-right propaganda outlets like the Today show.
Are you sure you've been paying attention longer than a week or two? The virus was being downplayed all of January and February by the media and other people not named Trump as "not a big deal" because "the common flu kills way more people."
That's not been my impression at all. But then, I don't live in the US. Maybe it's an American media thing?
Because this "skill" has been honed from a lifetime of obsession with media, he's exceptionally good at bypassing anything resembling rational thought, and hitting emotional triggers, resulting in otherwise intelligent people engaging with Frankfurtian Bullshit even when they should know better (opponents and supporters alike).
Many people in this country still absolutely listen to him, and trust him more than the media when the messaging conflicts.
Sadly, in this case it puts the people who put the most faith in him at even more risk.
The president has been visibly out-of-step with the rest of the federal government messaging on this. One voice, no matter the position, doesn't evaporate what the hundreds of others have been saying.
The President has been accusing the "Bureaucrats" of not caring about average Americans, fear-mongering the virus, and claims the Deep State is after him.
The President's followers do NOT believe the government experts. As per the sitting President's plan. The sitting President has cultivated an "Us lay people vs Them bureaucrats" atmosphere.
Case in point: My own Mother believes that the Coronavirus is a Chinese conspiracy to attack the President. And nothing I say could sway her opinion. Unfortunately, the voters of the President support, and believe in him more than even family.
What, and let someone else “hog” the attention and the spotlight? I’ve been reading about 45 since the 80s (most of the time, not by choice). “All eyes on me” seems to be far more important to the sitting president than “do the right thing”. I’m not saying “do <what he thinks is> the right thing” isn’t on the list, it’s just way down that list.
Because he judges how well he does his job on the performance of the stock market. He speaks to sooth the jitters of Wall Street.
It's not unique to the current administration. Most presidents have done this. It was even a recurring theme in the TV series West Wing.
I couldn’t imagine any of the presidents of the last decades to stand up and openly contradict his experts on something like this. Maybe behind the scenes but not in the open. He doesn’t seem to understand that he can only lose doing this.
Read my comment again. I didn't say that being contradictory was common. I said judging performance by the stock market is common.
I've heard "just the flu bro" a bunch and people still operating business as usual in spite of large events being cancelled.
Other obstacles to perceiving it as a big deal:
- Not grasping that a fraction of a percent mortality can be a big deal. Numbers under one percent make it sound indistinguishable from flu, even if it's 10x as deadly as flu.
- Having AIDS and Ebola as your mental prototypes for dangerous infectious diseases and feeling relieved when you hear COVID-19 is nothing like either one.
We truly must be living in different universes.
> So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!
https://twitter.com/realDonaldTrump/status/12370273563148697...
The top performing story on Facebook right now is a Fox News piece highlighting the President downplaying it:
https://twitter.com/JuddLegum/status/1237092136958545923
Basically the entire GOP leadership structure has decided that people are only worrying as much as they are to damage Trump politically. Essentially the only top level official giving the straight story is Dr. Fauci and he's immediately contradicted by others in the cabinet who seemed to be completely preoccupied with the stock market and the election.
I'm in WA state, where until last week testing wasn't being conducted on anyone that wasn't traveling from a level 3 country or in contact with a known infected person, EVEN IF THE WOULD-BE TESTEE WAS SHOWING SYMPTOMS. We keep talking about the count of infected (and relying on it to decide who to test) but it's unarguably low if we've not been testing, particularly as we apparently have introductions via Europe as well as China, plus community transmission.
Trump just a few days ago said that everyone who wants to be tested can get tested. According to the doctor's offices, that's still false.
Trump himself has a NUMBER of downplaying statements. So many I won't bother to list them. But lots of statements along the lines of "just the flu", among others.
> there's been an overabundance of information and caution
Hard to judge "overabundance" (see other article about how everything with a pandemic is premature until it is too late)
Today's headlines: "The White House has ordered federal health officials to treat top-level coronavirus meetings as classified, an unusual step that has restricted information and hampered the U.S. government’s response to the contagion, according to four Trump administration officials."
Note this prevents any expert who doesn't have clearance from attending.
