What Exactly is a Pandemic?

GLOBAL HEALTH WORKING GROUP

What Exactly is a Pandemic?

Jennyfer Ambe Co-Chair WCAPS Global Health Working Group March 18th, 2020 We are currently bombarded with so much information coming at us with incredible speed. The grocery stores, banks, all the utility companies, every imaginable company we ever signed up with during this digital age, has something to say to help us survive the COVID-19 pandemic. All of a sudden, everyone is an expert in Public Health. Yet, we keep getting asked some basic questions like, what is the difference between an outbreak, epidemic and a pandemic?

COVID-19, which is the name of the disease caused by the virus know as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started in December 2019 but was not announced by the World Health Organization until January 5, 2020. 44 cases of pneumonia were reported by the authorities to the World Health Organization, country office. This high incidence of pneumonia with an unknown etiology was puzzling to experts. No causal agent had been confirmed however the authorities did state that some of the patients either worked at or were vendors at a Seafood market.1 The city in which COVID-19 first infected workers and residents, has a dense population of about 9 million people and approximately 30 million visitors each year. It is a city, where there is considerable commerce; a cultural and historical hub; a traditional manufacturing economy; has research, technological institutions and four universities.2 The source of this virus is still unknown. Experts differ on the origin of the virus and do not seem to know who the index case was. Some have said the virus emerged from a snake, others have reported that it could have crossed over from an armadillo. Test swabs at the wet market tested positive in the area where fish were sold.3 What is

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Pneumonia of unknown cause – China. Disease outbreak news. Emergencies preparedness, response. World Health Organization. Retrieved from https://www.who.int/csr/don/05-january-2020-pneumonia-of-unkown-cause-china/en 2 Wong, .H. Wuhan, (2020, January 23). Inside the Chinese city at the center of the coronavirus outbreak. Retrieved from https://www.cnn.com/travel/article/wuhan-china-virus/index.html 3 Macintyre, R. (2020, February 28). Novel coronavirus COVID-19: update of current evidence & epidemic trajectory https://www.youtube.com/watch?v=ykCBV1hx5sY&feature=youtu.be

suspected is that the virus infected someone at the wet- market, therefore, this is likely to be ground zero.

COVID-19 quickly became an outbreak which according to the World Health Organization is when there are more disease cases than normally expected.4 Since this is a novel coronavirus, there is no “normal” or average, when it comes to expectations.

However, there were reports of very high case counts in the region when the virus appeared, making family clusters quite ill.

The outbreak was not contained and became an epidemic. The United States Center for Disease Control (CDC) and Prevention describes an epidemic as a sudden increase of case counts, in a particular area at the same time.5 This increase in an agent, in this case SARS-CoV-2, is evidence that the virus developed an enhanced mode of transmission from one person to another initially affecting people who were most vulnerable.

On January 30th the World Health Organization declared the outbreak a Public Health Emergency of International Concern (PHEIC). Regulations that govern PHEIC are defined in the WHO PHEIC procedures of 2005.6 This document outlines what constitutes “International Concern”. Notably the spread of a disease internationally, that puts other countries at risk, and which also necessitates an international coordinated response.

On January 13, the first case of COVID-19 was identified in Thailand;7 followed by the first case in Japan on the 16th of January. Four days later, on January 20th, South Korea reports its first case. The next day, the first confirmed case in the United States was recorded in Snohomish County, Washington state. On January 23rd the WHO released a statement saying that this is not yet a global health emergency.8 On March 11, the WHO declared the health situation a pandemic. There was no way to hold off from using this dreaded word in the face of 118,000 cases in at least 114 4

Disease Outbreaks (n.d.) World Health Organization Retrieved from https://www.who.int/environmental_health_emergencies/disease_outbreaks/en/ 5 Epidemic Disease Occurrence (2012, May 18) Principles of Epidemiology in Public Health Practice. Center for Disease Control and Prevention Retrieved from https://www.cdc.gov/csels/dsepd/index.html 6 Strengthening health security by implementing the international health regulations (2005). Retrieved from https://www.who.int/ihr/procedures/pheic/en/; ASecon., H., Woodward, A., & Mosher, D., (2020, March 19). A comprehensive timeline of the new coronavirus pandemic, from China’s first COBID-19 cast to present 7 Global News. Coronavirus outbreak: A timeline of how COVID-19 spread around the world.

8 Statement on the meeting of the international health regulations. (2020, January 23). World Health Organization. https://www.who.int/news-room/detail/23-01-2020-statement-on-the-meeting-of-the-international-health-regulations(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov)

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countries and 4,291 deaths. The Director General of the WHO stated that there was concern with the level and severity of the spread of COVID-19 as well as the “alarming levels of inaction” .9 The Public health definition of a pandemic is when the epidemic is occurring in several regions, countries, or continents and affecting large groups of people, therefore the public health definition had been met weeks earlier.

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World Health Organization Director-General’s opening remarks at the media briefing on COVID-19- 11 March 2020..

(2020, March 11). Retrieved from https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19--11-march-2020

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