On December 31, 2019, the World Health Organization office in China received a report of 29 pneumonia cases of unknown etiology in Wuhan city in Hubei province, central China. Within a span of one week, it became clear that the initial cases were linked with a seafood market where wild animals and live poultry were also sold.
The virus was swiftly identified as a novel beta-coronavirus and the genetic sequence was shared on January 12, 2020. The virus is now officially named SARS-CoV-2 and the disease it causes is officially termed COVID-19. News of this outbreak alarmed many public health officials as they recalled parallels with the severe acute respiratory syndrome (SARS) outbreak that previously occurred in China in November 2002. The SARS outbreak was also caused by a novel coronavirus spilling over from an animal reservoir and transmitted through respiratory droplets. SARS spread across the globe through international air travel, caused more than 8,000 cases and 774 deaths and cost US$20 billion to control.
The Global Spread of COVID-19
Within less than a month, COVID-19 has spread all throughout China and to neighboring countries, even to Europe and the USA. It became clear that the SARS-CoV-2 virus was highly transmissible from one person to another, but was significantly less lethal, with less than 20% of cases being classified as severe.
COVID-19 has the clinical features of an atypical pneumonia with dry cough, fatigue, fever, shortness of breath and muscle pain and is more often severe in the elderly and those with underlying medical conditions. Since there are currently no vaccines, therapies, or cure available for the virus, standard public health measures appropriate for a virus spread by close contact, droplets, and on environmental surfaces were implemented. Furthermore, authorities conducted comprehensive case finding and testing, contact tracing, and quarantining of cases and contacts. Also, in an effort to control the spread of the SARS-CoV-2 virus, the public was encouraged to stay at home if sick.
On January 30, 2020 the World Health Organization declared the COVID-19 outbreak a public health emergency of international concern, their highest level of severity, at a time when the disease has spread to over 20 countries and there were almost 10,000 confirmed cases and more than 200 deaths.
By then, the Chinese authorities had instituted highly rigorous control measures, including stopping public transport and flights in Wuhan and other major cities, prolonging the New Year holiday in an effort to prevent mass travel, minimizing mass gatherings, staggering factory and office working hours, keeping schools closed, restricting movement on the streets, and reducing movements within cities. The wearing of face masks became compulsory and the population of Hubei – with more than 50 million – were put under quarantine. Within 2 weeks, Chinese authorities also built two new hospitals with more than 2,500 beds to meet the surge in demand for medical care.
COVID-19: A Pandemic
By the middle of March, less than 3 months into the COVID-19 outbreak, there had been more than 200,000 cases confirmed around the world with more than 8,000 deaths, surpassing the SARS epidemic. On March 11, the World Health Organization has declared the COVID-19 a pandemic. “Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death,” said Dr. Tedros on March 11. “Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this coronavirus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”
The number of cases reported has been highest in China, although new cases are now being reported in 195 countries and territories around the world. The main initial battle to control this pandemic has been in China, where brave public health measures have bought the rest of the world some time and may have reduced the effective reproduction number to close to 1, thus bringing this pandemic under control. However, the rest of the world needs to stay vigilant, as the SARS-CoV-2 virus is highly transmissible and can cause severe disease and death, as has been seen in countries such as Iran, Italy, and South Korea. Indeed, the number of new cases is now highest in the United States.
Containment through case finding, contact tracing, isolation, proper hand washing, and social distancing remain the key public health approaches to controlling the pandemic in all parts of the world. This is particularly crucial for countries in South and Central America, sub-Saharan Africa and Asia that are not well-prepared and equipped for outbreaks. Global support and solidarity are highly important, as infectious diseases can easily cross borders. As John Nkengasong from Africa CDC has said, “The global health chain is only as strong as its weakest link, so a disease threat anywhere can quickly become a threat everywhere.”
Unfortunately, outbreak response preparedness is weak in many countries. Of the 45 low-income countries that have undertaken national preparedness assessment, none have been considered ready to respond, making them vulnerable to outbreaks. There are several reasons for this, including poor quality of healthcare, resource constraints, vulnerable supply chains, weak medicine procurement, and poor health and nutrition.
COVID-19 in the Philippines
In response to the outbreak, the Philippine government is strengthening partnerships and coordination across the country, including a common approach for monitoring and movement restriction of people at risk for COVID-19. Enhanced community quarantine has also been implemented in Luzon to contain the spread of the outbreak.
The Philippine Department of Health, in partnership with the Philippine government and local health offices, is working hard to contain the spread of the virus throughout the country. This includes developing and implementing national preparedness plans, point-of-entry controls, enhanced community quarantine, local lock-downs, travel restrictions, closure of schools and colleges, stringent social distancing measures, traveler screening, contact finding and tracing, travel bans, and the handling and management of Persons Under Investigation (PUIs) and Persons Under Monitoring (PUMs). Plans are continually being developed and improved for the sourcing and stockpiling of personal protective equipment (PPE) and other health necessities.
However, there is still a need to scale up support to frontline health workers and to reinforce the existing supply chain for PPE and other critical medical supplies. Regular communication with the public through trusted health experts is a high priority as well. This includes providing advice on what individuals can do to protect themselves, including proper hand washing, avoiding close contact with people with acute respiratory infections, promotion of cough etiquette, and social distancing.
Health Measures and Priorities
Research priorities include optimizing PPE and determining the utility of facemasks; development of point-of-care diagnostics; accelerating the evaluation of therapeutics, particularly of Kaletra and remdesivir for which trials are presently underway in China; and vaccines, which may prove crucial in the long term. All of these requires commitments of increased funding for both the COVID-19 research and outbreak response.
Other priorities include the promotion of rapid information sharing, including genetic sequences and samples; working to counter rumors and misinformation regarding COVID-19; and social science research to guarantee that communities support proposed health interventions.
Across the globe, national public health institutes, ministries of health, universities, and other public health agencies are working to fight this pandemic. However, this pandemic is not just a medical emergency and human tragedy, it is also starting to affect economic activities. Without urgent action, the socio-economic effects could have wide implications for economic markets, travel, trade, supply chains, aid provision, and the day-to-day lives of people living across the world.