05/10/2020

Some health experts wonder if the WHO’s deference to China helped spread the virus in the initial weeks.

Now more than a month into an escalating global health crisis there are questions about whether the WHOs praise in the early weeks created a false sense of security that potentially spurred the viruss spread.
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We were deceived, said Lawrence Gostin, a professor of global health law at Georgetown University who also provides technical assistance to WHO.
Myself and other public health experts, based on what the World Health Organization and China were saying, reassured the public that this was not serious, that we could bring this under control, he continued.
We were, he added, giving a false sense of assurance.
On Saturday, the death toll from the coronavirus recorded its largest daily jump 86 to raise the count to more than 720 deaths, nearly all in China. In Wuhan, the center of the outbreak, the first deaths of an American and a Japanese citizen were recorded.
Managing the outbreak of a new infection is never easy. In times of crisis, WHO a U.N. agency based in Geneva must work with member countries to get information and coordinate a response.
Experts familiar with the workings of WHO, including current and former advisers, stressed that careful diplomacy and public praise can keep countries in crisis from shutting out the world.
The agency learned valuable lessons from the 2002 outbreak of severe acute respiratory syndrome (SARS), which China initially tried to cover up. The agency is doing much right this time around, some experts said.
What we know so far about the coronavirus
But some fear that WHOs embrace of Chinas numbers and assessments in the early stages of this outbreak, as well as its ongoing praise for the countrys response, are testing the agencys global credibility right when it needs it most.
Im concerned about whether they can actually assume leadership effectively in terms of the international response, said Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations.
People trust the organization to be the guardian of global health because it is politically neutral and has expertise.
A statement from WHO said ensuring open lines of communications is critical in efforts to bring a disease outbreak under control.
To date, 99 percent of the cases are still in China, the statement added. The government committed early on to working with WHO, sharing data and more. The Chinese government are in the lead for their national response and WHO is doing its utmost to support them, for the sake of the Chinese people and the world.
WHO said that Tedros welcomes and expects scrutiny of the response effort. Everyones focus must be on ending the outbreak.
The SARS epidemic shook China and changed the way WHO responds to threats.
In the aftermath of the crisis, updated rules required WHO to report emerging diseases and gave it broader power to investigate threats using nonstate sources of information such as civil society groups.
One of the goals: preventing coverups.
In late December, rumors of a mysterious virus started circulating on Chinese social media. China notified WHO on Dec. 31 that there was a pneumonia of unknown cause in Wuhan. Based on Chinese data, WHO issued a Jan. 5 statement saying there were 44 cases and no evidence of person-to-person transmission.
But a Washington Post reconstruction of events showed that by Jan. 5, some Wuhan authorities knew that doctors were discussing the spread of a SARS-like virus. For this, they were detained and denounced.
It also found that local officials undercounted cases.
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My sense is there was delay in getting information from Wuhan to Beijing, even as Beijing was relatively open about sharing with WHO, said Mara Pillinger, an associate in global health policy and governance at Georgetowns ONeill Institute for National and Global Health Law.
David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine and current chair of WHOs advisory committee on infectious hazards, defended the response.
It is very difficult in the beginning of an outbreak to understand the potential, he said, pointing to U.S. failures in the early days of the AIDS crisis and Canadas struggle to coordinate provincial and federal authorities during SARS.
Jennifer Nuzzo, an epidemiologist and senior scholar at the Johns Hopkins Center for Health Security, said WHO was doing a good job under tough conditions.
But she noted that critical epidemiological data that researchers use to understand a virus information about who got sick, when was slow to get out from China.
One criticism that we should direct at WHO is that when it puts out situation reports, they are basically missing data from China, she said.
Its fair to ask, If you dont have data, why not? And what are you doing about it?
In late January, China moved from denial to drastic action.
On Jan. 20, with 400 million people about to travel for the Lunar New Year holiday, officials confirmed what many had long suspected: The virus could spread person to person.
President Xi called for swift, transparent action. It is necessary to release epidemic information in a timely manner and deepen international cooperation, according to state media reports.
Authorities started to seal off Wuhan, a city of 11 million, canceling some flights, trains and suspending public transportation.
In Geneva, an emergency panel convened to discuss the situation and decide whether to declare a public health emergency of international concern, or PHEIC, which signals serious, unusual or unexpected health crisis that poses a public health risk to other countries through international spread.
On Jan. 22, Tedros applauded Chinas recent efforts. What they are doing is a very, very strong measure and with full commitment, he said
The comment surprised public health experts because travel bans can create panic and make things harder for first responders.
On Jan. 23, China announced it was expanded the quarantine to other cities and millions more people.
Later the same day, in Geneva, WHO decided against declaring a PHEIC. That meant, among other things, no calls for restrictions on travel in and out of China, even as Beijing locked down the Chinese heartland.
Asked about Chinas quarantine, Tedros demurred.
At end of the day, a sovereign country has the autonomy to do what it thinks is right, he said, adding that he hoped it would be short.
In China, officials were increasingly talking about what went wrong. In a Jan. 27 interview, Wuhan Mayor Zhou Xianwang admitted that information should have been released more quickly.
But in a visit to Beijing, Tedros commended officials. The state-run Xinhua News Agency reported that Tedros lauded not only the corona response, but the very effectiveness of Chinas system.
On his return from Beijing, he heaped compliments on China and its president.
I was very encouraged and impressed by the presidents detailed knowledge of the outbreak and his personal involvement in the outbreak, he said. This was for me a very rare leadership.
On Jan. 30 WHO declared a PHEIC, finally acknowledging the risk the Wuhan outbreak posed to other countries. The Chinese government is to be congratulated for the extraordinary measures it has taken to contain the outbreak, Tedros said, adding that China is setting a new standard for outbreak response.
Some experts have defended the comments as sound strategy.
WHO has really tricky balancing act, said Devi Sridhar, a professor of global public health at the University of Edinburgh. If that means praising China publicly, thats what he has to do.
Others worried that it could shake faith in the U.N. body.
Praising Chinas leaders is not a bad idea, but do you want to do it in a professional and credible way, said the Council on Foreign Relations Huang.
For now, WHO seems to be sticking with the strategy.
At a new conference on Thursday, Tedros was asked, again, about China, including the death of one of the Chinese doctors who sounded the alarm on the virus, only to be detained by police. (He later died of the virus.)
He first deferred to a colleague, then took the chance to speak again, defending Chinas handling of the epidemic. It is very difficult, given the facts, he said, to say that China was hiding.
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