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The World Has a Plan to Fight Coronavirus. Most Countries Are Not Using it. The World Has a Plan to Fight Coronavirus. Most Countries Are Not Using it.
(1 day later)
For weeks, the World Health Organization resisted declaring the coronavirus outbreak a pandemic, fearing that doing so would incite panic across the globe.For weeks, the World Health Organization resisted declaring the coronavirus outbreak a pandemic, fearing that doing so would incite panic across the globe.
But facing the cameras on Wednesday, the agency’s director general, Dr. Tedros Adhanom Ghebreyesus, did just that, asking for global unity to “change the course of this pandemic.”But facing the cameras on Wednesday, the agency’s director general, Dr. Tedros Adhanom Ghebreyesus, did just that, asking for global unity to “change the course of this pandemic.”
It was a symbolic moment that underscored the standing of the W.H.O. as the world’s leading public health agency. But it also reflected the W.H.O.’s underlying weakness as an organization that by international treaty is supposed to lead and coordinate the global fight against coronavirus — yet that has, in many ways, been marginalized.It was a symbolic moment that underscored the standing of the W.H.O. as the world’s leading public health agency. But it also reflected the W.H.O.’s underlying weakness as an organization that by international treaty is supposed to lead and coordinate the global fight against coronavirus — yet that has, in many ways, been marginalized.
Global solidarity has been noticeably absent in the fight to stop an outbreak that has already killed more than 4,300 people and spread to more than 110 countries. No one seems to be in charge. There doesn’t seem to be a plan.Global solidarity has been noticeably absent in the fight to stop an outbreak that has already killed more than 4,300 people and spread to more than 110 countries. No one seems to be in charge. There doesn’t seem to be a plan.
[Read: As its coronavirus cases dwindle, China is turning its focus outward.][Read: As its coronavirus cases dwindle, China is turning its focus outward.]
Except there is one. The problem is that relatively few countries are paying much attention to it.Except there is one. The problem is that relatively few countries are paying much attention to it.
Fifteen years ago, the World Health Organization undertook a major revision of the International Health Regulations, the global framework for responding to outbreaks. The revision was intended to correct flaws in the global response to the 2003 SARS outbreak, which killed hundreds of people and pushed advanced health care systems to the breaking point.Fifteen years ago, the World Health Organization undertook a major revision of the International Health Regulations, the global framework for responding to outbreaks. The revision was intended to correct flaws in the global response to the 2003 SARS outbreak, which killed hundreds of people and pushed advanced health care systems to the breaking point.
The basic idea was that the W.H.O. would serve as a central coordinating body. Countries would notify the agency about outbreaks and share information to help scientists address an epidemic at the global level. The W.H.O. would coordinate efforts on containment, declare emergencies and make recommendations. The revised regulation is legally binding and has been signed by 196 countries, including the United States.The basic idea was that the W.H.O. would serve as a central coordinating body. Countries would notify the agency about outbreaks and share information to help scientists address an epidemic at the global level. The W.H.O. would coordinate efforts on containment, declare emergencies and make recommendations. The revised regulation is legally binding and has been signed by 196 countries, including the United States.
But dozens of countries are flouting the international regulations and snubbing their obligations. Some have failed to report outbreaks to the organization, as required. Others have instituted international travel restrictions, against the advice of the W.H.O., and without notifying global health officials.But dozens of countries are flouting the international regulations and snubbing their obligations. Some have failed to report outbreaks to the organization, as required. Others have instituted international travel restrictions, against the advice of the W.H.O., and without notifying global health officials.
“One of the biggest challenges we face is that too many affected countries are still not sharing data with W.H.O.,” Dr. Tedros said last month. He has also blamed some countries — he has refused to specify which ones — for failing to take the outbreak seriously enough.“One of the biggest challenges we face is that too many affected countries are still not sharing data with W.H.O.,” Dr. Tedros said last month. He has also blamed some countries — he has refused to specify which ones — for failing to take the outbreak seriously enough.
As part of the United Nations, the W.H.O. is broadly influential yet hampered by budget and political pressures. It lacks meaningful enforcement authority, creating a telling power imbalance. It is often accused of kowtowing to its donors — from powerful players like the United States and China to private funders like the Gates Foundation.As part of the United Nations, the W.H.O. is broadly influential yet hampered by budget and political pressures. It lacks meaningful enforcement authority, creating a telling power imbalance. It is often accused of kowtowing to its donors — from powerful players like the United States and China to private funders like the Gates Foundation.
These contradictions contributed to the agency’s much-criticized response to the Ebola outbreak in West Africa and led some scholars to question the need for such a weak institution. But Rebecca Katz, a scholar at Georgetown University, said such criticism misses a fundamental point.These contradictions contributed to the agency’s much-criticized response to the Ebola outbreak in West Africa and led some scholars to question the need for such a weak institution. But Rebecca Katz, a scholar at Georgetown University, said such criticism misses a fundamental point.
