COVID-19 - Did the WHO fail in controlling the global pandemic?

As the world combats COVID-19, questions are being raised on the competence of the World Health Organization (WHO) to issue safety guidelines that could have saved lives. The WHO declared coronavirus a pandemic on January 30, 2020 and followed this with measures such as social distancing and self-isolation aimed at containing its spread; however, this proved too late and too little. Moreover, it did not emphasize on the criticality of testing, crucial to controlling the pandemic.

Introduction
COVID-19 primarily affects the respiratory system. The usual symptoms are fever, cough, shortness of breath, and sore throat. The infection can be transmitted through close contact with the infected person and contaminated surfaces. China, the epicenter of the disease, managed to control it by conducting extensive screening and implementing complete lockdown; consequently, the number of infected people in the country has been declining. However, due to its negligence initially, the disease spread, affecting more than 200 countries and regions and infecting 1,859,000. It had claimed 114,700 lives until April 13, 2020. While the Chinese government needs to take the blame, another organization that has come under scrutiny is the World Health Organization (WHO). Recently, 169 new cases have been identified in China, following the lifting of ban on international travel; this indicates that the Chinese government and WHO are again downplaying the severity of the COVID-19 crisis. Furthermore, the US, which contributes 15% to the WHO's funding, has announced that it is going to stop the funds in a bid to penalize the organization for mismanaging the situation and covering up the spread. All pointers indicate that the WHO and Chinese government irresponsibly handled the outbreak in the initial stages, thereby allowing it to snowball into a pandemic that has nearly crushed the global economy and infected more 1.6 million people worldwide. The WHO's lax approach has raised questions about its relevance as a global authority, one that failed to deliver on the very premise it is built.

WHO guidelines
The WHO announced an interim set of operational guidelines on April 2nd, 2020, for member states, as follows:

1. Creating an investigative team – Clearly defining its composition, providing it the necessary tools, and ensuring its protection
2. Managing cases and contacts – Collecting test specimens, ensuring effective communication of risks
3. Tracing contact
4. Reporting and conducting further investigations

However, the first set of guidelines, announced on January 10th, 2020, were primarily focused on surveillance. In a span of just 10 days, from January 1st, a total of 41 cases had been reported. Ideally, the focus should have been on containing the spread. Furthermore, after January 13th, when the first case was reported outside China, international borders should have been sealed immediately to prevent the disease from spreading; yet, not prompt action was taken.

This raises the question: why was there a delay in circulating critical guidelines that could have been effective in controlling the pandemic in the initial stage?
In the light of the lack of timely response, we strongly believe the WHO has failed as an authority to monitor, control and guide the world in its fight against a deadly virus.

Delay in setting robust guidelines – Who is at fault?
The WHO initially claimed COVID-19 was not a major threat. It declared the outbreak a Public Health Emergency of International Concern (PHEIC) after a month (i.e., on January 30th, 2020), but by then it had affected around 11,791 people in 27 countries worldwide.

The WHO and China were both equally negligent in ascertaining the criticality of the situation. On January 14th, 2020, the WHO declared that COVID-19 did not appear to be transmitted through human interaction. This was based on the information it received from China. However, countries with previous outbreaks (SARS, MERS) reached different conclusions. Taiwan’s CDC approached the WHO via UN’s International Health Regulations to notify the organization of its suspicions about China withholding facts and figures on the disease. It also pointed out that the virus could spread through human contact. The WHO disregarded this information then, which has cost the world dearly in terms of loss of lives, livelihood, economy and much more.

The factors above indicate the WHO’s bias toward Beijing, its top contributor. The organization’s negligence toward issuing effective guidelines on time proved to be very costly for countries such as the US, UK, and other European nations that solely relied on information provided by it to prepare for the situation.

The impact

1. Countries with no prior experience
   The US, UK, Italy, France, Spain and Germany are among the countries most affected by the crisis, the common factor across these nations apart from their inexperience was underestimating the severity of the disease:

   1. Italy - Equipped with best healthcare facilities, had 162,488 infected people and 21,067 reported deaths until April 15th, 2020
   2. UK - Hesitation to impose stricter restrictions to keep the economy running adopted wait and watch policy; believed the country could contain the spread by developing herd immunity and push the pandemic curve to the right/flatten it. Result of this delay led to 93,873 people affected with 12,107 deaths reported till April 15th, 2020.
   3. US - US also turned a blind eye to the severity of the disease in its initial phase, they underutilized their testing capabilities, communication gaps between the CDC and State Health authorities; apart from delay in communication from the WHO, another factor was loopholes in the data reporting process adopted by Federal and State agencies.
      Also, the non-cohesiveness between the Federal and State agencies to implement policies that would have proved detrimental in controlling the pandemic in the US leading to 614,246 people affected with more than 26,000 deaths reported till April 15th, 2020.

