From the definition: A pandemic is an epidemic of disease that has spread across a large region; for instance multiple continents, or worldwide. We knew and saw that weeks ago.

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.

This really highlights the critical design flaw of the World Bank's Pandemic Emergency Financing Facility (funded by the pandemic bonds). By the time the conditions are triggered and funds distributed, it's already way too late into the pandemic. These fund should be made much earlier and more should be diverted into proactive measures to maximise effectiveness.

That's kind of the purpose, if its standards were too low, it would be triggerred too many times that we won't have any of it left to do anything honestly. The World Bank's Program is always suppose to be an emergency backup we hope never to use instead of substitute for a proper government planning in times of pandemic.

That is word for word copy/paste from Wikipedia, not the WHO. What is the criteria the WHO uses to determine a pandemic?

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country [Italy|Iran] in a different WHO region [Europe|Eastern Mediterranean] in addition to Phase 5 that is characterized by human-to-human spread of the virus into at least two countries [China & South Korea] in one WHO region [Western Pacific]. No threshold of cases or deaths triggers the community level definition and is left to discretion of the WHO.

So the WHO has done everything right. It is the hallmark of professionalism to follow rules even under pressure. And the WHo is under a tremendous amount of pressure right now.

I have had trouble finding one as well (the parent comment).

I found this article which claims The WHO's use of the term is arbitrary based upon the conditions at hand.

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.

As I said there is probably no official WHO definition or criteria due to big economic impact of such declaration and it is decided on a case by case basis.

EDIT: I was wrong, here is the chart: https://www.who.int/influenza/resources/documents/pandemic_p...

Yes, it is. Parent never asked for WHO definition in the first place, I wonder if there is any at all, probably a commercial secret. Pandemic in WHO definition is when Director General of WHO declares it a pandemic, probably after confirming with member states who contribute, they were criticized in 2009 for declaring too early too, so criteria might have changed.

For reference, WHO's pandemic definition is phase 6 in this 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.

This definition has too much room for subjectivity. It needs objective criteria. Or maybe WHO might need to have a numerical metric that says high large the impact of a virus or its associated disease is, just like the earthquake magnitude.

Yup; a month ago, they were saying it wouldn't be called a pandemic until it had (secondary) community transmission in a second country.

My reaction to this push alert today was "wait, they hadn't called it a pandemic yet??"

I believe India may even be of more concern than Africa. Of the two, India has the older aged population.

Wow, what is the source of this outrageous claim??

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.

Or more likely, the poor of Africa who live in close, unsanitary conditions will be hit incredibly hard because their healthcare system cannot cope

By and large improved health care won't affect population resistance all that much, it just improves survival rate. In an earlier time you would have been right, European germs caused more Native American deaths than Europeans themselves when they first colonized, but nowadays with global trade we all end up sharing the same diseases for the most part.

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.

First of all "there is still natural selection" in literally all life, so I think you're meaning something else. But to what your point actually is, do you have any source on that?

I know several people that would have not been able to reach adulthood 100 years ago but have now reproduced and have passed on their diseases to their offspring. There is no doubt that natural selection in humans is much weaker now then in the past.

That's not what natural selection means... medical innovations are still natural selection factors. It doesn't stop, we just naturally figure out how to get better at it.

This was a bit of a poorly-considered comment.

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.

I'm gussing that the downvotes are because of an implicit link to eugenics and racism.

those liking scifi: Asimov explored the idea in one of his novels. "Spacers" vs "Earthers" in the novel "The Caves of Steel"

This is uninformed speculation.

Why isn't Africa innately resistant to HIV then?

For H1N1 as far as I remember the pandemic designation happened far earlier and that was a joke of virus compared to covid-19 comparing the mortality rates.

Any successful containment measure will be later criticized as "too early" and/or "too aggressive".

Much, much better than the alternative.

H1N1 was serious and compared to this, well handled.

This is exactly right. Disease response can be very paradoxical.

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.

H1N1 was not successfully contained at all, it infected 15-20% of the world's population and ended up just being a bad flu strain, not a world ending pandemic as only 575k people died (for a mortality rate of around .05%)

>H1N1 was serious and compared to this, well handled.

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.

https://en.wikipedia.org/wiki/2009_flu_pandemic

Do you have citations for the “10X as fatal” comment? I am having a hard time understanding the situation because facts are hard to come by.

I edited my comment to remove the 10x claim. The fact is that the numbers are fluid right now and it's wrong to pull a figure out like that.

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 -

http://news.bbc.co.uk/1/hi/health/8406723.stm

> COVID-19 currently has a 3.4% case fatality ratio according to the WHO last week -

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.

“Princess Diamond” deaths are excluding people who died in their home countries that where infected on the cruse ship. They had 6 deaths as of February 28th and then excluded all future deaths and cases “cases found after disembarkation” from the total.

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.

Are these stats not accurate?

https://www.worldometers.info/coronavirus/#countries

They are saying 7 deaths and 32 critical.

I don’t know about the cruse ship, but it seems like it’s double counting a death in Australia on both the cruse ship and an Australian death. I would double check the totals.

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...

I really wish everyone was doing the random-sampling-of-general-population thing. Even if they could only do it on a fairly small scale, I suspect it'd give a much better picture of where we're really at than the "confirmed cases" floor.