“If there wasn’t a W.H.O., you’d have to invent it,” said Dr. Katz, who has studied health regulations for more than a decade. “They are in a bit of a tough spot because you know you have international law but then you also know that every nation is sovereign,” she said.“If there wasn’t a W.H.O., you’d have to invent it,” said Dr. Katz, who has studied health regulations for more than a decade. “They are in a bit of a tough spot because you know you have international law but then you also know that every nation is sovereign,” she said.
This time, some former critics credit the W.H.O. for doing a better job, declaring a global emergency much quicker than it did during the SARS and Ebola outbreaks, consistently sharing information with the public and convening more than 300 scientists and research funders to help develop tests, vaccines and medicines.This time, some former critics credit the W.H.O. for doing a better job, declaring a global emergency much quicker than it did during the SARS and Ebola outbreaks, consistently sharing information with the public and convening more than 300 scientists and research funders to help develop tests, vaccines and medicines.
Even so, the agency is also marginalized in many ways.Even so, the agency is also marginalized in many ways.
The most obvious examples are the global flouting of international travel restrictions. More than 70 countries have instituted the restrictions, according to the W.H.O., including the United States, where President Trump announced on Wednesday night restrictions to travel from the European continent.The most obvious examples are the global flouting of international travel restrictions. More than 70 countries have instituted the restrictions, according to the W.H.O., including the United States, where President Trump announced on Wednesday night restrictions to travel from the European continent.
Yet in four advisories it has issued since early January, the W.H.O. has consistently advised against them, cautioning that limits on international movement during public health emergencies are unlikely to stop the pathogen’s spread.Yet in four advisories it has issued since early January, the W.H.O. has consistently advised against them, cautioning that limits on international movement during public health emergencies are unlikely to stop the pathogen’s spread.
The rules do not apply to domestic travel restrictions or to decisions made by private airlines, but the W.H.O. has repeatedly warned that international bans can block needed resources, or delay aid and technical support. Such restrictions are justified only at the beginning of an outbreak to buy nations time to prepare, the agency said. Beyond that, they are more likely to cause significant economic and social harm.The rules do not apply to domestic travel restrictions or to decisions made by private airlines, but the W.H.O. has repeatedly warned that international bans can block needed resources, or delay aid and technical support. Such restrictions are justified only at the beginning of an outbreak to buy nations time to prepare, the agency said. Beyond that, they are more likely to cause significant economic and social harm.
Meanwhile, only 45 of the more than 70 countries that have adopted international travel restrictions have fulfilled the requirement to report their actions to the agency, a spokesman said.Meanwhile, only 45 of the more than 70 countries that have adopted international travel restrictions have fulfilled the requirement to report their actions to the agency, a spokesman said.
Restricting travel “is a good political placebo. It’s going to make people feel safe,” said Clare Wenham at the London School of Economics, a scholar who has studied the health regulations for more than a decade. “Why are we not learning that this doesn’t work?” Dr. Wenham asked about travel restrictions.Restricting travel “is a good political placebo. It’s going to make people feel safe,” said Clare Wenham at the London School of Economics, a scholar who has studied the health regulations for more than a decade. “Why are we not learning that this doesn’t work?” Dr. Wenham asked about travel restrictions.
W.H.O. itself has sent out mixed signals in recent weeks. In a report it issued this week, the agency said that some travel restrictions “may have delayed the importation of new cases.” But W.H.O. did not change its fundamental opposition to international restrictions or revise its travel advisory.W.H.O. itself has sent out mixed signals in recent weeks. In a report it issued this week, the agency said that some travel restrictions “may have delayed the importation of new cases.” But W.H.O. did not change its fundamental opposition to international restrictions or revise its travel advisory.
Then there is the unwillingness of some countries to lift a ban on the export of protective equipment, complicating the broader fight against the disease. France and Germany have put limits on exports of such gear.Then there is the unwillingness of some countries to lift a ban on the export of protective equipment, complicating the broader fight against the disease. France and Germany have put limits on exports of such gear.
“We can understand that governments have a primary responsibility to their own health workers,” said Michael Ryan, who heads the W.H.O.’s health emergencies program.“We can understand that governments have a primary responsibility to their own health workers,” said Michael Ryan, who heads the W.H.O.’s health emergencies program.
He urged nations to stop hoarding gear and called for solidarity across the globe.He urged nations to stop hoarding gear and called for solidarity across the globe.
“The life of a health worker in one country is certainly as valued as the life of a health worker in another,” Dr. Ryan said on Monday.“The life of a health worker in one country is certainly as valued as the life of a health worker in another,” Dr. Ryan said on Monday.
The national governments that signed onto the international regulation also left themselves a loophole, which they are exploiting now.The national governments that signed onto the international regulation also left themselves a loophole, which they are exploiting now.
The loophole was the product of hours of negotiations in Geneva, where the revisions were finalized in 2005, according to Gian Luca Burci, who served as the agency’s legal counsel for 11 years. Mr. Burci said negotiators stayed up until 5 a.m. before agreeing on a trade-off that balanced “public health considerations and the retention of the ultimate political power.”The loophole was the product of hours of negotiations in Geneva, where the revisions were finalized in 2005, according to Gian Luca Burci, who served as the agency’s legal counsel for 11 years. Mr. Burci said negotiators stayed up until 5 a.m. before agreeing on a trade-off that balanced “public health considerations and the retention of the ultimate political power.”
