This is puzzling many people. COVID19 is now in every continent. So why don't they call COVID19 a pandemic? You are right, if a flu outbreak got this far, the WHO would say it is a pandemic, for sure, indeed they would have called it a global pandemic weeks ago.

Definition: a pandemic (as the WHO use the word) is a disease that is spreading by community transmission throughout the world with no possibility of stopping it by quarantine. A viral pandemic can only be stopped with vaccines. Meanwhile you do your best to protect the most vulnerable from it.

But this is not spreading like a pandemic. Take India: India has 3 cases, all recovered, If this was a flu pandemic India would have tens of thousands of cases by now, for sure. It doesn't fit the same picture. Something is different.

Take for example the 2009 flu pandemic in India - it had 44987 lab confirmed cases and 2728 deaths. This has not happened yet with COVID19 and so far there is no sign that it will. Something is different about COVID19. Most countries are managing to stop it very quickly with the first few cases.

Look at say Seattle - one of the first cases in the US was there. One case, recovered, no other cases in Seattle or Washington State.

This is a common pattern in countries once they put the precautions in place.

Egypt has one case also recovered, with no new infections - this was the first case in Africa.

The second case in Africa is in Algeria, and again it is only one case, and the patient there is also in isolation.

Brazil has 1 case. But this may well be its only case,He is now under isolation at home, and in stable condition after being treated

The UK has 13 cases, and 8 have already recovered.

You can explore the map here, the situation is the same for most of the countries with cases:

If the cases are detected early and quarantine put in place promptly then it often just stops right away. This is just not what you expect for a pandemic.

Many people with COVID19 don’t pass it on to anyone, while a few pass it on to many, the so called “superspreaders” just because of habits, e.g. very social, lots of friends, and the situation they are in. This is what we are seeing with the countries. Some just have 1 case - they were not infected by a superspreader. Others get a big cluster and that seed was started by a superspreader.

Italy, and Iran were not prepared enough for immediate fast response. They were also a bit unlucky, Italy had a superspreader who infected many and had no obvious connection with China. They missed the patient 0 who maybe had only mild symptoms, and clearly never knew they had it. Iran's case may be similar - the details are not clear yet.

South Korea is a special situation with a church where there was a lot of close contact, hugging and singing together, leading to a lot of community transmission but just within the church.

Italy and South Korea are working on containing COVID19 following the Chinese model.

Iran stopped religious gatherings because they found that they were the main cause of the spread. I don't know what else the have done, but the WHO are there today. We will hear what they are doing soon, probably with the next WHO press conference.

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EXPECT CASES TO INCREASE

When you see the news about increasing cases in these places - don’t be alarmed. It increases rapidly doubling every three days or so until containment is in place. Italy has just put in strict containment, and as of writing this has 374 cases. 12 deaths, only 1 recovered:

The WHO have praised Italy for their quick response. But expect it to increase by several hundred more, maybe to over 1000 in Italy just from those already infected.

Several thousand cases in Italy by mid march would be no surprise and it still can be contained at that point.

Similarly don’t be scared if South Korea, or Iran also get several thousand cases. Many of those will be ones already infected and if there are a few slip through the net, it doesn’t matter so long as they have brought down the numbers enough so that each old case infects on average less than one new case.

Singapore, has 91 cases, and 62 recovered. It expanded fast to start with. Now Singapore adds at most a few cases per day.

Also Singapore has excellent medical care. Everyone with a fever, cough , pneumonia etc in Singapore who goes for treatment is tested for many different respiratory viruses. The COVID19 got there in the last week of January and since then they have added it to the list of viruses to check. Outside the known chains, all the cases test negative. If there was significant hidden symptomless spreading, then it would surface here and there throughout Singapore with more serious cases. This is just not happening.

For details and cites see my:

Hong Kong and many provinces in China are reporting the same. Opportunistic tests of large samples of patients who seek treatment for respiratory diseases, as large as 10,000 and 50,000 cases in China just don’t show the extra cases you’d expect if there were symptomless spreaders. They do miss a few but the number they are missing have to be very small.

There is a lot of independent evidence that these hidden cases don’t exist (or are not significant - you could have symptomless infected people but if they don’t infect anyone else it would make no difference to the picture).

China now have a serology test, testing blood serum for antibodies, nearly ready. This will let them do population studies to find not just those with the virus also those that had it and are now over it, which will give much more detailed understanding of these processes. But either way whatever is happening outside of the known cases doesn’t seem to be significant in propelling the outbreak.

You don’t have to get everyone. You just need to significantly reduce the number of new cases infected for each old one to well below 1 and it will stop quickly.

In the early stages these new clusters often double every 3 days until the people get used to dealing with it.

China has 24 provinces that yesterday reported no new cases which used to have many a day.

It is just not behaving like flu. So they don't call it a pandemic.

With flu then they are familiar with how it works and they can call it a pandemic early when hardly anyone has it.

They can do that because from past experience, they know it is unstoppable at a certain point. That is why they are getting so much stick for not calling this a pandemic.

But it is not flu as they keep saying.

So they can't use the same criteria.

