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Surgical intensive care – current and future challenges? | Editorial | Qatar Medical Journal.

[Open Access] [Received: 17 June 2019; Accepted: 04 September 2019; Published online: 13 January 2020]

Authors: Stefan Alfred Hubertus Rohrig, Marcus D. Lance, M. Faisal Malmstrom.

Bjorn Ibsen, an anesthetist who pioneered positive pressure ventilation as a treatment option during the Copenhagen polio epidemic of 1952, set up the first Intensive Care Unit (ICU) in Europe in 1953. He managed polio patients on positive pressure ventilation together with physicians and physiologists in a dedicated ward, where one nurse was assigned to each patient. In that sense Ibsen is more or less the father of intensive care medicine as a specialty and also an advocate of the one-to-one nursing ratio for critically ill patients.

Nowadays, the Surgical Intensive Care Unit (SICU) offers critical care treatment to unstable, severely, or potentially severely ill patients in the perioperative setting, who have life-threatening conditions and require comprehensive care, constant monitoring, and possible emergency interventions. Hence there is one very specific challenge in the surgical setting: the intensivist has to manage the patient flow starting from admission to the hospital through to the operating theater, in the SICU, and postoperatively for the discharge to the ward. In other words, the planning of the resources (most frequently availability of beds) has to be optimized to prevent cancellations of elective surgical procedures but also to facilitate other emergency admissions. SICU intensivists take the role of arbitrators between surgical demand and patient's interests. This means they supervise the safety, efficacy, and workability of the process with respect to all stakeholders. This notion was reported in 2007 when Stawicki and co-workers performed a small prospective study concluding that it appears safe if the dedicated intensivist takes over the role of the last arbitrator supported by a multidisciplinary team.1

However, demographic changes in many countries during the last few decades have given rise to populations which are more elderly and sicker than before. This impacts on the healthcare system in general but on the intensivist and the ICU team too. In addition, in a society with an increased life expectancy, the balance between treatable disease, outcome, and utilization of resources must be maintained. This fact gains even more importance as patients and their families claim “high end” treatment.

Such a demand is reflected looking at the developments that have taken place over the last 25 years. Mainly, the focus of intensive care medicine was on technical support or even replacement of failing organ systems such as the lungs, the heart, or the kidneys by veno-venous extracorporeal membrane oxygenation (VV-ECMO), veno-arterial ECMO (VA-ECMO), and continuous veno-venous hemofiltration (CVVH) respectively. This means “technical care” became a core capability and expectation of critical care medicine. In parallel, medical treatment became more standardized. For example, lung protective ventilation strategies, early enteral feeding, and daily sedation vacation are part of modern protocols. As a consequence, ventilator time has been reduced and patients therefore develop delirium less frequently. These measures, beside others, are implemented in care bundles to improve the quality of care of patients by the whole ICU team.

The importance of specialty trained teams was already pointed out 35 years ago when Li et al.,2 demonstrated in a study performed in a community hospital that the mortality was decreased if an ICU was managed 24/7 by an on-site physician. The association of improved outcomes and presence of a critical care trained physician (intensivist) has been shown in several studies since that time.3,4,5,6 A modern multidisciplinary critical care team consists at least of an intensivist, ICU nurse, pharmacist, respiratory therapist, physiotherapist, and the primary team physician. Based on clinical needs, the team can be supplemented by oncologists, cardiologists, or other specialties. Again, this approach is supported by research: a recent retrospective cohort study from the California Hospital Assessment and Reporting Taskforce (CHART) on 60,330 patients confirmed the association between improved patient outcome and such a multidisciplinary team.7

If such an intensive care team makes a difference, why do not all patients at risk receive advanced ICU-care? It was already demonstrated by Esteban et al., in a prospective study that patients with severe sepsis had a mortality rate of 26% when not admitted to an ICU in comparison to 11% when they were admitted to an ICU.8 Meanwhile, we know that early referral is particularly important, because for ischemic diseases the timing appears to make a difference in terms of full recovery.

So, the following questions arise: Should intensive care be rolled out to each ward and physical admission to an ICU or be restricted to special cases only? For this purpose, the so-called “Rapid Response Teams” (RRT) or “Medical Emergency Team” (MET), which essentially are a form of an ICU outreach team, were implemented. The name, composition, or exact role of such team varies from institution to institution and country to country. Alternatively, should all ward staff be educated to recognize sick patients earlier for a timely transfer to a dedicated area? This would mean that ICU-care would be introduced in the ward.

