22 March 2020, COVID-19 Narrative Eight

By Dr David Nabarro, Strategic Director of 4SD, Special Envoy of World Health Organization Director-General on COVID-19 and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London

Get ahead of COVID-19 NOW!

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This is my reading of the situation today.

  • Acceleration:
    The COVID-19 pandemic advances as a series of outbreaks that start with one case, move to chains of transmission, then become established with community transmission (and it is hard to know where people have been infected).  This can quickly lead to explosive outbreaks that overwhelm health services and are associated with high mortality.  We have seen in China and Italy that this growth from first case to explosive outbreak can happen in 2 to 3 weeks.  The pandemic is accelerating rapidly.  It is likely that there will be a number of new explosive outbreaks emerging in Europe and the US in the coming week or two. We may not know where they are because the level of testing is low: the sign that this is happening will be overloaded health facilities and exhausted health workers.   Some scenarios for where the world might be at the end of the year are most disturbing: this is an unprecedented situation. 
  • Speed:
    The pandemic is thought to be doubling in size in around 2.5 days.  It increases 8-fold in a week, 250-fold in three weeks and 1000-fold in 4 weeks.  It is 20 days since the World Health Organization presented its report on what needs to be done based on the China experience.  The WHO guidance for containment and suppression of COVID-19 outbreaks has been followed by South Korea, Hong Kong and Singapore, and in some parts of Europe.  The guidance works if containment is undertaken swiftly and robustly at the very start of a COVID-19 outbreak.  It seems likely that today the overall size of the pandemic (in terms of cases and suffering) is 500 times greater than it was when that report was presented: many times more effort is needed now than would have been needed had there been concerted and evidence-based action taken then.  The response challenge just gets harder and harder if connected and robust action is delayed, even by a day or so.
  • Urgency:
    Urgent, unconditional connected action by all leaders of nations, business, finance, science and society is vital now. The urgency is because of the rapid exponential spread. The intensity is far greater than reported because not all those with COVID-19 within different countries (including in Europe and North America) are being tested. The spread into poorer nations in Latin America, Africa and Asia is happening at speed. 
  • Global challenge needs connected response:
    This is a global challenge and needs a connected global response.  There is an immediate need for authentic, legitimate and wise global leadership.  When the G20 leaders meet (virtually) at the beginning of the coming week they should agree immediately to implement of a common and effective approach to contain and suppress the pandemic.  They must give high priority to enabling all nations to have the necessary capacity to stop (within days) any new transmissions that start up within their borders and prevent them from becoming established outbreaks. G20 nations should agree to enabling all nations (especially poorer nations) to reach this standard.   Such actions should be advanced with a global perspective without any regrets.  Holding back for any reason, even if for one or two days, will cost lives.
  • Advancing a connected global response:
    It would be best for all if there is a single accountable authority for advancing a connected global response.  It needs to be put in place immediately.  It might be led by the UN Secretary-General and his Deputy, together with the WHO Director General, the President of the World Bank and the Managing Director of the IMF.  It could be asked by the G20 to lead and direct the response for as long as necessary – with all the command and control powers that they need. The member states of the UN could request this type of leadership through the UN General Assembly if the G20 cannot agree. It is vital that no time is lost.  There should be a strenuous effort to avoid any action which may undermine the options for all nations, G20 and beyond, to work together.
    The pandemic will advance ever more quickly if a connected response is delayed or hampered by provocative name-calling. There is just too much at stake. “No regrets” policies must apply for the coming months.
  • Critical tasks: 
    The global approach will include the following COVID-19-related tasks in the coming months.
    They are:
    a.     suppressing COVID-19 outbreaks and avoiding massive loss of life through ensuring effective public health capacity everywhere including large-scale testing;
    b.     sustaining resilient health systems that can respond to people’s non- COVID-19 health needs as well as treating COVID-19 patients (includes protecting and prioritizing the needs of health workers, assuring essential supplies);
    c.     maintaining physical distancing to reduce opportunities for transmission everywhere; and
    d.     enabling the just recovery of societies and livelihoods following what may be a major social and economic crisis which will impact on different countries and regions.
  • Physical distancing:
    Enabling people to keep more than 2 metres from each other (physical distancing) is vital.  It involves restrictions on movement and assembly, and these threaten the livelihoods of people dependent on cash incomes, in informal employment or small businesses, everywhere.  The way that this is done (shutdowns, lockdowns, shelter-in-place etc) determines the extent to which people experience economic pain or social stress: when distancing strategies are adopted they should be accompanied, where feasible, by strategies that support the resilience of poorer people in their communities.  One important action is waivers on fees for cash transfers at this time: they will be vitally important in helping low income people to get through the impact of lock downs.
  • When and how this will end:
    It is impossible to predict where, when and how this pandemic will end with any accuracy. When it does end there will be a need for countries to be able to respond rapidly to any new outbreaks that start. They must be on high alert and able to respond rapidly and robustly when someone is suspected of having the disease.

It will take the world much longer to suppress this pandemic if nations continue to work independently and are inconsistent in their application of WHO guidance.

We need to make a jump in our level of impact.

Act now, act audaciously. Before it is too late.

On 21 February 2020, Dr David Nabarro, Strategic Director of 4SD and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London, was appointed as a World Health Organization (WHO) Director-General Special Envoy on COVID-19. In this role, David and five other special envoys are providing strategic advice and high-level political advocacy and engagement in different parts of the world to help WHO coordinate the global response to the epidemic. David joins special envoys Professor Dr Maha El Rabbat, former Minister of Health of Egypt; Dr John Nkengasong, Director of the African Centres for Disease Control and Prevention; Dr Mirta Roses, former Director of the WHO Region of the Americas; Dr Shin Young-soo, former Regional Director of the WHO Region of the Western Pacific and Professor Samba Sow, Director-General of the Center for Vaccine Development in Mali in this collective effort.

Please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 for official guidance from the World Health Organisation on the virus. These Narratives are being written and shared by David for those who want more information and to help raise awareness and readiness of all actors.

Snapshot from WHO COVID-19 Situation Report – 61, as of 23:59 CET 20 March 2020

→ WHO Risk Assessment Global Level VERY HIGH
→ 266,073 confirmed cases (+32,000 new in the last 24 hours)
→ 11,184 deaths (+1,344 in the last 24 hours)
→ 6 new countries/territories/areas has reported cases of COVID-19 in the past 24 hours (Papua New Guinea, Isle of Man, Timor-Leste, Haiti, Cabo Verde, Zimbabwe)
→ WHO has updated their case definitions
→ WHO Regional Directors call for solidarity
→ Updated Technical Guidance
→ New and updated courses on OpenWHO Massive Online Open Courses on COVID-19 for health professionals, decision-makers and the public

1 Comment
  1. Excelente información! El mundo en riesgo lo que va quedando de él ante nuestra irresponsabilidad como especie e su cuidado – agradezco la solidez y la metodología de la narrativa – presentación.


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