“Likely to be revised downward”

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

In S. Korea the mortality rate is 0.77%. In China outside of the Hubei provence where things have gotten out of control the mortality rate is 0.88%.

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.

I’m afraid it’s very much 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)

Not sure what the demographics of S. Korea is, whether they have a younger population or not, but it's irrelevant.

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.

A couple of things I’m not sure are correct there though.

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).

It's been estimated to be between 2 and 3% for at least a month now.

https://en.wikipedia.org/wiki/Coronavirus_disease_2019#Epide...

The mortality rate is presently 6.01% and fluctuating, making this virus about twice as deadly as the Spanish Flu.

As this is being downvoted, the math I’m using is below.

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)

Those numbers aren't terribly useful since so many cases are mild or even asymptomatic. Most organizations are estimating 2-3% mortality, and are quick to point out that this is probably an overestimation due to the lack of testing in asymptomatic individuals.

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.

That Wiki link would serve as a citation.

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.

About 240x as fatal.

The mortality rate is presently 6.01% and fluctuating, making this virus about twice as deadly as the Spanish Flu.

You've claimed this three times already. Do you have a substantiating link? Furthermore, saying "six point oh one percent" instead of just "approximately six percent" gives a false air of precision that could not possibly hold -- even you admit the estimate is still in flux.

At the risk of compounding the problem of having posted this in several places, copying into this reply:

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)

NIH director quoted 10x as fatal today.

Data from the China CDC suggests 20x as fatal: https://www.businessinsider.com/coronavirus-compared-to-flu-...

go to /r/covid19 - it's one of the highest SNR about this clusterf* on the wide internet. plenty of CFR (case fatality ratio) estimation papers there.

Yeah, it's like we're trying to find the correct balance between nonchalance and action.

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.

Is there some guarantee that containment measures which are actually too early or too aggressive are "much, much better than the alternative?" It seems to me that such a claim is ignoring that there are actual costs to containment measures instead of actually comparing the costs of containment measures with the costs of delaying them.

What are you talking about? One billion people were infected by H1N1. It wasn't handled at all.

H1N1 mortality rate was 0.05% and that’s under rate of a standard flu season.

WHO had a good section in their situation report a few days ago comparing Covid-19 and the standard flu: https://www.who.int/docs/default-source/coronaviruse/situati...

No, it wasn’t. It had pretty much the same mortality rate as the normal flu.

What was the difference between the handling of this and H1N1?

H1N1 was declared a pandemic but was not handled at at all and a huge amount of people got it, but luckily it was a joke of virus with 2 orders of magnitude less deaths than covid-19.

Can you post exact numbers you are talking about?

Was it? Maybe my perception is skewed from being in one of the earliest countries hit, but my memory of H1N1 is that we pretty much gave up everything but vaccine development once we realized it was uncontainable.

H1N1 spread far faster and killed far more people: https://en.wikipedia.org/wiki/Influenza_A_virus_subtype_H1N1

The reason people are trying to downplay H1N1 is because they hate the flu comparison. People understand the risks and accepted deaths, from the flu. That bothers the doom and gloom folks.

I was telling someone the other day that H1N1 is seen as being not that big of a deal, and if another one or two pan out that way, then the next one after that will kill a lot of people because they start thinking that it was a 'cry wolf' sort of situation.

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.

The definitions of "outbreak", "epidemic", and "pandemic" have nothing to do with disease severity.

Sooner or later would an easily transmissible virus with both influenza and pneumonia characteristics arise.

A lot of people criticized the WHO exaggerated the danger of H1N1, which is partially why they were a lot careful about raising alarms this time.

Also, what's hard to remember is that we already had (or were very close) to a vaccine candidate for H1N1 by the time it was declared a pandemic in April 2009. Even before the U.S. declared a national state of emergency, more than 11M+ vaccine doses had been produced for the U.S alone: https://www.cdc.gov/h1n1flu/vaccination/updates/101609.htm

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.

Please don't do this here.

I believe I read somewhere that it had to be declared an epidemic on two continents for it to be called a pandemic.

I've heard they were counting off countries with cases. My wife told me the other day that she read that "4 more countries with coronavirus and WHO will call it pandemic".

That's ironic because the WHO supposedly doesn't use the category "pandemic" or 6-phases of pandemic anymore.

https://canoe.com/news/world/who-no-longer-uses-pandemic-cat...

The WHO themselves said that there is no longer an official criteria for something being a pandemic.

> Pandemic label was a response to objective criteria

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.

I don't understand what you think is to be saved by inciting panic. There's plenty of coverage, all this classification does is open up money from the IMF I believe. A Pandemic classification doesn't change most people's behaviors, but it does cause toilet paper/hand sanitizer shortages.

At least in the US, companies and other organizations are hesitant to be the first ones to stick their necks out and cancel events/encourage remote work. Our federal government's incompetent/evasive/opaque response to the crisis has let the burden fall on local governments in the hardest-hit areas.

Labeling this a pandemic would have given cover to organizations that wanted to be more cautious but were afraid of "looking stupid".

Months ago? The first cases were identified in Hubei on 29 December. The first cases of COVID-19 outside of China were identified on January 13 in Thailand and on January 16 in Japan.