WHO says it no longer uses 'pandemic' category, but virus still emergency | Hacker News Reader

WHO says it no longer uses 'pandemic' category, but virus still emergency

uk.reuters.com

82 pointsjacquesm103 comments

Remember that the WHO has no real power, its a coordination body at the best. Its not like the US CDC which can impose restrictions and rules in the US. The WHO can't go into a country without that country's approval. They rely on that country giving out information. So in another words, the WHO must convince the country in question that its in their best interest to cooperate with the WHO.

One CBC article says it the best:

The WHO doesn't have the authority to tell Xi Jingping what to do, let alone take over the fight on the ground. All it can do is engage in what is known as disease diplomacy, and try to convince China that its interests and the world's concerns are completely aligned.

"In some ways the SARS outbreak taught the WHO that you have to have the country that is most affected — the epicentre of the outbreak — on its side. It can't risk alienating the Chinese," says Lee. "I'm sure they know that they're not getting full co-operation, but they're still trying to encourage that."

https://www.cbc.ca/news/health/china-coronavirus-cover-up-cl...

The No.1 contributor to WHO budget is US tax payer, and the leadership of WHO was begging countries like US not to close flight routes to China in the midst of rapidly spreading disease.

For any observer casual or otherwise it is evident WHO leadership is more worried about being on the good side of China than the health of the world.

Indeed. Cutting off travel was the most effective way of stopping the spread outside of China.

It's been over 100 years since the world has had a pandemic. It is frankly entirely predictable that we don't really know what to do when one happens, and that we'll collectively be generally complacent until it is on where ever our doorstep happens to be.

I'm not one with a high opinion of global governance anyhow, but even if it was competent it would be incompetent, because the competent thing to do for so long has been to assume "not going to be a pandemic". There isn't really a solution to these sorts of fat-tail outcomes; you can't spend trillions planning for them all the time because even if you do, your funding will be cut, but then when the time comes, you won't be prepared.

"It is frankly entirely predictable that we don't really know what to do when one happens, and that we'll collectively be generally complacent until it is on where ever our doorstep happens to be."

Maybe your average Joe wouldn't know what to do, but if the leaders of the organization which is supposed to globally manage such situations don't really know what do to, then they should all be replaced. That's literally their job.

Ironically, I think that's exactly backwards. Average Joes actually have a chance of getting this right. Institutions are the ones that essentially can't, because if they treated pandemics correctly in the past several decades, they'd be defunded for wasting money on the fat tail events that could have happened, but didn't, so clearly, they don't need that money.

You're thinking in terms of people; you need to think in terms of organizations, which are in some ways just people writ large, but in other very important ways, are not just people writ large. It would be completely plausible and understandable that the majority of individuals in the WHO or CDC are aware of some truly bad thing in progress even as the organization is telling everyone not to worry and just stay calm at all costs. It's hard to grok, but it's the way it is.

There have been a few pandemics in the last 100 years... A very recent one being the 2009 flu pandemic (swine flu).

HIV is an ongoing pandemic.

Or maybe closing flight routes was a bad response rooted in fear and not logic?

I don't know much about pandemics, but i would need to see experts who are independent of both WHO and USA say that WHO's policy is bad, before believing that they have been unduly influenced

I think this virus is getting sincerely underestimated in our echo chamber, and it's only because the reported cases in the US have been low. If Italy has multiple quarantine zones, think about how many travelers are coming back from Italy who are probably infected but don't even know it yet. I hope I'm wrong.

>I think this virus is getting sincerely underestimated in our echo chamber

this is an incredibly hot take. It seems to me that the majority of the media along with hackernews consistently contribute to unsubstantiated fear mongering

I don’t believe it is, the virus can be quarantined efficiently if the country is responsive to the outbreaks. Vietnam had early outbreaks, quarantined areas via a ring system, and the country has contained the virus very well.

This is a country that is poorer than South Korea, Japan, or Italy and shares a border with China.

I'm not trying to fear-monger here, so please don't read that as my intent.

Are you sure though? An "outbreak" is detected by someone having symptoms, by which time they've infected others. If you're an in area with lots of travelers, by the time you have an outbreak, it's already moved on.