A first attempt to answer this question, whether to deploy critical care resources to deteriorating patients outside the ICU 24/7, was given by Churpek et al.9 The success of the rapid response teams could be related to decreased rates of cardiac arrest outside the ICU setting and in-hospital mortality. Interestingly, an analysis of the registry database of the RRT calls in this study showed that the lowest frequency of calls occurred between 1:00 AM to 6:59 AM time period. In contrast, the mortality was highest around 7 AM and lowest during noon hour. This indicates that not simply the availability of such a team makes a difference but also the alertness of the ward-teams is of high importance to identify deteriorating patients in a timely manner. Essentially, this would necessitate ward staff being trained to provide a higher level of care enabling them to better recognize when patients become sicker to avoid a delayed call to the ICU.

Alternatively, a system in which the intensivist plays a major role in daily ward rounds could be beneficial. So, the ward doctor should become an intensivist. However, the latter means the ICU is rolled out across the whole hospital which would consume a huge amount of resources.

Another option would be 24/7 remote monitoring of patients at risk that notifies the intensivist or RRT in case of need. The infrastructure, technology, and manpower to put this in place also has associated costs.

As the demand for ICU care will rise further in the future, intensivists will play an even more important role in the healthcare system that itself is under enormous economic pressure to ensure the best quality of care for critically ill patients. Besides excellent knowledge and hard skills, intensivists need to be team players, communicators, facilitators, and arbitrators to achieve the best results in collaboration with all involved in patient treatment.

© 2019 Rohrig, Lance, Faisal Malmstrom, licensee HBKU Press.

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School-based vaccination programmes: An evaluation of school immunisation delivery models in England in 2015/16 | Vaccine.

[Open Access] [Received 30 April 2019, Revised 8 January 2020, Accepted 9 January 2020, Available online 21 January 2020] [In Press, Corrected Proof]

Highlights.

* MenACWY and Td/IPV may result in high coverage if offered to the youngest cohort.

* National and local factors i.e. disease/vaccine perception may influence coverage.

* LAs with high HPV coverage in 2013/14 had higher coverage with 2 doses in 1 year.

* LAs with high HPV coverage also achieved high coverage for MenACWY and Td/IPV.

* Local capacity i.e. funding and experience predict the success of a model.

Abstract.

Schools are increasingly being used to deliver vaccines. In 2015/16 three school-based vaccination programmes were delivered to adolescents in England: human papillomavirus (HPV), meningococcal groups A, C, W and Y disease (MenACWY) and tetanus, diphtheria and polio (Td/IPV). We assessed how school delivery models impact vaccine coverage and how a delivery model for one programme may impact another. Routinely collected national data were analysed to ascertain the school grade achieving highest coverage within each one-dose programme and to compare two-dose delivery models (within year vs across years) for the HPV vaccine. We also assessed whether the HPV delivery model was associated with coverage in other programmes.

MenACWY and Td/IPV coverage was highest in younger school grades. Overall similar HPV coverage was achieved with both models (86.7% two doses within one year, 85.8% two doses across two years, p = 0.20). High two-dose HPV coverage in 2015/16 was reported in areas that achieved high HPV coverage in 2013/14 when three doses were required. Areas with high three-dose coverage in 2013/14 achieved higher coverage with a within-one-year approach (92.0% vs 85.2%, p < 0.001), whilst areas reporting low coverage in 2013/14 achieved lower but similar coverage in 2015/16 with both models (79.2% vs 80.9% p = 0.29). MenACWY and Td/IPV coverage were higher in areas with high HPV coverage in 2013/14. Among high HPV coverage areas, MenACWY coverage was higher when HPV doses were delivered within year.

School-based programmes should be offered as early as feasible and acceptable to optimise coverage. The choice of delivery model for HPV should take into account local performance and provider experience. Single providers may delivery multiple vaccines and the delivery for one programme may affect the performance of other programmes. Providers should consider local circumstances including past and current vaccine coverage and factors influencing coverage when deciding what delivery model to adopt.


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Pakistan: Tragedy continues to befall children: Polio cripples another child in Sindh | The News International.

[January 30, 2020] M Waqar Bhatti writes:

KARACHI: One more child has fallen victim to poliovirus in Sindh, taking the number of those crippled for life across the country by the dreaded disease across the country, poking holes into the efficacy of the govt backed the anti-polio campaign.

