The World Health Organization on Wednesday declared the rapidly spreading coronavirus outbreak a pandemic, acknowledging what has seemed clear for some time — the virus will likely spread to all countries on the globe.




















































Director-General Tedros Adhanom Ghebreyesus said the situation will worsen.
“We expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher,” said Tedros, as the director-general is known.
As of Wednesday, 114 countries have reported that 118,000 have contracted Covid-19, the disease caused by the virus, known as SARS-CoV2. Nearly 4,300 people have died.
In the United States, where for weeks state and local laboratories could not test for the virus, just over 1,000 cases have been diagnosed and 29 people have died. But authorities here warn continuing limits on testing mean the full scale of spread in this country is not yet known.
The virus causes mild respiratory infections in about 80% of those infected, though about half will have pneumonia. Another 15% develop severe illness, and 5% need critical care.
WHO officials had said earlier they were hesitant to call the outbreak a pandemic in case it led governments and individuals to give up the fight. On Wednesday, they stressed that fundamental public health interventions can still limit the spread of the virus and drive down cases even where it was transmitting widely, as the work of authorities and communities in China, Singapore, and South Korea has shown.
“Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this coronavirus,” Tedros said at the WHO’s headquarters in Geneva, in making the announcement. “It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”
At the same time, Tedros said: “This is not just a public health crisis, it is a crisis that will touch every sector — so every sector and every individual must be involved in the fight.”
Tedros said this was the first coronavirus to reach pandemic levels, but also said “we have never before seen a pandemic that can be controlled.”
The virus, which probably originated in bats but passed to people via an as yet unrecognized intermediary animal species, is believed to have started infecting people in Wuhan, China, in late November or early December. Since then the virus has raced around the globe.
While China appears on the verge of stopping its outbreak — it reported only 24 cases on Tuesday — outbreaks are occurring and growing in a number of locations around the world including Italy, Iran, and the United States.
South Korea, which has reported nearly 8,000 cases, also appears poised to bring its outbreak under control with aggressive measures and widespread testing. But other countries have struggled to follow the leads of China and South Korea — a reality that has frustrated WHO officials who have exhorted the world to do everything possible to end transmission of the virus.
“We cannot say this loudly enough or clearly enough or often enough: All countries can still change the course of this pandemic,” Tedros said Wednesday.
Tedros used the fact that 90% of the cumulative cases have been reported in just four countries as evidence that the rest of the world still had time to prevent an explosion of cases with action.
WHO officials also stressed that countries should be implementing a strategic combination of both containment and mitigation measures. The former involves trying to detect and stop known chains of transmission by isolating cases and following and potentially quarantining their contacts. Mitigation involves community-level steps like social distancing and comes into play when the virus is spreading more broadly and transmission chains can’t be tracked. They dismissed questions that such efforts are too costly or resource-intensive, given what countries could face if they do not slow the spread of the disease.
“What we’re seeing is successful are the fundamentals of public health,” said Maria Van Kerkhove, who heads WHO’s emerging diseases and zoonoses unit. Countries need to test and ensure their laboratories and hospitals are ready. They need to have plans for how to handle mild cases differently than severe cases. And individuals need to play a role as well, she said, including by washing their hands and keeping away from others if they might be sick.
“By protecting themselves, they’re preventing the onward transmission, which may lead to another vulnerable person,” Van Kerkhove said. Vulnerable populations include older people and people with existing health problems, who face higher risks of more severe infections and death.
Mike Ryan, the head of the WHO’s emergency program, said that the public health interventions might not stop the virus in its tracks, but that slowing the spread of the virus — or “flattening the curve” — was vital to avoiding an overwhelmed health system. People with severe cases can require long periods of critical care and strain the resources of hospitals. He said he was worried about “the case load, the demand on the health workers, the dangers that come with fatigue, and potentially shortages of [personal protective equipment]. We all must move quickly.”
Tedros at one point spoke of a lack in some countries of resources, capacity, and resolve. WHO officials have argued for weeks that some countries were not moving rapidly enough to prepare for an outbreak or responding aggressively enough.
When asked which countries they were referring to, the officials declined to criticize individual member states publicly. But they noted the failures in some countries to trace contacts, to communicate clearly, to be able to test widely, and to coordinate among agencies and between federal governments and states or provinces.
The U.S. response has been hampered by several of those problems.
“You know who you are,” Ryan said about the countries that were not responding adequately.