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12 March 2020updated 08 Apr 2020 8:52pm

Why did the World Health Organisation wait so long to declare coronavirus a pandemic?

Having tried to avoid panic, the international body now believes that complacency is the bigger danger. 

By Laura Spinney

Yesterday, on 11 March, the director-general of the World Health Organisation (WHO), Tedros Adhanom Ghebreyesus, or Tedros as he is known, declared the Covid-19 outbreak a pandemic – that is, according to the WHO’s definition, “the worldwide spread of a new disease”.

The decision was taken, he explained, because the WHO was “deeply concerned” by the severity and rate of spread of the disease, and by the alarming levels of inaction.

While the rate of new infections has been declining in China, the number of cases outside that country has increased 13-fold in the past two weeks and the number of countries affected has tripled. There are now more than 127,000 cases in 125 countries – the world has 195 countries – and 4,292 people have died. “In the days and weeks ahead, we expect to see the number of cases, the number of deaths, and the number of affected countries climb even higher,” Tedros said.

The WHO has been widely criticised for not declaring a pandemic earlier. But the organisation had declared a global health emergency on 30 January, acknowledging then that the crisis corresponded to the maximum level of threat. That decision unlocked all the WHO’s available powers and resources for addressing the crisis. So then why declare a pandemic now?

The key is those “alarming levels of inaction”. The WHO knows that panic is counterproductive, but that complacency is too. If in the past few weeks it has tried to avoid panic, it now judges that complacency is the bigger danger.

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“We cannot say this loudly enough, or clearly enough, or often enough: all countries can still change the course of this pandemic,” Tedros insisted. “If countries detect, test, treat, isolate, trace, and mobilise their people in the response, those with a handful of cases can prevent those cases becoming clusters, and those clusters becoming community transmission.”

“Declaring a pandemic does change the alert system in many countries, in addition to changing ordinary people’s psychology,” says Annalies Wilder-Smith, a professor of emerging infectious diseases at the London School of Hygiene and Tropical Medicine. Asked if the declaration had come too late, she pointed out that the WHO was criticised for declaring a pandemic too early during the 2009 swine flu pandemic, which US Centres for Disease Control and Prevention estimates killed around 284,000 people worldwide – relatively few compared to previous flu pandemics. It has been careful not to make the same mistake again. “I think that Dr Tedros chose the right timing: not too early, not too late.”

Too many people are treating Covid-19 like flu, says Wilder-Smith. Although the Chinese data suggest the symptoms are mild in 80 per cent of cases, 14 per cent of patients are severely ill and 5 per cent are critically ill. The elderly and those with underlying conditions are particularly vulnerable – but not only them. Because pneumonia is common for those with severe cases of coronavirus, the burden on intensive care units is much higher than for flu.

Across Europe, hospitals are busy preparing themselves for the coming wave of illness, while in parts of northern Italy they are already struggling to cope. But not all governments are showing the kind of joined-up thinking that is going to be necessary to minimise the pandemic’s impact, says Wilder-Smith – and that Singapore and Hong Kong, now widely held up as models of good Covid-19 management, have been practising.

Last night in Paris, for example, the Uefa Champions League football match between Paris Saint-Germain (PSG) and the German side Dortmund was played in an empty stadium, but more than 3,000 PSG fans gathered outside to celebrate their team’s victory – with the blessing of the police. In Britain, the NHS helpline was criticised earlier this week for not advising British citizens returning from northern Italy to self-isolate.

Public health experts agree that managing the pandemic in the coming weeks and months will require coherent government responses and for individuals to realise they can make a difference if they act in a socially responsible manner. “It’s doable,” Tedros said.

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