This was confirmed by Polio Eradication Initiative confirmed on Wednesday who announced that one more child was crippled by the Wild Polio Virus 1 in Ratodero area of Larkana, saying as the date of onset was in December 2019, it would be considered as a polio case of 2019. “A 26-month old male child from the Union Council Jumo Agham, Taluka Ratodero, Larkana has been crippled by the Wild Polio Virus 1 (WPV1),” an official of the Emergency Operation Center (EOC) Polio in Sindh said. With this new case the number of polio cases, in 2019 in Sindh reached 28 and 140 in the country, the EOC Sindh official said who added that only two children have were crippled by the Wild Polio Virus 1 in 2020 in Sindh.

The EOC Sindh official maintained that in the case of the latest polio case from Ratodero area of Larkana where 26-month-old male child, Waqar son of Wahid Bux Brohi was crippled by polio, the date of onset for the case is 24/12/2019 so it would be considered as a case of 2019. “Investigations into her vaccination history are ongoing, however, only three polio doses could be verified by EPI card. He is experiencing weakness in her right arm and leg,” the official added.

The long gap in the door to door campaigns during 2019 has clearly affected the immunity of children creating a large pool of vulnerable children and the fight to build their immunity and to reverse this trend is ongoing.

The first step was the successful Dec NID which was followed by a successful case response in Hyderabad, MPK, SBA, Sukkur and Larkana divisions in January during which 6 million children were given OPV. This would be followed with another national campaign in February and yet another in April. These campaigns and their success is extremely important to reduce the number of polio cases and remove the virus from the environment.

The current risk to our children is very real and while it is our job to deliver these vaccines at the doorstep, caregivers must also step up and protect the children through vaccinations.

The National EOC and Sindh EOC asked the parents to ensure the immunization of their children during both routine as well as the special campaigns in the next few months. The total case count for 2019 now stands at 140 for all of Pakistan and 28 for Sindh while the total case count for 2020 stands at 6 in Pakistan out of which 2 are from Sindh.


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Polio this week as of 29 January 2020 | GPEI via Reliefweb.

[30 Jan 2020] [Published on 29 Jan 2020 —View Original]

  • It is with profound sorrow that the WHO announces the sudden demise of Dr Peter Salama, who passed away on 24 January 2020. Dr Salama contributed to polio eradication at WHO through his work as Executive Director of the Health Emergencies Programme and most recently as Executive Director of the Division of Universal Health Coverage – Life Course. Read more

  • Want to know more about the new cVDPV2 strategy and nOPV2? have a look at the newly released fact-sheet which provides a summary of the current situation and the new tool under development.

  • With the evolving public health emergency associated with the increase in new emergences of circulating vaccine-derived poliovirus type 2, a draft decision has been made available for consideration by the Executive board. Read more

  • Summary of new viruses this week (AFP cases and environmental samples):

    • Afghanistan: three WPV1 positive environmental samples
    • Pakistan: six WPV1 cases, ten WPV1 positive environmental samples, four cVDPV2 cases and one cVDPV2 positive environmental sample
    • Nigeria: two cVDPV2 positive environmental samples
    • Democratic Republic of the Congo (DR Congo): two cVDPV2 cases
    • Somalia: three cVDPV2 positive environmental samples
    • Angola: 15 cVDPV2 cases
    • Ethiopia: one cVDPV2 positive environmental sample
    • Philippines: one cVDPV1 case
preview

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Pakistan: Polio problems | Editorial | Daily Times.

[JANUARY 31, 2020]

Polio problems are on the rise again. On Wednesday, three new cases were detected in three provinces while two health workers, both women, were killed in a drive-by shooting by motorcyclists in Razaar tehsil of Swabi. The workers were on work for a three-day immunisation drive in Swabi district. 2019 left the worst trail of polio cases in recent years, while 2020 has also started off on a dismal note. Of the three confirmed cases of the virus made public on Wednesday, two are stated to be from this year and one from last year. With this, the number of polio cases reported in 2019 has reached 140 and that for 2020 to six. Of the new year cases, one is from Khyber Pakhtunkhwa and another from Balochistan. It is unfortunate that an 11-month-old boy, of district and tehsil Tank, was reported positive for poliovirus. As per the National Institute of Health (NIH), the child’s lower limbs have been paralysed which means he will have to live a disabled life, all because of the criminal negligence of his parents. In Balochistan’s Nasirabad district, a 20-month male child, resident of Dera Murad Jamali tehsil’s Sikandarabad union council, will also live as a polio-hit patient for his whole life. From 2019, a 26-month-old boy, a resident of Larkana district, Ratodero tehsil, UC Jumo Agham, has been confirmed a polio positive case. Like the previous cases, the fresh cases also belong to poor families. These families are prone to propaganda against polio vaccination on the basis of religious and social influence.