These are some of the key differences:

  • Flu has about 1 in 3 symptomless spreaders - they don’t have any symptoms and wherever they go they pass on the disease to others. COVID19 so far has no evidence of symptomless spreaders
  • For flu, children are affected and they infect others at school. Though children do get COVID19, for some reason they rarely get it bad and don’t seem to infect anyone else.
  • Flu spreads through the community, COVID19 mainly spreads through households e.g. one family visiting another and other very close contact situations where normally they know each other. This makes contact tracing much easier and though they can’t find everyone they can find nearly all contacts which is all you need to reduce the R0 number way down.

It is also partly a mind set thing. Up to now nobody thought that such a way of containing a respiratory disease could work. The experts themselves outside China were deeply skeptical that it would work. It wouldn’t work for flu but it did for this.

Perhaps it would work for other coronaviruses too, and even for colds (if we wanted to eliminate them)?

Anyway now we have this mindset, countries around the world are copying the chinese example and finding it works.

With the European Commission donation of $123 million then the WHO can build resilience into Africa and other countries with weaker health care, so that they can use similar methods too once they have it there as is inevitable.

We now have the first case in Algeria today and in Brazil. These can be contained in the same way.

The details vary for each country, how to do it ,but China showed the way - that it is possible. China now have vast experience in this too and the doctors and health workers and experts in China are eager to share their findings and expertise with the rest of the world.

Sources for the Corona Virus

WHAT YOU MUST DO IF YOU ARE IN AN AFFECTED AREA

From: LIVE #AskWHO on #COVID19 with @mvankerkhove #coronavirus

What you must do if you are in an affected area:

  • Wash your hands frequently - and your children too
  • When you sneeze or cough sneeze or cough in a folded elbow. Or use a tissue, and when used, throw it away and wash your hands.
  • Make sure you have the latest information about COVID19 from your parents, from WHO, from trusted sources - this is a rapidly changing situation and every day learn more and more and the more we learn the more we want you to know
  • Wear a mask if you are sick, if you have respiratory symptoms - using it to protect other people
  • If your mask gets very wet at the front you have to replace it. Don’t touch the front, take them off at the sides and discard in a covered bin and put on a new one.

Casey Carmichael: Why not a quarantine longer than 14 days?

  • Contact trace and follow for 14 days upper end of incubation period. We believe most will show symptoms after 5–6 days. There are possibly outliers - but we look for case pairs - very hard to do - constantly looking at data and we are very firm and confident at this upper bound.

Symptoms:

  • Dry cough. Shortness of breath. Very few runny nose and sneeze. Just come back from China and from more than 70,000 cases very few runny nose or sneeze.
  • Shortness of breath or chest pain - need to seek medical help quickly.

Tests in mass way?

  • From start of outbreak working very hard to have PCR tests - take a sample from your nose and down your throat to determine if you have COVID19. Available RNA sequence within a week of the start. Usually takes hours to a day to get results back.
  • Working hard for point of care or bedside test in minutes - not quite there yet but lots working hard to make it quicker

Is it airborne?

  • No, it transits via droplets. These particles drop - that’s why we say 1–2 meters - anything beyond they don’t disperse.
  • In health care facilities - sometimes have to do procedures on very sick people intubation - more than 1–2 meters - airborne precautions for healthcare workers but ordinary situations no

Difference between flu?

  • Not flu. Very hard to tell if it is flu or COVID19 in early stages. Transmits differently, who is infected, very serious disease. 80% mild disease and will recover. 20% go on to severe disease and require advanced care. Many with severe disease now going on to cover. It doesn’t mean you will die, it means you need the right care and very good chance of survival.

Severe disease

  • Start with mild disease. What we look for are risk factors - individuals with underlying medical conditions, older age - people over 60 with cardiovascular disease, chronic respiratory disease, diabetes, higher risk of severe disease.

Can virus particles survive inside parcels

  • Some studies look at virus survival - how long can you detect a live virus on a surface. Not full results yet. From SARS and MERS - doesn’t last long on cardboard. On other surfaces like plastic - can be killed by disinfectants - normally ones with bleach

WHO site - guidance - coronavirus

How to find out if there are cases near you?

  • In some countries, big data, see on a map if there are cases nearby you. Watch news talk to parents, loved one, health care provider. Lots of good information online but also lots of bad information online. Situation reports on WHO.

Even if somebody in next house has Coronavirus if you do the sensible things to protect yourself you are alright. No tin the air circulating around.

Seen in China overwhelming involvement of community - this is very powerful.

You can do this, take control to protect yourself and your family. Everyone in China really working to fight this disease.

Q. Flu vaccine

  • Will not protect against COVID19 but will for flu

SARS vaccine in development in some years - and MERS - taking the work they have done for those pathogens and using to develop vaccines for COVID19

Q. If a person contracts COVID19 and goes to pneumonia - treated with antibiotics?

  • Normally mild disease -including mild pneumonia. Antibiotics won’t work against a virus but may have co-infection of bacteria and will work against that.

Q. how to detect?

  • If feeling unwell stay at home for a few days. If fever or shortness of breath seek health care early. Talk to health care provider and they will probably ask where you have been - and been to a place where there is COVID19 transmission - not everywhere. Then take a sample - a little uncomfortable but not painful. Test might take a while in a laboratory but know within 24 - 48 hours. If concerned probably asked to stay in isolation.