I'm watching South Korea - they have plenty of travel, a good population, and an effective government. If they can contain it, that's a good sign, if not, likely a portent of what the western world can expect if carriers become more numerous. So far too early to say, but that's where I'm looking. (And I'm no expert at all, so if anyone has reasons that I'm looking in the wrong place as a bellweather, please share).

My real issue is the lack of good info. We've gotten an R0, but I've not heard anyone express confidence in the results of infection (another commenter suggested 20% require respiratory assistance, but is that of flat infected or of those that are detected as infected in part BECAUSE their symptoms are serious?)

Vietnam detected a presence outside of Hanoi and quarantined an entire town of 10,000 over a week ago. There haven’t been any new cases since.

https://news.yahoo.com/vietnam-quarantines-village-10-000-07...

They are now quarantining all travelers from South Korea or denying them entry.

The country is known for operating a ‘brutal’ but efficient quarantine.

> another commenter suggested 20% require respiratory assistance, but is that of flat infected or of those that are detected as infected in part BECAUSE their symptoms are serious?

The latter. Unfortunately we don't know what fraction of cases are detected, but it's believed to be around 10%.

Interesting in this context is to look at the postmortem of the previous pandemic in 2009, the number of cases initially confirmed and the final tally over the same period once all the facts were in.

The relevant wikipedia bit:

"A flu follow-up study done in September 2010, found that "the risk of most serious complications was not elevated in adults or children."[31] In a 5 August 2011 PLoS ONE article, researchers estimated that the 2009 H1N1 global infection rate was 11% to 21%, lower than what was previously expected.[32] However, by 2012, research showed that as many as 579,000 people could have been killed by the disease, as only those fatalities confirmed by laboratory testing were included in the original number, and meant that many of those without access to health facilities went uncounted. The majority of these deaths occurred in Africa and Southeast Asia. Experts, including the WHO, have agreed that an estimated 284,500 people were killed by the disease, much higher than the initial death toll."

From:

https://en.wikipedia.org/wiki/2009_flu_pandemic

It is far too early to conclude that Vietnam has contained "very well" and very possible that cases in a very poor country like Vietnam could be missed

Vietnam was the first country to end SARS and is known for operating a very efficient but ‘brutal’ quarantine. You live or die staying where you are.

Maybe it’s easier in a poor country. People just don’t travel as much.

There are a ton of tourists that travel to Vietnam.

Yes, but it doesn’t impact the tourists very much if they can’t travel there as someone who relies on travel for business or to meet their family.

I've commonly heard people comparing this virus to the flu. There's a pretty good post on reddit comparing them. The summary is that Covid-19 is 20x as deadly, requires 10x as many hospitalizations, and is more transmissible.

https://old.reddit.com/r/Coronavirus/comments/f8k2nj/why_sar...

But that's only if you believe that the number of measured cases are the number of actual cases. They would need to randomly sample the population for that to be true. My guess is that most people just get a small cold from this virus -- and some have a big reaction. So we really don't know the death rate.

True, and I’m surprised the POTUS has yet to announce the closing of air traffic from and to Italy.

Although, the zones under lockdown are 10 towns in Lombardy (the region where Milan is), and I guess they’re not the cities most visited by tourists.

Also, there is no information about the patient zero, but Lombardy (and especially Milan) has a huge presence of Chinese citizens and I am not surprised it all started there.

Viruses do not discriminate based on race and not all travellers who have brought the virus abroad have been Chinese. Saying things like “there are a lot of Chinese so I’m not surprised” is a very dangerous path to go down. Sad to see this on HN

Viruses don't discriminate, but immigrants (and descendants of immigrants) do tend to visit their original home countries (and/or ancestor's home countries) more than the rest of the population. People of Chinese descent living in Italy are more likely to visit China than people of Italian descent in Italy (or Irish or whatever non-Chinese descent). Areas with high concentrations of Chinese people are thus more likely to have been exposed to a traveler than some other areas. There's nothing racist about this.

Of course hot spots for transmission like airports will spread it beyond the Chinese communities.

Viruses can discriminate by race.

Indians got wiped out by Smallpox, for instance.

