The World Health Organization declared the coronavirus outbreak a global emergency Thursday after the number of cases spiked tenfold in a week, calling it an “extraordinary event” that endangers countries outside China and requires a coordinated international response.
This new declaration—made Thursday at the organization’s Geneva headquarters—will lead to more travel and trade restrictions on China. Already many companies in the US have shuttered their China offices, while airlines are canceling direct flights.
As of Thursday, the novel coronavirus known as 2019-nCoV has infected more than 7,800 people in China, killing 170 people. All told, 18 countries have confirmed cases, including eight in the United States.
The rapid, relentless rise in cases has public health experts wondering if the US is prepared for a SARS- or H1N1-type epidemic that could infect thousands of people across multiple states. Americans who’ve spent time in China are now returning to their home soil. The 201 Americans who were evacuated from Wuhan this week currently remain quarantined at a southern California military base. Meanwhile, university administrators have been telling foreign exchange students to leave China as soon as possible.
The coronavirus outbreak also coincides with peak winter flu season, and it’s unclear whether US hospitals have enough doctors and nurses to treat a potential surge in new patients. “The thing I’m most worried about is the capacity of hospitals and health clinics to handle the increase in patients,” says Jennifer Nuzzo, an epidemiologist and senior scholar at Johns Hopkins’ Center for Health Security. “It’s respiratory flu season right now, and if you go to any hospital they are stretched to the max.”
CDC officials said Wednesday they are monitoring 92 people in 36 states for the coronavirus; eight people have tested positive, including the first person-to-person transmission in the US. In past skirmishes with disease outbreaks, information gaps led to dangerous transmissions of disease. In 2015, for example, a Texas nurse became infected by the Ebola virus even though she was following the CDC guidelines at the time. After the incident, the CDC revised its guidelines for health care workers.
In China, health care workers are battling shortages of personal protective gear like masks, suits, and gloves. Given that most of these mass-produced medical supplies are made in Chinese factories, Nuzzo says, US health care workers could also be at risk if shortages persist. “The medical supply chain is generally thin, and there are some vulnerabilities there,” she says.
Because of the many unknowns surrounding the coronavirus’s infectiousness, many people might be spreading the disease without knowing it. “If you are exposed today and don’t show symptoms for 14 days, and are contagious for seven, then you are a spreader for seven days and don’t know to wear a mask,” says David Marcozzi, who managed emergency disease response at the National Security Council under the Obama administration.
Already some Americans have begun to hoard facemasks, even though the outbreak hasn’t reached a serious level, according to US public health officials. There is a backup, however, if the Chinese medical equipment shortages continue.
The 2020 federal budget includes $2.6 billion for the public health emergency fund, with $620 million for the Strategic National Stockpile, which is a repository of drugs, vaccines, and equipment like masks and syringes that stays hidden at undisclosed locations, and $258 million to prepare hospitals to handle emergencies.
Despite these numbers, overall funding for public health in general has fallen during both the Obama and Trump administrations, and the current appropriations aren’t enough to handle a serious epidemic, says Asha George, executive director of the Bipartisan Commission on Biodefense, a think tank that advises Congress on public health and security. “It’s hard to make something that’s not immediately visible a high priority,” George says. She says the US public health system is not prepared to handle an outbreak similar to the situation in China.
There’s also a question of who’s in charge. As of Wednesday, the White House had not designated any single individual to coordinate the administration’s response to the coronavirus outbreak, which has involved the Department of Health and Human Services as well as the state and defense departments. President Donald Trump hasn’t spoke publicly about the coronavirus outbreak since it began, but he tweeted this week that the US has offered help to China and that “our experts are extraordinary!”
But the real question is how countries with less established infrastructures might handle an outbreak. “The main reason for this declaration is not because of what has happened in China but because of what is happening in other countries,” said Tedros Adhanom Ghebreyesus, the WHO’s director-general, in a press conference. “Our greatest concern is the potential for the virus to spread to countries with weaker health systems that are ill-prepared to deal with this.”