   Eventually, these nations turned to countries with previous experience in dealing with epidemics (SARS and MERS), such as Singapore, Taiwan, and Hong Kong, and applied the learnings. By following simple, basic protocols and imposing strict restrictions on movement, these countries reported a relatively low number of cases.

2. Countries with learnings from SARS and MERS outbreaks:

   South Asian countries have been able to control the situation better than those which relied on the WHO. The steps they took were:

   1. Taiwan
      1. Intensive screening – The first country to correctly assess the status; started screening people travelling from Wuhan even before the Chinese government acknowledged the spread of coronavirus
      2. Sealed international borders – Before the WHO declared COVID-19 a pandemic, suspended all flights from China and started contact tracing of people with a history of travel history from that region
      Outcome: Registered only 378 cases and 3 deaths, while 67 had recovered by April 8th, 2020
   2. Vietnam - Halted all flights from China and shut down schools in the initial month of January 2020 itself
   3. Hong Kong – Ensured people strictly adhered to hygiene measures declared by the government; prohibited social gathering; implemented WFH; shut down schools swiftly
   4. UAE – Adopted case identification and contact tracing to effectively check the spread, in line with extensive screening approach; conducted 12,738 coronavirus tests per million compared to South Korea, which carried out 5,567 coronavirus tests per million
   5. South Korea –
      1. Extensive testing – Implemented an expansive and well-organized testing program
      2. Contact tracing – Personal data (such as credit card usage, hotel check-ins, etc.) analyzed for contact tracing disclosed on social media to determine contact with any infected person on the way and ascertain risk zones
      3. Commercialization of testing kits – Commercialized testing kits fast; first test approved on February 7th, when the worldwide count of confirmed cases was as low as 34,546
3. Countries with no prior experiences but were quick to act:
   1. India - No experience with SARS/MERS, but was quick to assess the situation, learn from its neighboring countries and respond accordingly. The country started screening international travelers on points of entry such as airports and railway stations and imposed a 21-day nationwide lockdown which has been extended by 19 days. Given its population of 1.3 billion, this was a big step in its fight against COVID-19. Also, the country has capacity to conduct 10,000 COVID-19 tests per day which can be increased with the help of private players.
   2. Other countries - Iceland, the Czech Republic and Mongolia have also scaled up their testing capabilities. Iceland can test 10,405 people per million, while the Government of Mongolia mobilized a taskforce of 832 individuals to monitor 336 checkpoints countrywide as early as February 23rd, 2020.

How to contain the infection?
Aggressive testing holds the key to control the situation. PCR-based testing is employed currently to determine the presence of coronavirus; the principle it works on is detecting RNA associated with COVID-19 virus to establish its presence.
PCR tests are accurate with turnaround time varying from few hours to couple of days; the method is useful as a confirmatory test as well as for surveillance and epidemiologic research.
However, there are certain disadvantages associated with PCR-based testing –

1. It can only be conducted by a skilled technician.
2. It has a longer turnaround time for results compared to other rapid diagnostic tests.
3. It does not distinguish between people who are currently infected and people who developed immunity.

To address these challenges, researchers are developing serological tests based on antibodies. These have short turnaround time, are easy to handle, can be done at home and can identify people with immunity against COVID-19.

Future of WHO?
In the fight against COVID-19, some countries have fared better than others in terms of controlling its spread. Those with prior experience in dealing with similar epidemics, have leveraged their knowhow in coming up with apt preventive measures and ensuring medical facilities are well equipped to tackle another respiratory virus outbreak. For those without any experience, lack of timely guidance from the WHO exacerbated the situation, for the measures they took fell short of meeting the requirement. COVID-19 is not the first life threatening disease that has wreaked havoc the world over, nor is it likely to be the last. In tackling such calamities, what is of utmost importance is that global health authorities like the WHO ensure they remain committed to the very cause for which they have been established. They need to rise above partisan politics and do the needful in a timely manner, or else it will not be long before their relevance is questioned.