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USA: Nevada: Interact Club donates $1,000 to fight polio | Laughlin Times.

[Source article may not be viewable in EU except via a suitable VPN]

[Jan 30, 2020]

INTERACT

The Laughlin High School Interact Club students presented a $1,000 donation to  David Talbot, of Crutches for Africa, to help Africans afflicted with polio and to distribute vaccines in an attempt to eradicate the disease.

Kane Wickham writes:

LAUGHLIN — The Laughlin High School Interact Club students raised $1,000  for Crutches for Africa, a nonprofit that seeks to aid Africans hit with the polio virus.

The Interact program is an offshoot of Rotary Clubs of America which has 20,372 clubs located in 159 countries with approximately 468,556 members worldwide. The mission behind the Interact program, according to the Rotary Club website is, to bring together young people ages 12-18 to develop leadership skills while discovering the power of service above self. 

The Laughlin Interact Club has done two projects for the year the first: raising $500 for the Purple Pinky project to combat polio in Africa through donations and food sales at the LHS homecoming, an accomplishment that earned members the right to see LHS Principal Dawn Estes and teacher Heidi Zenefski get to wear purple-dyed hair for a week around school. The Interact team assembled in Room 505 for a presentation by David Talbot of Crutches for Africa who was there to show the students exactly what the disease they have been fundraising to fight — polio — looks like in real life. Polio is a disease that most Americans in 2020 know little about. It was a major health issue in America back in the 1940s and ’50s until Jonas Salk and Albert Sabin’s successful vaccines came out in 1955. It remains a serious health issue for a few nations that still see the polio virus in their midst today such as Nigeria, Afghanistan and Pakistan. 

The LHS Interact students presented Talbot a check for $1,000 to aid in the ongoing battle to eradicate the disease from Africa where it does the most harm today. 

Talbot showed film footage of some modern-day African polio victims who often must crawl to move about on a daily basis. 

Others use wooden poles and wheelbarrows to get about. In Pakistan and Afghanistan, Talbot said, there are dangers associated with trying to bring help to those already suffering from polio and others who might contract the disease. 

He explained that in those nations the mistrust of the intentions of those who try and help fight the disease — especially Americans — runs deep. Many people in those nations suspect that the people who come to help fight the disease are either sterilizing the population or poisoning the populace they seek to treat.

Zenefski, advisor of the Interact Club at LHS, showed her obvious pride in her students who went the extra mile to help fight this debilitating disease by raising funds to aid those afflicted with it in Africa. She said, “These are the best students in the region.”

The $1,000  donation has the possibility of immunizing around 3,000 people in Africa as the vaccines now cost roughly about $1 for three doses, the cost of a Snickers candy bar, said Talbot. 

The donation also  may be used to purchase crutches, walkers and wheelchairs to be shipped to Africa for those already affected permanently by the disease, giving them the gift of mobility that they have never known in their lives.


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Malaysia: Lifesavers: Sandakan medical team’s hard work administering polio shots wins over social media | Malay Mail.

[Thursday, 30 Jan 2020 04:31 PM MYT]

A nurse giving out free polio vaccine to a baby. — Picture courtesy of Facebook/PKPKS.A nurse giving out free polio vaccine to a baby. — Picture courtesy of Facebook/PKPKS.

Anne Grace Savitha writes:

PETALING JAYA, January 30 — Going through dirt roads and pushing vehicles just to reach the people they serve are all in a day’s work for healthcare staff in Sandakan.

This is in addition to them carrying out their regular duties, including taking patients’ information and administering polio vaccination for babies.

Their hard work was recently brought to light on Facebook earlier this week when the page Promosi Kesihatan Pejabat Kawasan Sandakan (PKPKS) posted pictures of them doing their work.

[See source article for copies of Facebook posts]

The post was duly shared by another Facebook page, SandakanKini, that captioned pictures of the nurses on duty — “They deserve a raise of salary” referring to the dedication these nurses have put in by heading to the villages while carrying their medical equipment to serve the people staying in rural areas.

Nurses carrying their medical equipment in a village in Sandakan, Sabah. — Picture courtesy of Facebook/PKPKSNurses carrying their medical equipment in a village in Sandakan, Sabah. — Picture courtesy of Facebook/PKPKS

The free polio vaccine service was given in conjunction with the Sabah Polio Immunisation Campaign and was carried out since December 27 last year, by the health and rural clinics of Sandakan.

