Although WHO has yet to call the outbreak of SARS-CoV-2 infection a pandemic, it has
confirmed that the virus is likely to spread to most, if not all, countries. Regardless
of terminology, this latest coronavirus epidemic is now seeing larger increases in
cases outside China. As of March 3, more than 90 000 confirmed cases of COVID-19 have
been reported in 73 countries. The outbreak in northern Italy, which has seen 11 towns
officially locked down and residents threatened with imprisonment if they try to leave,
shocked European political leaders. Their shock turned to horror as they saw Italy
become the epicentre for further spread across the continent. As the window for global
containment closes, health ministers are scrambling to implement appropriate measures
to delay spread of the virus. But their actions have been slow and insufficient. There
is now a real danger that countries have done too little, too late to contain the
epidemic.
By striking contrast, the WHO-China joint mission report calls China's vigorous public
health measures toward this new coronavirus probably the most “ambitious, agile and
aggressive disease containment effort in history”. China seems to have avoided a substantial
number of cases and fatalities, although there have been severe effects on the nation's
economy. In its report on the joint mission, WHO recommends that countries activate
the highest level of national response management protocols to ensure the all-of-government
and all-of-society approaches needed to contain viral spread. China's success rests
largely with a strong administrative system that it can mobilise in times of threat,
combined with the ready agreement of the Chinese people to obey stringent public health
procedures. Although other nations lack China's command-and-control political economy,
there are important lessons that presidents and prime ministers can learn from China's
experience. The signs are that those lessons have not been learned.
SARS-CoV-2 presents different challenges to high-income and low-income or middle-income
countries (LMICs). A major fear over global spread is how weak health systems will
cope. Some countries, such as Nigeria, have so far successfully dealt with individual
cases. But large outbreaks could easily overwhelm LMIC health services. The difficult
truth is that countries in most of sub-Saharan Africa, for example, are not prepared
for an epidemic of coronavirus. And nor are many nations across Latin America and
the Middle East. Public health measures, such as surveillance, exhaustive contact
tracing, social distancing, travel restrictions, educating the public on hand hygiene,
ensuring flu vaccinations for the frail and immunocompromised, and postponing non-essential
operations and services will all play their part in delaying the spread of infection
and dispersing pressure on hospitals. Individual governments will need to decide where
they draw the line on implementing these measures. They will have to weigh the ethical,
social, and economic risks versus proven health benefits.
The evidence surely indicates that political leaders should be moving faster and more
aggressively. As Xiaobo Yang and colleagues have shown, the mortality of critically
ill patients with SARS-CoV-2 pneumonia is substantial. As they wrote recently in The
Lancet Respiratory Medicine, “The severity of SARS-CoV-2 pneumonia poses great strain
on critical care resources in hospitals, especially if they are not adequately staffed
or resourced.” This coronavirus is not benign. It kills. The political response to
the epidemic should therefore reflect the national security threat that SARS-CoV-2
represents.
National governments have all released guidance for health-care professionals, but
published advice alone is insufficient. Guidance on how to manage patients with COVID-19
must be delivered urgently to health-care workers in the form of workshops, online
teaching, smart phone engagement, and peer-to-peer education. Equipment such as personal
protective equipment, ventilators, oxygen, and testing kits must be made available
and supply chains strengthened. The European Centre for Disease Prevention and Control
recommends that hospitals set up a core team including hospital management, an infection
control team member, an infectious disease expert, and specialists representing the
intensive care unit and accident and emergency departments.
So far, evidence suggests that the colossal public health efforts of the Chinese Government
have saved thousands of lives. High-income countries, now facing their own outbreaks,
must take reasoned risks and act more decisively. They must abandon their fears of
the negative short-term public and economic consequences that may follow from restricting
public freedoms as part of more assertive infection control measures.
© 2020 Manuel Silvestri/Reuters Picutres
2020
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