Pandemic? WHO Notes That Outside China, 81% of Coronavirus Cases Are in Just Four Countries

Patrick Goodenough | March 2, 2020 | 7:09pm EST
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Japanese police officers in Tokyo on Sunday. (Photo by Philip Fong/AFP via Getty Images)
Japanese police officers in Tokyo on Sunday. (Photo by Philip Fong/AFP via Getty Images)

( – Ninety percent of confirmed cases of the novel coronavirus worldwide have been in China, mostly in a single province, and in the other 65 countries affected as of Monday, 81 percent of cases are limited to just four countries – South Korea, Italy, Iran and Japan.

Of the remaining 61 affected countries, 19 have reported just one COVID-19 case each to date, and another 20 have reported fewer than ten cases each.

Furthermore, eight affected countries (Vietnam, Philippines, Cambodia, Russia, Belgium, India, Nepal, Sri Lanka) have not reported any new cases in two weeks or more, indicating containment is working in those countries.

Citing such figures, and other reasons, the World Health Organization continues to hold off on naming the outbreak a global “pandemic,” while saying it will not hesitate to do so if the evidence points to such a situation.

In the U.S., the White House coronavirus taskforce is following the WHO’s lead on the matter.

“There’s many definitions that people use around ‘pandemic’ and one issue that the WHO is focused on is just sheer magnitude,” Health and Human Services Secretary Alex Azar said at a White House briefing on Monday evening.

Despite the very large spread of cases within China, he said, “the actual absolute number of cases outside of China, while reflecting community spreading, are not of the magnitude comparable to any other pandemics that have been declared before – even the H1N1 [influenza] where you have billions of individuals infected across the world.”

Azar, who spoke earlier in the day to WHO secretary-general Tedros Adhanom Ghebreyesus to get the WHO’s thinking on the matter, said, “We don’t have a view as to whether they should designate it a pandemic or not a pandemic.”

“Our view is that would be for the World Health Organization to define,” said Vice President Mike Pence, in charge of the national response to the outbreak. “This isn’t so much about semantics. I think our briefing today was we’re in more than 60 countries at this point. And so we’re going to continue to focus on ensuring that we do all we can to prevent people coming into the country with the disease, to mitigate any spread of the disease once we identify cases, and of course, to provide treatment.”

Speaking at a humanitarian forum in Riyadh at the weekend, Tedros said of the pandemic question, “We don’t see intensive and sustained community transmission in multiple countries.”

He added that the current clusters in South Korea, Iran, and Italy may move in that direction, or the situation may change in other countries, thereby meeting the WHO definition of a pandemic.

Asked to clarify that definition, Tedros said a pandemic requires sustained “community transmission” in multiple countries.

The term “community transmission” is being widely used around the world in the context of  COVID-19, but WHO has a specific definition: “community transmission is evidenced by the inability to relate confirmed cases through chains of transmission for a large number of cases.”

WHO differentiates between “community transmission” and “local transmissions,” a term which it uses to indicate “locations where the source of infection is within the reporting location.”

So for the current outbreak, the WHO says that 26 countries (including the United States) have reported “local transmission,” while the rest are all “imported cases only.”

WHO designated the H1N1 swine flu outbreak in 2009 as a global pandemic, and explained that it had done so because human-to-human spread and community-level outbreaks were reported in at least two WHO regions.

Currently, COVID-19 cases are present in all six geographic regions recognized by the WHO – Asia, Americas, Eastern Mediterranean, Europe, South-East Asia and Western Pacific.

A baby is vaccinated against H1N1 flu in France in 2009. (Photo by Johanna Leguerre/AFP via Getty Images)
A baby is vaccinated against H1N1 flu in France in 2009. (Photo by Johanna Leguerre/AFP via Getty Images)

However, compared to worldwide 88,948 total COVID-19 cases and 3,043 deaths (as of Monday), the CDC estimated that there were 60.8 million cases of H1N1 in the U.S. alone in the one-year period April 2009-April 2010.

And CDC experts estimated that the H1N1 death toll worldwide over that same 12-month period was 201,200 respiratory deaths plus an additional 83300 cardiovascular deaths.

The CDC refers to three criteria for a pandemic – a disease that kills; that has sustained person-to-person spread; and that involves worldwide spread.

“The fact that this disease has caused illness, including illness resulting in death, and sustained person-to-person spread is concerning,” it says on its website in relation to COVID-19. “These factors meet two of the criteria of a pandemic. As community spread is detected in more and more countries, the world moves closer toward meeting the third criteria, worldwide spread of the new virus.”

The U.S. taskforce members stressed, again, that the risk to Americans is low.

“Things can change. But right now, today, on this day, Monday, if you look at the country as a whole, the risk is low,” said Anthony Fauci, director of the NIH’s National Institute of Allergy and Infectious Diseases.

“We want people to go about and live their normal lives in this nation right now,” said CDC director Dr. Robert Redfield. “There’s no travel restrictions in the United States.”


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