It's not about race at all -- China isn't exactly a vacation destination; very few non-Chinese visit China. Considering the lunar new year was timed right with this outbreak (and the Chinese tradition to visit relatives on LNY), it's not ridiculous to assume that areas with higher Chinese populations have a higher chance of having the virus.

This whole outrage culture thing needs to go away.

> I guess they’re not the cities most visited by tourists.

https://www.businessinsider.nl/coronavirus-italy-spread-deat...

Milan and Venice are in that region.

>True, and I’m surprised the POTUS has yet to announce the closing of air traffic from and to Italy.

You're surprised that the guy who tweets every all time high in the DJIA would be hesitant to do anything that might compromise the only thing (confidence and irrational exuberance) that is holding up a bubble trading at a Shiller PE of 32?

People don't worry about that because it'd be good news. The virus has been circulating for a while now - if there were a huge number of currently unknown infections, that would strongly suggest that the virus isn't as severe as currently believed. There's no way we could fail to notice disease clusters hospitalizing as many people as in Wuhan.

I was laughing at Sars and Swineflu/Birdflu. I was laughing at this 3-4 days ago. I am not laughing anymore

What China is doing in Wohan is insane, even for China. The only way it makes sense is if they are looking at numbers several magnitudes higher than we are (e.g if you are looking at Black Death/Spanish flue numbers, not less than normal flue numbers), which would indicate that the Chinese government is lying.

Cases in Italy are exploding and the US are only testing people who are showing up with symptoms who have recently traveled from Wuhan (ie not China in general, not Vietnam, not Hong Kong), despite good evidence that the decease can travel from human to human (which does not quite mean it is aerosolized) so we simply do not know how bad the US is doing at the moment.

Supply lines are already under pressure. In some places in China vehicular traffic is less than 5% of what it normally is.

I don't think the world is ending, and this is not going to be another Black Death or even a Spanish Flu (we have much better tech, world citizes are not filled with rats and all sources indicates that this Flu is mostly bad for the old and the inferm, unlike 1920) but I expect this one to be really bad.

It is going to be a "pandemic" regardless of what we do short of sealing off all travel for a long time. It does not kill a vast majority of the people it infects unlike Ebola so there will always be a large pool of carriers and the time it remains in circulation will be much longer. So if anything this is being underhyped. It is going to spread everywhere eventually.

There are already vaccine prototypes in the lab. The hope is we can delay the spread long enough that they can get out of the lab and into mass production. Next years flu shot could contain this as well if all goes perfect. If we can just hold back until then we are okay. That is a big if though.

Source on vaccine prototypes being in the lab? I recall seeing headlines a few weeks back that the genome had been sequenced, but hadn't heard anything regarding vaccine progress since then.

google finds plenty. I linked to one.

They are all early prototypes based on work that the lab was already doing. Nothing is anywhere close to human trails that I know of.

That is at least 12-18 months away

That is why I used works like "hope" and "big if". If everything goes perfect it can happen. It only needs one of the early attempts to turn out to work, do great in early testing and be easy to manufacture. Easy to manufacture depends on scale - if the virus turns out to be spreading fast it will be easier to manufacture because a lot of resources will be put into building the ability to make whatever turns out to work.

Safety becomes less important in the worst cases too. If you have a 1% chance of going blind from the vaccine, or a 20% chance of death, a vaccine that would normally fail tests looks good. (20% chance of death of course means the virus mutates to both spread faster and kill more people - generally unlikely)

Yeah, keep holding out hope for a viral vaccine

Do you have sources for this, or are you talking about the SARS vaccine in Houston that has not been tested on the COVID-19 and never got past animal testing for SARS? If the latter, I agree that it seems promising and is a better state than I thought we were in, but calling it a COVID-19 prototype is just not accurate.

Google finds plenty of sources. https://www.healthline.com/health-news/how-long-will-it-take...

Again, I'm not sure if anything will come out of it - to develop and test a useful vaccine in a useful amount of time requires everything to go perfect. I only claimed progress in the lab.

I don't see anything that can be credibly claimed as a "prototype", which implies far more than "progress in a lab"

If that's true, then that's worse than it's portrayed by the authorities. I've read that roughly 20% of those who get it need intensive care with artificial respiration, but there are not enough facilities to accommodate such patients if a larger wave of infections occurs.