A report by Bernama disclosed that a total of 109,232 children in Sabah, of age five and below have been given the polio vaccine since January 25.

Last year, a three-month old boy from Tuaran, Sabah, was admitted to the intensive care unit (ICU) for poliomyelitis, and it was the first reported case in the country. This year, the number rose to three as two other boys were also affected by the disease.

Polio is a lethal disease caused by poliovirus, and it can spread from one person to another by infecting the spinal cord and causing paralysis.

Social media users were quick with their praise and voiced their appreciation to the medical team.

Facebook user, Surinda Amsa, commented on PKPKS post: “Congratulations on the work done, and may God bless you.”


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Pakistan: Safety Of Polio Workers | The Nation.

[30th January 2020]

Polio workers in Pakistan risk their lives every year to perform the task that the state allots to them. Becoming a polio worker is also synonymous with understanding the danger that comes with the job. Pakistan has become home to misconceptions about the polio vaccination and both, urban and rural population is unwilling to vaccinate their children. In some areas, the problem is quite extreme particularly in Khyber Pakhtunkhwa (KP). In the province of KP, we have witnessed multiple attacks on the polio workers in the last couple of years.

Prime Minister (PM) Imran Khan's polio eradication programme has also been initiated in the current term and polio workers face the same risks to their lives. A female polio worker has lost her life in Swabi after motorcyclists opened fire at them. Areas, where it is difficult to operate for the polio workers , must be brought under state scrutiny to help create awareness regarding the use of the vaccination. At the same time, people must also be made aware of the innocent loss of lives. These polio workers set out to perform duties in favour of the people of the state. If they are not provided safety, the loss of lives will never stop.

The safety of polio workers should be the agenda of the government, particularly when it is relying heavily on them to bring down the number of polio cases in the country. The government should collect data to understand what areas pose a threat to the safety of these workers and devise alternative plans to get the children vaccinated. At the same time, there is a need to initiate awareness campaigns in the country outlining why vaccination is important, discussing some of the misconceptions related to it, and government offices they can connect with if they have missed the vaccination.

It is important to fight misconceptions in this case because it is the primary cause of loss of lives in this case. Due to the gross misrepresentation of what the vaccination actually does, both educated and uneducated people are willing to skip vaccinating their children. The same mentality gives rise to the threat that these misconceptions pose to the lives of the health workers who are just doing what the state requires of them. This particular incident should not go unnoticed. Polio health workers become an easy target and these deaths go unquestioned despite the dedication these people show for their jobs.

The government should provide a safety net to the polio workers in the country so that they feel safe while performing their job. Along with increased safety, the government also needs to invest in awareness campaigns that will help reduce the stigma around the polio vaccination.


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WHO declares coronavirus outbreak a global health emergency | STAT.

[JANUARY 30, 2020]

WHO presser January 29
From left, WHO spokesman Tarik Jasarevic; Director-General Tedros Adhanom Ghebreyesus; Dr. Michael Ryan, emergency chief; and Maria Van Kerkhove, head of emerging diseases and zoonosis, attend a press briefing on the new coronavirus on Wednesday in Geneva.FABRICE COFFRINI/AFP VIA GETTY IMAGES

Andrew Joseph writes:

The World Health Organization on Thursday declared the outbreak of a novel coronavirus a global health emergency, an acknowledgement of the risk the virus poses to countries beyond its origin in China and of the need for a more coordinated international response to the outbreak.

“This is the time for science, not rumors,” WHO Director-General Tedros Adhanom Ghebreyesus said in making the announcement following a meeting of the agency’s emergency committee. “This is the time for solidarity not stigma.”

Tedros, as he is called, stressed the decision was not meant to criticize the Chinese response to the outbreak, which he and other WHO officials have gone out of the way to praise. Instead, he said, the declaration of a public health emergency of international concern, or PHEIC, is meant to help support less developed countries and to try to prevent the virus from spreading in those places that are less equipped to detect the disease and handle cases.

“We don’t know what sort of damage this virus could do if it spread in a country with a weaker health system,” Tedros said.

Last week, the committee had recommended that a PHEIC not be declared yet because of limited spread of the virus outside of China. Tedros reconvened the committee this week because some other countries, including Japan, Germany, Vietnam, and, as of Thursday, the United States, had reported limited human-to-human transmission of the virus — a warning sign that the virus could start circulating more broadly outside China.

