Covid-19: A Looming Pandemic

We’ve seen the word pandemic get thrown around quite a lot in the past month. But what exactly does it mean?

The word pandemic originates from the Greek words pan meaning “all” (as in across the globe) and demos meaning “people”. It is a term used by epidemiologists to describe diseases growing rapidly in numbers in multiple countries at the same time [1].

A pandemic is an unpredictable event that can have a number of consequences on human health and economic well-being worldwide [2]. Covid-19 has rummaged through our economies and our stock markets are all down (but for companies that sell masks, sanitizers, and other antiseptic disinfectants). The outbreak has also proceeded to bring us down to our knees, leading to cancellations of large gatherings/events, and the closing of schools and major cities. Airports around the world are cracking down on cases of the novel coronavirus with further testing, adding time at immigration and border control. Further to this, a potential pandemic puts increased demands on health care systems around the world – especially in wintry weather.

According to the World Health Organisation, we are in an “unchartered territory” when it comes to tackling the novel Covid-19 coronavirus. This is because when a new virus first emerges, we have very little to no immunity to fight it. Our immune systems have to start the duel against the virus from scratch (i.e. from making the weapons for survival) as soon as it is exposed to the virus. The virus on the other hand, has it’s entire arsenal ready for combat. Our body is at a clear disadvantage and needs to understand the virus’ battle plan to outwit it; a process that is not 100% immediate. For this reason, a large proportion of the global population will be affected [3], making containment the key to preventing the virus from spreading to become a pandemic.

As you are probably aware, we have no cure for the novel coronavirus. We have however developed (at an unprecedented rate) at least 10 vaccines all of which are now undergoing clinical trials [4]. Despite this, we will not have a vaccine until the end of the year at the very least. Accordingly, prevention methods are at the heart of what we can do. Planning and preparation are therefore both critical to mitigate the adverse effects of a possible pandemic.

Looking at how COVID-19 has spread around the world within the last couple of months – it is clear to most that a pandemic is looming, if it is not already here. Why is it then, that the World Health Organisation has been avoiding the P-word? To understand this, we need to look further into how a pandemic differs from an epidemic.

An epidemic is an increase in number of disease cases within a region or country. It could be said that epidemics lead to pandemics. Looking at Covid-19s disease progression, we know that the epidemic began in Wuhan, and then spread to further parts of China. With the number of tourists leaving China, the virus was able to spread and is now found in a number of countries worldwide. Is this alone a clear sign of a looming pandemic??

The UN health agency (as well as the World Health Organisation) has repeatedly insisted that Covid-19 has not yet caused a pandemic [5]; that we are still in the midst of multiple epidemics that can be prevented. The virus however, clearly has the potential of becoming a pandemic.

World Health Organisation – Pandemic or Not?s

In 2009, the World Health Organisation revised their criteria for the global six phases of a pandemic. The criteria relates to where the virus causes disease and how it spreads from one geographical area to another. This criteria is as follows [6]:

Phase 1: Viruses circulating within animals only. No human has been infected by this virus, thereby a low risk for humans.

Phase 2: The virus circulating in animals is known to have previously caused infection in humans. The risk of humans being affected is now higher than it was in Phase 1. At this stage the virus is considered a potential pandemic threat.

Phase 3: The virus has now spread to humans, and caused small clusters in people. However, at this stage there is very limited circumstance-based human-to-human transmission. Since there is still limited transmission, it does not indicate any more of a pandemic threat.

Phase 4: Further evidence found of an increase in verified human-to-human transmission thereby causing community-level outbreaks. This ability to cause an outbreak marks a significant upward shift in the risk of a pandemic. More people are affected.

Phase 5: This refers to significant human-to-human transmission in more than one WHO region (generally speaking, in 2 or more geographically close countries). At this stage, it is clear that a pandemic is imminent and that there is a narrow time frame to finalise organisation, communication and the implementation of planned mitigation measures.

Phase 6: The pandemic phase. The pandemic phase is when the number of cases peaks.

Post-Peak Period: This is when the pandemic disease levels begin to slow in most countries that have adequate surveillance. It is possible that China is currently in this phase, as the number of new cases reported daily has now dropped dramatically. It is however uncertain whether additional waves of the disease will occur and it is recommended that we prepare for another wave.