No, only 20% of cases.

The key difference is that not all infections turn into cases. A lot of people seem to get a lesser version of the disease, and may not feel symptoms beyond those of a bad cold -- these people never get diagnosed, and so don't factor into the 20% case severity ratio.

It does seem like it is worse than the authorities say, but I can't imagine that that 20% number is based on much more than the number who goes to the hospital, which would be only a small percent.

Overall I am worried, but I expect society to survive, minus some issues (and of course some deaths).

With China's rise this is our weird new future. Western institutions are trying their best to not offend China, so we end up with very muddled news releases.

Does anyone here think it's a bad idea to travel internationally at this time? I have a trip from US to UK planned in 2 weeks...

Bad idea. Don’t go.

In my opinion: The risk is still acceptably low if you're a young, healthy person, but only if you're able to self-quarantine after the travel and avoid contact with anyone beyond the age of fifty or who has respiratory problems for the first month afterwards.

Follow guidelines, but use common sense. If we're in a situation where it's too risky for certain groups to travel, then it's also risky for travelers to interact with them.

Also keep in mind that, depending on the situation at the time and they length of your trip, you might not be able to return. Make sure nothing terrible will happen in that situation.

I am a young and relatively healthy person.

It's quite possible that your won't be able to return for a few months.

Really?? Where does it state that?

In the past week it’s been discovered that the virus has spread in two developed countries - South Korea and Italy. Already a bunch of countries have created travel restrictions and it’s only a matter of time until the restrictions increase. If a similar outbreak is discovered in the UK while you are there, you might become subject to similar restrictions. You’d be unlucky if it happened while you are there, but it wouldn’t be shocking. We’re trying to predict the policy response to an unknown future so it’s very hard to say.

What I don't understand, why are actual tests for the virus being done so reluctantly?

I'm german and followed the media coverage and initial panic a few weeks ago when the first case appeared in germany. There was a rush of people who wanted to get themselves tested - but got turned down with the info that only persons who are already suspect (show symptoms AND just got back from china) were eligible for testing.

Now we're realizing that infection paths cannot be tracked anymore and there is very likely a huge number of unknown infected persons.

If you got a virus that is both asymptomatic and infectious for 14 days, wouldn't you want to test as many people you can, as early as possible?

So basically “we officially deprecated the designation pandemic and call it an alphabet soup, but it’s what we used to call a pandemic”.

That makes it so much clearer. I mean are they trying to help people understand things or not?

Wonder what will happen with the Olympic games. Even a simple delay would be huge.

Corona family viruses are flu season events. The deadly regular flu is a well known member.

The hope is that come spring-summer it will wane off and provide enough time for a vaccine to be developed.

So healthy young athletes should be good to go for the summer.

Influenza and coronovirus are two broad non-intersecting categories of viruses. They're not the same thing.

I think the concern is the large crowds of ordinary people using trains, airplanes, hotels, restaurants and event venues, not the athletes.

Influenza viruses (Orthomyxoviridae) aren't even in the same phylum as coronavirus.

I think the bigger concern is the large international crowd. I will be attending a conference with international attendees and I've started to become concerned.

Will the summer heat reduce the spread and transmission of the virus? This is a theory being floated by many of my friends and family in India. Wondering if its true.

On the flip side - the cold tends to keep people indoors and away from others. The warm weather tends to make people go outside and interact with others.

On the other hand people interacting indoors are closer to each other and breath the same air and handle the same things more than people outdoors.

I saw a bioxriv preprint that said the virus has trouble surviving outside the human body above 75deg F

I've been leaning towards this hypothesis lately. We haven't been seeing large increases in cases in countries in the more southern latitudes thus far. Singapore, Indonesia, Thailand India, Malaysia, and Australia have not been reporting large increases in cases like we are seeing in China, Italy, Iran, and South Korea.

Of course there is another explanation, these countries could be under-reporting or not detecting new cases...

That's what I'd been lead to believe.

WHO - Philippines are saying otherwise:

https://news.mb.com.ph/2020/02/08/who-ph-2019-ncov-can-survi...

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