Earlier this week, the World Health Organisation (WHO) announced that countries should be “in a phase of preparedness,” highlighting that it was still too early to call the COVID-19 outbreak a pandemic. Head of WHO’s health emergencies programme, Mike Ryan, added that now is the time to “do everything you would do to prepare for a pandemic.” As of 28 February 2020, there have been 78,959 reported cases of COVID-19 in China, 2791 of which resulted in deaths. Beyond China, there have been 4351 cases in 49 countries, and 67 deaths, with Denmark, Estonia, Lithuania, Netherlands, and Nigeria reporting their first cases as of Thursday, 27 February. These cases were described as having links to Italy, where 24 cases have been exported from the country to 14 others – the most recent being Luxembourg. Similarly, 97 cases have been exported to 11 countries from Iran, whose number of new coronavirus cases appear to increase daily, as with South Korea and Italy.

Though Dr Tedros Adhanom Ghebreyesus, WHO Director-General, acknowledged that the “continued increase in the number of cases, and the number of affected countries over the last few days, are clearly of concern,” he continued that “for the moment we are not witnessing the uncontained global spread of this virus [nor…] large scale severe disease or deaths.” The conclusion of the WHO’s Joint Mission with China, which brought 25 national and international experts from the WHO, China, Germany, Japan, Korea, Nigeria, Russia, Singapore, and the United States of America, expressed that “most cases [of COVID-19] can still be traced to known contacts or clusters of cases”. “As long as that’s the case,” added Dr Ghebreyesus, “we still have a chance of containing the virus, if robust action is taken to detect cases early, isolate and care for patients and trace contacts”.

Since the confirmed detection of the virus on 30 December 2019, where three bronchoalveolar lavage samples taken from a patient with pneumonia of unknown etiology in Wuhan Jinyitan Hospital tested positive for “pan-Betacoronavirus” (WHO), the Central Committee and the State Council in Wuhan launched a national emergency response, spending over $800 million, deploying thousands of medical staff, and building two field hospitals. Alongside categorising it as a Class B infectious disease on 20 January, indicating a shift from an “initial partial control approach to the comprehensive adoption of various control measures in accordance with the law” (WHO), President Xi Jinping deployed prevention and control work, requesting it be the top priority of the government at all levels. From this, a Central Leadership for Epidemic Response and the Joint Prevention and Control Mechanism of the State Council were established, prompting a national approach which strongly promoted “universal temperature monitoring, masking, and hand washing” which soon evolved to a “science and risk-based approach” (WHO) to better respond to the situation. This adaptability was further seen in the tailoring of containment measures to the “provincial, country and even community context, the capacity of the setting, and the nature of novel coronavirus transmission there” (WHO).

China’s approach was applauded by the WHO, saying, “In the face of a previously unknown virus, China has rolled out perhaps the most ambitious, agile and aggressive disease containment effort in history”. Yet Chinese officials, including President Xi Jinping himself, have come under fire over claims that they had earlier downplayed reports of when the virus was discovered. As seen in an earlier article, a study conducted by Imperial College researchers estimated an additional 1,659 people were infected by the virus by mid-January as compared to official Chinese records, bringing in to question the transparency of the Chinese government. This tension could be earlier seen with the death of Li Wenliang, a doctor from the Wuhan Central Hospital, on 7 February. Li Wenliang, who had initially raised alarm about a SARS-like virus early in December 2019 was accused of spreading rumours at the time the government was believed to be downplaying the severity of the outbreak.

Further, the “aggressive containment” of the disease should be looked at critically as it had and continues to entail strict travel restrictions. Though this has been, in many ways, responsible for the reduction in newly reported cases of the virus in China, as 2478 cases at the beginning of February decreased to 409 two weeks later, it has also resulted in widespread discrimination or “anti-Hubeiness,” making it difficult for many to remain or become employed. The use of financial incentives, with the local government of Shijiazhuang, for instance, promising its citizens up to RMB2,000 (US$290) for reporting anyone returning from a visit to Wuhan, can be especially worrisome. With this, the WHO’s support of the Chinese government’s methods must be further assessed as they were quoted saying, “China’s exceptional coverage with and adherence to these containment measures has only been possible due to the deep commitment of the Chinese people to collective action in the face of this common threat”.

These methods, however, are not limited to China. Recently Italy and South Korea, where the daily rate of newly confirmed cases are particularly high, announced their own travel restrictions. In Lombardy and Veneto, a lockdown is in place as 50,000 residents will not be able to leave without special permission. Similarly, around 7,7000 troops have been quarantined in South Korea after 11 military members were infected. Due to this, travellers from Italy and South Korea now face additional screening, particularly in the U.S., where travellers from Iran are being denied entry into the country. It is clear then, that not only are airlines scaling back their services, but borders are being closed. One instance of this is in Azerbaijan, who on Saturday, 29 February, announced that it would close its shared border with Iran for two weeks. This comes amid the spread of the virus to Iraq, Afghanistan, Kuwait, Oman, and Bahrain, leaving Saudi Arabia as the only Gulf State to not have reported any coronavirus cases.

As institutions, industries, and services seek temporary closure, economies should expect to be impacted. According to Standard Chartered, up to 42% of China’s economy could be affected due to the lockdown. With China being called the “factory of the world,” the outbreak has interrupted the supply chain sourcing, according to Reuben Mondejar, professor for Asian Initiatives at the IESE Business School. Analysts looking at Italy’s economy warns of a fourth recession in 12 years due to businesses coming to a standstill in the face of the outbreak. The global airline industry could potentially lose $29 billion, as noted by the International Air Transportation Association (IATA).

Yet, “the world is ill-prepared for another influenza pandemic,” as said by Victor Dzau, president of the National Academy of Medicine. He looked to the 2014-2016 Ebola outbreak in West Africa as a point of reference, suggesting that though the “epidemic was contained…the costs in human lives and in economic and social disruption were significant with more than 11,000 deaths”. Though the situation is different, with the WHO saying COVID-19 cannot be compared to “well-known pathogens,” Dzau brings to light the many aspects of an outbreak that need to be considered beyond containment. For peace to be achieved, one must look at the health, societal, and economic dimensions and potential consequences of the virus. Progress has been made since previous outbreaks, however, have been made. Since then several institutions and organisations, such as the UN High-Level Panel on the Global Response to Health Crises, have produced reports detailing how outbreaks can be better managed, including the creation of programs and alliances, improving on monitoring systems, and “continued progress in science and research, public health, and governance” which Dzau describes is “critical for ensuring pandemic preparedness”.

Already, epidemiologists at the WHO have been monitoring any developments in the outbreak, increasing the assessment of the risk of spread and impact to a global level. Additionally, more than 20 vaccines are in development worldwide, with several clinical trials – the results of which should be expected in the coming weeks. In China, studies are being conducted to better understand the zoonotic origin of the COVID-19 outbreak, including “environmental sampling from the Huanan Wholesale Seafood Market and other area markets, and the collection of detailed records on the source and type of wildlife species sold at the market…” (WHO). The Joint Mission report further suggests 22 recommendations for China, affected and unaffected countries, the international community, and the general public, of how best to prevent the spread of the virus. Other than calling for countries to “educate their populations, to expand surveillance, to find, isolate and care for every case, to trace every contact, and to take an all-of-government and all-of-society approach,” the Joint Mission importantly calls for the recognition of “true solidarity and collaboration…between nations to tackle the common threat that COVID-19 represents.” After all, as BBC Health and Science Correspondent James Gallagher noted, “pandemic is just that – a word – it will not unlock more money or give the WHO new powers”.