As new cases of the novel coronavirus come in steadily in the Middle East, an emergency committee convened by the World Health Organization (WHO) said the situation is serious and requires close monitoring, but stopped short of calling it an international public health emergency.
“What they said was that the current virus is serious in that it is persistent, it can cause serious disease, and it could spread further in the future,” explained Dr. Keiji Fukuda, WHO’s assistant director-general of health security and environment. “However, when they weigh everything, there is not enough evidence to declare an emergency. When you do that, it is really quite a dramatic action and can have negative effects.”
An emergency can involve travel restrictions affecting international trade or religious events, for example. The WHO committee paid particular attention to the Umrah and the Hajj, the annual Muslim pilgrimages to Saudi Arabia, where most of the cases have been found. The Hajj will take place this year in October. Though the Umrah pilgrimage can be undertaken at any time, crowds are expected to peak during Ramadan (July 9–August 7).
However, even convening an emergency committee indicates international concern. This is only the second time that the WHO has convened such a committee under international health regulations that came into force in 2007. The first was in response to the H1N1 influenza pandemic in 2009.
Committees consist of public health experts from around the globe who meet via teleconference to explore evidence and information and provide recommendations to the WHO director-general. The WHO decided to convene the Middle East coronavirus committee before the disease became a more serious threat, Fukuda explained last week in announcing the move. As of July 17, the day the committee convened, 82 cases had been confirmed, with a mortality rate of 55%.
Canada was represented on the committee by Dr. Theresa Tam, head of health security infrastructure at the Public Health Agency of Canada (PHAC). WHO and PHAC refused requests for an interview with Tam. Canada had two members on the previous H1N1 emergency committee, both experts in aviation medicine.
In addition to considering current medical evidence, the committee heard from officials in all countries affected by the virus. Though deciding whether an outbreak or other event constitutes an emergency is “case by case, not a cookie-cutter approach,” emphasized Fukuda, criteria published on the WHO website state that an emergency is a serious, sudden, unusual or unexpected event that affects areas outside the state where it originates and requires immediate international action.
In deciding whether to declare an emergency, the committee considers whether a declaration is “on balance going to be helpful? Is putting that notification out there going to have beneficial effects?” according to Fukuda. If a committee did declare an emergency, it would be asked to make recommendations on how to prevent or reduce the international spread of disease while avoiding unnecessary interference with international traffic.
Although it decided not to call the outbreak an emergency, the committee did offer “guidance” — less directive than recommendations — to the WHO. As a result, the WHO will be issuing travel guidance in the coming days, which will suggest that patients with chronic health conditions planning to visit the Middle East consult their physician first. Other technical advice concerns surveillance, serology, epidemiologic studies, risk communication and data collection.
The committee will meet again in the early fall or earlier if there is renewed concern because of an escalation in cases or new research findings. Research in many areas is underway, but unanswered questions remain: “How are people getting infected? How many mild cases are out there?” Fukuda asked. “We don’t know.”