The Korean government recently lifted the alert level to the highest in the four-tiered system to prevent the spread of the new coronavirus, but some critics said the move was too hasty.
Critics said China, where the first confirmed case of the COVID-19 infection occurred, did not declare the highest alert level across the country. Just because new confirmed cases spiked centering mostly on the Shincheonji Church in Daegu and Daenam Hospital in Cheongdo, near Daegu, did not have to mean the government had to raise the virus crisis level to the highest, they said.
The World Health Organization (WHO) said Korea could handle the crisis, and the coronavirus outbreak has yet to meet the criteria for a pandemic.
Why WHO says coronavirus outbreak is not pandemic
Under the International Health Regulations (IHR), the WHO declares Public Health Emergency of International Concern (PHEIC) when an international spread of disease threatens the public health of other countries.
Conditions for a PHEIC declaration include two or more of the followings: if a disease’s impact on the public health is serious; if an event is unusual or unexpected; if there is a high risk of transmissions between countries; and if there is a significant risk of restricting international trade or international travel.
Even if the disease meets only one condition, the WHO can hold an urgent meeting of the emergency committee to recommend a declaration of PHEIC. So far, the WHO has declared PHEIC six times, including the H1N1 (or swine flu) pandemic in 2009, Ebola declaration in 2014, and the ongoing new coronavirus outbreak in 2020.
The latest PHEIC declaration on the COVID-19 outbreak was considered “phase 4,” out of six phases of the alert. Phase 4 means the risk of human-to-human transmission is significant, and the disease is at the early stage of a pandemic.
The WHO’s pandemic phase is divided by six – animal-to-animal infection in phase 1, transmissions among a small number of humans in phase 2, transmissions among many people in phase 3, an epidemic in community-level outbreaks in phase 4, community-level outbreaks in two or more countries in phase 5, and a pandemic in two or more regions of the world.
The WHO declared the highest alert at phase 6 only one time – during the swine flu in 2009.
WHO Director-General Tedros Adhanom Ghebreyesus said in a briefing Wednesday that the world could still control the outbreaks of the new coronavirus, and the disease was not a pandemic yet.
Calling the COVID-19 a pandemic was equal to sending a signal that the authorities could not control the virus anymore, and using the word without careful analysis would not be beneficial at all, Ghebreyesus added.
The use of the word pandemic should be prudent because it can amplify irrational fear and stigma, and paralyze each nation's system, he noted.
How different is COVID-19 from 2009 swine flu?
Then, how can we assess the current COVID-19 outbreak, compared to the flu pandemic in 2009?
In Korea, the health authorities hold a crisis evaluation meeting to declare the infectious disease crisis alert. The disease alert level has four stages – interest (blue), caution (yellow), alert (orange) and serious (red). Blue is for observing a new infectious disease outbreak overseas. Yellow is declared when the disease occurs in Korea. Orange is for local transmissions of the disease in a limited region. Red is for local transmissions across the nation.
During the flu pandemic in 2009, the government declared caution (yellow) on May 1, 2009. Two months later, it raised the level to alert (orange). When the first death occurred on Aug. 15, local transmissions began in earnest. However, it was Nov. 3 when the government raised the alert level to the highest of serious (red). It took six months from the first confirmed case to the declaration of the highest alert level.
The 2009 flu outbreak claimed 263 lives and infected 750,000 people in Korea. However, Tamiflu was available to treat the patients, and a vaccine against H1N1 influenza came out. The immunization against the swine flu started in November. The treatment and the vaccine began to reduce the number of infections and deaths.
During the new coronavirus outbreak in early 2020, the government moved faster to raise the alert levels. On Jan. 8, when a 36-year-old Chinese woman showed similar symptoms of mysterious pneumonia reported in China, the nation declared interest (blue). As the nation confirmed the first case of COVID-19 on Jan. 20 involving a 35-year-old woman who had lived in Wuhan, China, the authorities lifted the level to caution (yellow). A week later, on Jan. 27 when new confirmed cases rose to four, the level went up one more notch to alert (orange).
As new confirmed cases surged in Daegu and North Gyeongsang Province, the government again raised the alert level to the highest, serious (red). It took less than a month to raise the level to the highest.
In contrast, China was slow to lift the alert levels. Beijing applied the highest alert level only to 30 provinces and local districts on Jan. 21. As of Feb. 23, the authorities instead lowered the emergency coronavirus response measures in four provinces -- Yunnan, Guangdong, Shanxi, and Guizhou.
The problem is that COVID-19 has no vaccine or treatment.
Although the government raised the threat level to the highest, which had to accompany mid-to-long-term measures, the only difference in disease control was to divert the authority to contain the disease from the Minister of Health and Welfare to Prime Minister, critics said.
The government recently restricted group events, the use of collective facilities, suspended schools and childcare centers, and recommended work adjustments at companies, state-run institutions, and private organizations. However, those measures were possible even without raising the alert level to the highest, critics noted.
‘Government had to prevent local governments’ disease control failure’
Other observers said the central government had to lift the crisis level to the highest because local governments did not fully cooperate in sanitizing their communities.
When the nation should contain local transmissions, not only the health authorities but local autonomous governments should take aggressive actions.
However, local governments were slow to cooperate, and the raising of the alert level was a preemptive measure to prevent any failure to control the spread of the disease, experts said.
Jeong Eun-kyeong, director of the Korea Centers for Disease Control and Prevention, said lifting the alert level to the highest was to block the disease spread from Daegu and North Gyeongsang Province to other regions of the nation.
Particularly as many members of the Shincheonji Church in Daegu contracted the disease, the cooperation of the local government was crucial. Still, the lack of epidemiological investigation at the local level made the central government raise the alert level, sources said.
“If we fail to control the Daegu situation, it will become like Hubei Province in China,” an infectious disease specialist said. “What we do about Daegu will be the key to whether Korea can survive this outbreak or not.”
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