Countries were reluctant to cede total control to an international agency. They drafted a provision that gave them the right to take health measures that they believed would have similar or better results than W.H.O. recommendations — on the premise that these measures were scientifically grounded and for the common good.Countries were reluctant to cede total control to an international agency. They drafted a provision that gave them the right to take health measures that they believed would have similar or better results than W.H.O. recommendations — on the premise that these measures were scientifically grounded and for the common good.
“States gave themselves a ‘get-out-of-jail-free’ card,” Mr. Burci said.“States gave themselves a ‘get-out-of-jail-free’ card,” Mr. Burci said.
Under the rules, countries are obligated to report to the health agency within 48 hours any measures that they take beyond the collective guidelines, as well as report the rationale behind their actions. Many countries have failed to do so during the coronavirus outbreak, and the W.H.O. can do little about it.Under the rules, countries are obligated to report to the health agency within 48 hours any measures that they take beyond the collective guidelines, as well as report the rationale behind their actions. Many countries have failed to do so during the coronavirus outbreak, and the W.H.O. can do little about it.
In some cases, W.H.O. officials learned of travel shutdowns only after they happened, from reports in the media.In some cases, W.H.O. officials learned of travel shutdowns only after they happened, from reports in the media.
Updated June 1, 2020 Updated June 2, 2020
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
“What do we really mean if nobody is following W.H.O.’s recommendation with impunity,” Mr. Burci asked.“What do we really mean if nobody is following W.H.O.’s recommendation with impunity,” Mr. Burci asked.
Because they have no power to enforce international regulations, W.H.O. officials have to walk a diplomatic tightrope. In a statement, a W.H.O. spokesman said that the agency “cannot compel countries to change measures they have implemented.”Because they have no power to enforce international regulations, W.H.O. officials have to walk a diplomatic tightrope. In a statement, a W.H.O. spokesman said that the agency “cannot compel countries to change measures they have implemented.”
Last month, Dr. Tedros sent two letters, which have not been made public, reminding nations about their obligations. His staff has collated media reports on the flurry of travel restrictions and is chasing after countries to obtain their rationale.Last month, Dr. Tedros sent two letters, which have not been made public, reminding nations about their obligations. His staff has collated media reports on the flurry of travel restrictions and is chasing after countries to obtain their rationale.
Agency officials have resisted naming and shaming countries that breach the rules and have largely dodged media questions on the subject.Agency officials have resisted naming and shaming countries that breach the rules and have largely dodged media questions on the subject.
“The W.H.O. doesn’t interact in public debate or criticize our member states in public,” Dr. Ryan said on Wednesday when asked which countries had failed to rise to the occasion.“The W.H.O. doesn’t interact in public debate or criticize our member states in public,” Dr. Ryan said on Wednesday when asked which countries had failed to rise to the occasion.
“You know who you are,” Dr. Ryan said.“You know who you are,” Dr. Ryan said.
Part of that hesitation comes down to money, said Ashish Jha, a director of Harvard Global Health Institute. The organization has said that it needs $675 million to fund its response to the coronavirus outbreaks. As of this week, nations have pledged to donate about $300 million.Part of that hesitation comes down to money, said Ashish Jha, a director of Harvard Global Health Institute. The organization has said that it needs $675 million to fund its response to the coronavirus outbreaks. As of this week, nations have pledged to donate about $300 million.
“W.H.O. is at the mercy of its member states,” Dr. Jha said. “Countries don’t have to listen.”“W.H.O. is at the mercy of its member states,” Dr. Jha said. “Countries don’t have to listen.”
Even as the agency struggles to nudge member states to comply with the regulations, the coronavirus pandemic poses major questions for the future. One pressing question is on how the world will cope if an outbreak develops in countries with underdeveloped health care systems.Even as the agency struggles to nudge member states to comply with the regulations, the coronavirus pandemic poses major questions for the future. One pressing question is on how the world will cope if an outbreak develops in countries with underdeveloped health care systems.
Two-thirds of the world’s countries lack the necessary laboratories and surveillance systems to detect outbreaks and comply with international regulations. The Group of 7 has pledged to help poorer nations but has not always followed through.Two-thirds of the world’s countries lack the necessary laboratories and surveillance systems to detect outbreaks and comply with international regulations. The Group of 7 has pledged to help poorer nations but has not always followed through.
The world is not ready for “a fast-moving, virulent respiratory pathogen pandemic,” a W.H.O. report said last year.The world is not ready for “a fast-moving, virulent respiratory pathogen pandemic,” a W.H.O. report said last year.
Dr. Katz, the Georgetown scholar, said stronger international regulations would help prepare for such an outbreak.Dr. Katz, the Georgetown scholar, said stronger international regulations would help prepare for such an outbreak.
“This is what we have. This is the agreement we have. This is the organization we have,” she said.“This is what we have. This is the agreement we have. This is the organization we have,” she said.