Post-Pandemic Period: This is when levels of the outbreak have decreased/returned to more “normal” levels. It is then expected that the pandemic virus will behave like a flu virus and affect us only during certain times of the year. It is also possible that the virus disappears soon, or slowly fizzles out and/or never returns. Unfortunately, there is only one way to know.

Please note: As per the recent press conference, the World Health Organisation no longer uses the above six phase system. A link to this conference can be found here. The above criteria have been scrapped after (and possibly because) the World Health Organisation was the target of criticism for declaring the H1N1 flu in 2009 a pandemic. This declaration triggered countries to prepare for expensive yet unnecessary countermeasures. This could be one of the many reasons as to why the WHO is overly cautious with the use of the P-term with Covid-19.

In response to Covid-19, the World Health Organisation has already declared the highest possible level of alarm: a public health emergency of international concern. The World Health Organisation as well as the United Nations Health Agency have steered caution to the P-term as “using the word pandemic carelessly has no tangible benefit, but it does have significant risk in terms of amplifying unnecessary and unjustified fear and stigma, and paralysing healthcare systems. It may also signal that we can no longer contain the virus, which is not true” [7].

The World Health Organisation has also affirmed that they will not “hesitate to use the word pandemic if it is an accurate description of the situation.” They are continually monitoring the epidemic and have thus far witnessed no sustained and intensive community transmission of the virus nor large-scale severe disease or death [7]. They have also reminded all countries to prepare for a potential pandemic, irregardless of whether or not they have had any confirmed cases of the virus to date.

Centre for Disease Control and Prevention – Pandemic or Not?

Similar to the World Health Organisation, the CDC have three criteria for a pandemic. Knowing that Covid-19 has the potential to spread between people, and can also lead to death fulfils the first two criteria of the CDC definition of a pandemic. Worldwide community spread is the third criteria [8]. At this point in time, we are seeing outbreaks in many more regions, but they are still occurring in clusters. In these countries with clusters, the source of almost every case has been identified i.e. we are not seeing much community transmission. Some countries have even slowed or stopped transmission [9]. As more and more people in different countries become affected, we move closer to meeting the third criteria – worldwide spread of the virus.

Currently, the immediate health risk from being exposed to the virus is considered comparatively low, but this will only go up. People in communities or in close contact with people affected with Covid-19 are at a higher risk of being affected. This includes health care workers. The same stands for travellers that have come from an area that have signs of community spread.

According to both the now redundant World Health Organisation six-phase criteria, as well as the CDC criteria, it is when containment fails and the outbreak reaches a level where it can no longer be controlled, that Covid-19 would move into the pandemic phase. A number of health officials have said that the question is no longer whether there will be a pandemic at all, rather the question is when this will happen [9]. The German Health Minister on the other hand, has already stated that Coronavirus is now a worldwide pandemic [10].

Regardless of whether Covid-19 is currently referred to as a pandemic or not, the general consensus is that it will get there eventually. In the end, it is just a word. However, it has the consequence of causing fear, hysteria and hopelessness among the public. It should be noted that at the pandemic stage although containment may have “failed” to prevent the virus from affecting a huge number of people, it will certainly slow Covid-19 down, buying governments much needed time to get their ducks in a row, and also allowing scientists to continue to search, develop and test vaccines.

In conclusion, remember that although a pandemic is inevitable, and we have no cure for Covid-19, your best bet is to ensure you are taking all the precautionary measures you reasonably can. For my previous post on precautionary measures you can take, please click here.

References:
[1] https://www.telegraph.co.uk/global-health/science-and-disease/pandemic-what-meaning-coronavirus-uk/

[2]https://apps.who.int/iris/bitstream/handle/10665/259893/WHO-WHE-IHM-GIP-2017.1-eng.pdf?sequence=1

[3]https://apps.who.int/iris/bitstream/handle/10665/259884/9789241513623-eng.pdf;jsessionid=59B5794231C4ECEB05B16268857C426D?sequence=1

[4] https://www.statnews.com/2020/03/02/coronavirus-drugs-and-vaccines-in-development/

[5] https://news.un.org/en/story/2020/02/1058141

[6] https://www.who.int/csr/disease/swineflu/phase/en/

[7] https://news.un.org/en/story/2020/02/1058141

[8] https://www.cdc.gov/coronavirus/2019-ncov/summary.html

[9] https://www.nytimes.com/2020/02/28/health/coronavirus-pandemic-epidemic.html

[10] https://www.dw.com/en/coronavirus-is-now-a-worldwide-pandemic-german-health-minister-says/a-52634082