Enlarge /. A pedestrian with a protective mask stands on Mission Street in San Francisco, California on Thursday, February 27, 2020. California monitors 8,400 people for signs of the virus after their trip to Asia.
With the dizzying international spread of the novel corona virus, the World Health Organization announced on Friday that the global threat from COVID-19 has increased. According to the latest estimates by the organization, the risk of spreading and the risk of impacts has meanwhile increased worldwide from "high" to "very high".
Between Thursday and Friday, five other countries identified their first cases – Belarus, Lithuania, the Netherlands, New Zealand and Nigeria – and large outbreaks in Italy (888 cases) and Iran (388 cases) continued to export cases. So far, at least 24 cases in 14 countries are associated with Italy and at least 97 cases in 11 countries with Iran, the WHO reported on Friday.
There are more than 85,400 cases and 2,924 deaths worldwide, with 53 countries reporting cases in addition to China as of Saturday morning. While China still has over 90 percent of these cases, the daily case numbers outside of China now exceed those inside China.
China reported 331 new cases on Friday, while 1,027 cases were reported elsewhere, according to the latest WHO report. The largest outbreak outside of China is currently in South Korea, where 3,150 cases have been reported. Italy has the second largest group of cases, followed by the Diamond Princess outbreak, which has now reached 705 cases.
The proliferation and increasing number of cases outside of China are "clearly worrying," said WHO Director General Tedros Adhanom Ghebreyesus at a press conference on Friday.
While this increased the risk, he and his colleagues at WHO also saw reason to be hopeful: most of the cases that arise in new locations can clearly be traced back to known contacts and case groups – for example from Italy and Iran.
"We do not yet see any evidence that the virus is spreading freely in the communities," said Dr. Tedros on Friday. "As long as this remains the case, we still have the ability to contain this virus – if robust measures are taken to identify cases early, isolate and care for patients, and track contacts."
And there is clear evidence that containment can work. In addition to China's dramatic drop in cases this month, eight countries with identified cases have passed two weeks without reporting new cases, Dr. Tedros. At the time of publication on Saturday, 15 of the 53 countries with cases reported only one new case. Another 19 countries with 10 or fewer cases.
In addition, Dr. Tedro attaches great importance to putting global cases in the right light: There are about 6,000 cases among the more than 6 billion people outside of China.
This virus is serious and dangerous, but it can be present, Dr. emphasized. Tedros.
In fact, the step towards increasing the threat level should convey precisely this point, said Dr. Michael Ryan, executive director of the WHO's Health Emergency Program, in the briefing.
“This is a reality check for every government on the planet: wake up. Getting ready. This virus may be on the move and you need to be ready. You have a duty to your citizens, you have a duty to the world to be ready, and I think that says this warning. It is said that we can avoid the worst, but our concern is highest. "
Such a willingness to avoid the worst has so far not been seen in the United States.
As of Saturday morning, the United States has reported four COVID-19 cases that could represent cases of spread in the community. That said, the four people may have infected people in their own community because the virus has spread undetected to the public. In all four cases, the infected people had no known travel exposure and had no contact with a person known to be infected.
It is an alarming sign that the United States, despite its importance on the world stage and the time it has taken to prepare, is unable to detect and contain the virus.
Of the four cases, two are in California, one in Oregon and another in Washington State. Three of the cases (with the exception of one in California) are currently suspected, which means that state health officials have tested and found patients positive, but are still pending final confirmation by CDC tests.
When all cases are confirmed, the number of the country is at least 66. There are 44 passengers returned by the Diamond Princess and three people returned from Wuhan, China, where the outbreak started in December.
Thirteen cases appear to be travel-related, and two other cases were person-to-person in the United States based on a known travel-related case.
The four remaining cases may have been common in the community. One of these cases – a California woman living in Solano County – was announced earlier this week. The news cycle was still fluctuating when news of the other three cases came late Friday.
The case of the Solano County woman is particularly worrying as it shows several weaknesses in the country's COVID-19 readiness. The woman was reportedly checked in to a local hospital with flu-like symptoms on February 15. The patient was initially suspected of having COVID-19. However, the woman was not tested until February 25th, mainly due to the low availability of tests and federal recommendations that the tests focus on people with known exposure (and she had no known exposure). Between that time, her condition worsened and she was intubated and connected to a ventilator.
The first significant weakness is the low availability of tests, which were mainly performed in laboratories operated by the disease control and prevention centers. The agency has sent test kits to states, but some states have reported problems with their kits. The CDC tried to fix an unspecified bug in the kits, but the process was slow. So far, the CDC has reported testing 459 people, which is only a fraction of the number tested in other countries.
"This was not going as smoothly as we would have liked," said Dr. Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, at a press conference on Friday. She reported that the CDC had found a workaround that would allow states to step up testing.
Increased testing capacity is critical to identifying new cases and preventing the virus from spreading further in the United States, particularly with the possibility of spreading within the community – and the community in which the first case was identified shows further weakness out.
The first case of possible community expansion occurred in Solano County, California, where hundreds of repatriated citizens, who were at high risk of transmitting the virus, happened to be quarantined. Repatriated citizens arrived at Travis Air Force Base in Solano in early February, a week or two before the woman developed symptoms. The potential community that spreads near high-risk residential areas increases the possibility that the quarantine has failed.
This concern was compounded by news of a whistleblower allegation that the Department of Health and Human Services was sending untrained personnel without adequate protective equipment to deal with these high-risk repatriated citizens. If so, HHS puts employees at risk of contracting the virus and then spreading it to their families and communities.
According to the whistleblower's complaint, 13 unprepared personnel were sent to Travis Air Force Base, Solano, between February 2nd and 7th, when airplanes arrived with repatriated citizens. The complaint alleges that employees were not tested for coronavirus afterwards and returned to their normal offices and duties. Some took commercial flights back to their stations in various unspecified parts of the country.
The CDC did not answer any questions from Ars regarding the potential for quarantine at Travis Air Force Base to be closed.
The three other cases that may be common in the community appear to be unrelated to the Solano woman, according to the Washington Post. One case concerns a 65-year-old woman from Santa Clara County, California. The Oregon case involved a Washington County person who had spent some time in a primary school near Portland. This school has now been closed for cleaning. The Washington state case involves a student from Snohomish County north of Seattle. This student's school has also been closed and students with known contacts are isolated at home for 14 days.
The cases are an alarming sign that the United States has failed to deliver and is already out of control of the virus.
Last week's reports expressed concern about another weakness in the country's readiness – that information about the virus and the situation in the United States may be censored by the Trump administration. According to a Friday report in the New York Times, all statements and appearances by federal officials about the coronavirus – including those from CDC officials – must now be filtered through Vice President Mike Pence's office, which President Trump appointed on Wednesday to the coronavirus response to lead.
The move has reportedly taken on leading experts, particularly Dr. Anthony Fauci, one of the country's leading experts in viruses and infectious diseases and director of the National Institute for Allergy and Infectious Diseases. According to the Times, Dr. Fauci told his colleagues that the White House had instructed him not to do anything else without permission.
Dr. also sounded Messonnier's comments in the CDC briefing on Friday were more careful than normal and contained a striking reference to President Trump. It was the first time that the CDC referred the President to COVID-19 cases after copies of the briefings.
"As always, President Trump and our top priority are the health and safety of the American people," said Dr. Messonnier in her opening speech on Friday.
The CDC declined an invitation from Ars to comment on the reported censorship.
According to the CDC's transcription archive, Dr. Messonnier only mentioned the word "Trump" on another occasion on February 3 when she said: "And what I saw in such situations, science should surely surpass everything else. "