Members of the emergency committee had previously been divided over whether to recommend Tedros declare a PHEIC. Those opposed seemed to want to see if China’s efforts to control the outbreak could preclude broader worldwide transmission. Some 99% of the global cases have been in China, and the large majority of infections in other countries have been in people who picked up the virus while in China and then traveled to the other nations.

As of Thursday morning, there have been more than 7,800 confirmed coronavirus infections around the world, all but 82 of which were in China. There have been 170 deaths, all in China. Infections caused by the coronavirus, provisionally called 2019-nCoV, were first reported in December in the central Chinese city of Wuhan, though it’s possible the virus was spreading among people there before then.

The declaration comes as individual countries have started to close borders and restrict trade to China, and as airlines have halted some flights. Experts say such measures are not effective in stopping the spread of a virus and may discourage countries experiencing outbreaks from being forthright. The PHEIC gives Tedros certain additional authorities, including the ability to urge countries not to limit travel and trade, though the recommendations do not have to be followed.

Still, the PHEIC could rally some global coordination for a more unified response. Dr. Michael Ryan, the WHO’s emergency chief, told reporters Wednesday that 194 countries implementing unilateral trade and travel restrictions was an economic, political, and social “recipe for disaster.”

As they initially held off on calling a PHEIC, WHO officials stressed that they and national health officials around the world had still mounted a wide-reaching and aggressive response to the outbreak. At a press conference Wednesday, they seemed to lament that so much attention was paid to the binary of whether something was a PHEIC or not a PHEIC. Tedros said he wished it was more like a stop light, with yellow serving as a warning.

It’s seen as “PHEIC, no PHEIC, either green or red,” Tedros said. “I think we have to revise that. It would be good to have the green, the yellow, and then the red, something in between. … There could be some intermediate situation.”

Also Thursday, the WHO said it plans on provisionally calling the disease caused by the virus “2019-nCoV acute respiratory disease” until officials settle on a name.

China has taken unprecedented steps to try to contain the outbreak, quarantining tens of millions of people in Wuhan and other cities by shutting down travel within, to, and from the areas. Experts, however, say, it’s not clear such massive efforts are likely to prove effective, given that the virus seems to be spreading in many locations in China and that the lockdowns could keep or drive people away from seeking care if they are sick.

In the United States, officials have been screening passengers arriving from Wuhan for signs of illness and informing them to call a health care provider if they start to get sick. (Officials from the Centers for Disease Control and Prevention have said the number of people arriving from Wuhan has dropped since China imposed the travel ban from there, but that they were continuing with their screening policies.) The CDC has also boosted surveillance at 20 entry points where officials are normally based in case an arriving traveler shows signs of a disease.

There had been five confirmed cases of the coronavirus in the United States, all related to travel to China. But just hours before the WHO declared the PHEIC, the CDC announced that one of those people — a woman in Illinois — had passed the virus on to her husband. U.S. officials had anticipated an incidence of such limited transmission and are working to prevent any broader spread of the virus.

WHO officials have said if sustained transmission of the virus occurs outside China, it becomes much harder to stop overall.

The virus can cause severe cases of pneumonia and milder cases of cough and fever, according to studies of early infections in Wuhan. It’s likely that authorities have not been able to keep track of many mild cases, including people who were not sick enough to seek care, and researchers have documented cases of the virus in people showing no symptoms.

It’s not clear if people need to be showing symptoms to pass the virus on, though even if asymptomatic people can spread the virus, they may be less likely to than people who are sneezing and coughing — routes for the virus to jump from one person to another.

Coronaviruses, a family that includes SARS and MERS, are thought to originate in bats and can jump from there or another animal to humans. Many of the early cases in Wuhan — though not all — were tied to a seafood market that also sold live animals for meat.

The emergence of a global coronavirus outbreak from China is reminiscent of the SARS outbreak of 2002 to 2003, which went on to kill nearly 800 people. The PHEIC designation was created following an update to the International Health Regulations after that outbreak.

The first PHEIC was declared for the 2009 H1N1 flu pandemic, and others have included the 2014-2016 West African Ebola outbreak and the Zika outbreak in 2016. The WHO set up an emergency committee to assess whether MERS should be declared a PHEIC, but it concluded after meeting several times that the disease did not constitute a global health emergency.

Ahead of WHO’s decision Thursday, there were two active PHEICs: the ongoing Ebola outbreak in the Democratic Republic of the Congo and the continued transmission of polio.

About the Author

Andrew Joseph

General Assignment Reporter

Andrew is a general assignment reporter.


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