A few days ago: "US health officials wanted to recommend that elderly Americans avoid flying amid the coronavirus crisis. The White House overruled them"
The president tweeted this 2 days ago [1]:
> So last year 37,000 Americans died from the common Flu. It averages between 27,000 and 70,000 per year. Nothing is shut down, life & the economy go on. At this moment there are 546 confirmed cases of CoronaVirus, with 22 deaths. Think about that!
This is what the Surgeon General said on Sunday [2]:
> "If we had massive numbers of cases we would be seeing more deaths. And so we actually feel pretty good that some parts of the country have contained it just like when you look at the flu," Adams said on CNN's "State of the Union" Sunday. "When we look at the flu tracker, some parts of the country are having much more severe flu seasons. Some are having very mild flu seasons. The same thing for coronavirus."
[0] https://www.c-span.org/video/?469747-1/president-trump-annou...
[1] https://abcnews.go.com/Politics/stocks-dive-coronavirus-spre...
[2] https://abcnews.go.com/Politics/stocks-dive-coronavirus-spre...
But even with the research on pandemic readiness showing that neither capacity nor governance has been up to the task people are still pretending it's just a political choice and the results will be fine. If I remember correctly it as CSIS thing: https://healthsecurity.csis.org/final-report/
If you are otherwise healthy, this is like getting a cold with a fever for a week, then feeling better.
Sure, call it a pandemic, because it is worldwide. But honestly it's just not that remarkable. This isn't some godly virus with 25% death rates!
The trouble is that (1) the people who need hospital to be fine need hospital. They won't be fine if it isn't there, and (2) by being a selfish ass and treating it like just the flu, when it's a disease that grows exponentially in a no-immunity population, people are amplifying the speed and height of the peak, which means not enough hospital places.
If you get a situation where effectively nobody who needs hospital can get it - then those 20-ish percent just drop dead. And then there's your godly death rate.
2% of those infected with influenza (estimated, 4% of those who sought medical intervention) in 2017-2018 required hospitalization.
That's part of the problem; even if it was "just like the flu" (it is not; in particular the percentage of cases requiring advanced medical treatment is much higher, which will lead to a rise in mortality as that treatment is oversubscribed), the flu would be pretty scary if the annual vaccine didn't exist.
The flu is actually quite scary - they are the frog in hot water.
This is a new thing and you should treat it as a new thing. There has not in living memory been one this bad, against which we had no defense except to avoid catching it and spreading it.
Unless there's information that's not making it out of Italy, the death statistics reported today don't seem to align with the picture painted by those tweets.
It is remarkable in that it is novel, but that's mostly it.
Please educate yourself: https://www.flattenthecurve.com/
Which is that entire communities can be infected in a very short amount of time, overwhelming local medical infrastructure and resulting in deaths and harm because the doctors simply can't keep up. What was originally something that could be treated then becomes life threatening.
Please also note that many people who require intensive care but survive are left with huge chronic damage to their lungs that will affect their quality of life for the rest of their lives.
“Earlier in the epidemic, there was hope that 3.5 percent was grossly overestimated, however as evidence continues to emerge, there is dwindling support for that hope.”
[1] https://www.ecodibergamo.it/stories/bergamo-citta/evitiamo-i... (Italian)
[2] https://en.wikipedia.org/wiki/List_of_countries_by_median_ag...
The messaging from the media (who are laypersons) and the politicians (who are economically motivated laypersons) has been that this is "just the flu". Weak messaging from both the WHO and the CDC has only reinforced this in the public's perception.
The WHO should have taken the decisive move to encourage greater caution by employing the "pandemic" label. That label comes with real power. While there is danger in crying wolf, it was evident months ago from the growth rate of the virus and the lack of quarantine procedures being put in place that this virus would reach the pandemic stage.
If the role of the WHO is to stave off pandemics and not just to monitor them, then elevating the risk profile of the virus should have been a top priority. Since people look to the WHO for guidance, their actions have direct impact to sequestration and bringing the outbreak under control.
Both the WHO and the CDC were too afraid to take early action. Their wait and see approach will ultimately result in more human deaths and suffering.