Q. reinfection

  • I am not aware of people being reinfected. Sick for some time, matter of weeks. When they recover, not heard of anyone being reinfected. But very early days, 7 weeks very quick. Lots of knowledge every day so is one of the questions we have.

Q. What about asymptomatic transmission

  • Most will have mild disease, some severe, some die. Some individuals very mild disease and some will shed viruses. We have cases not asymptomatic but presymptomatic. We often find they were not truly asymptomatic none at all - but were not feeling very well. Feeling like a train hit you but wondering if you just over did it the night before.

    We do have some reports of truly asymptomatic - it is very rare but possible. Not a major driver of transmission - not the people to fear.

Q. What will lit do in warmer than cooler temperatures

  • We are learning in different countries. Lots of cases in China, vast majority still. Colder climates. Guangdong - do see transmission. Too early to say if outer temperature is a factor. Need to assume for now that it can transmit everywhere.

Q. What should you do when traveling?

  • To protect while traveling - travel when well, wash your hands, respiratory hygiene, eating cooked food or wash before consuming. Wear mask if you yourself are ill, fi you have respiratory symptoms

Q. Many children affected?

  • Big report from China 50,000 cases, I think 2% were among children, very low number. In flu children are really important, in COVID19 not. Don’t know why yet. Even if infected only mild disease

Q. can be transmitted from pets or chickens?

  • Lots of investigations underway - not found in animals. Believe it in wild animals. No evidence in pets or between pets and people - or chickens

Q. Any treatments help people get better quickly

  • Really important studies done in the right way - look at appropriate use compared to others. No results yet but over 100 clinical trials some Western some Traditional Chinese Medicine - in patients with patient consent

Q. What about swimming pools.

  • You can use them just fine, many have chlorine, not aware of any transmission in swimming pools - and are happening in places with swimming pools.

We talk about people infected and not infected and ask “What did you do” and learn risk factors of infection. Travel history, jobs, ..

What are the risk factors?

  • For severe disease - cardiovascular, diabetes, underlying respiratory disease, older age

Q. Should we stop our kids going to school?

  • Depends where you live. Lots of schools closed in China and opening soon. Here where there is no transmission perfectly safe to send children to school

Q. What if work colleague has fever and coughing and refuses to seek help

  • It is flu season, lots of people who have it - talk to colleague - important seek health care if they have chest pain, breathing

Q. Ask employer about what to do if you are no longer able to work in office

  • Talk to everyone about getting ready - what would you need to do if it showed work - lots of ways can work at home if possible with your job - talk to family - lots of good information about what this is and what it isn’t.

Young children, parents stay at home and look after children - need to discuss with employers what to do.

Read about this look at website, latest information at hand.

Q. how tell difference common cold and coronavirus

  • In area where circulating - call medical facility. If shortness of breath then call medical facility say where you have been

Q. Can it spread through drinking water.

  • It cannot spread through drinking water.

Q. Touching surfaces - paper plastic and cardboard surfaces - do you recommend wearing gloves

  • Important to makes sure you wash hands thoroughly, soap and water or

Q. Aerosol transmission from flushing toilet.

  • Good to close the lid before flushing the toilet to make sure nothing else spreads - but not the virus.

LIVE #AskWHO on #COVID19 with @mvankerkhove #coronavirus

Short summaries:

Wash your hands

  • after coughing or sneezing
  • when caring for the sick
  • before during and after you prepare food
  • before eating
  • after toilet use
  • when hands are visibly dirty
  • after handling animals or animal waste

When coughing or sneezing

  • cover mouth and nose with flexed elbow or tissue
  • Throw tissue into closed bin immediately after use
  • clean hands with alcohol-based hand rub or soap and water after coughing or sneezing and when caring for the sick

  • Avoid close contact when you are experiencing cough and fever
  • Avoid spitting in public
  • If you have fever, cough and difficulty breathing seek medical care early and share previous travel history with your health care provider

How to cope with stress during the outbreak

  • It is normal to feel sad, stressed, confused, scared or angry during a crisis
  • Talking to people you trust can help. Contact your friends and family.
  • If you must stay at home, maintain a healthy lifestyle - including proper diet, sleep, exercise and social contacts with loved ones at home and by email and phone with other family and friends
  • Don’t use smoking, alcohol, or other drugs to deal with your emotions
  • If you feel overwhelmed, talk to a health care worker or counselor. Have a plan, where to go to and how to seek help for physical and mental health needs if required
  • Get the facts. Gather information that will help you accurately determine your risk so that you can take reasonable precautions. Find a credible source you can trust such as WHO website or a local or state public health agency
  • Limit worry and agitation by lessening the time you and your family spend watching or listening to media coverage that you perceive as upsetting
  • Draw on skills you have used in the past that have helped you to manage previous life’s adversities and use those skills to help you manage your emotions during the challenging time of this outbreak.

Advice for public (WHO)

See also my

(also has a list of my other COVID19 posts on Quora.

WHO COVID19 pages

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