Canadian health authorities have announced a positive test for SARS-2-COV in a returning traveler from Iran. Yesterday, Iranian authorities announced two deaths from COVID-19. There are eighteen confirmed cases, which are spread across the country, and include a case in Tehran. It would seem plausible based on a the death count so far, and a case fatality rate of two percent, that there are over a hundred cases circulating in Iran. It is telling that one of the Iranian cases is a doctor, which suggests transmission within the health care system. Given that a case has appeared in Canada, which likely has fewer travelers than Iran’s neighbors such as Iraq, we can expect that health authorities will announce new cases in these nations in coming days. Unfortunately, two of Iran’s neighbors -Afghanistan and Syria- are in the midst of civil wars, and have damaged health care systems. Sadly, the cases in these countries will likely first be detected in critical cases, which will make it unlikely that these countries can control community transmission.
In Korea the number of COVID-19 cases has increased dramatically over the last few days. Over night 48 new cases were announced, which brought the total to 204. Singapore, which has one of the best health care systems in the world, is struggling to contain its outbreak. Singapore’s efforts at contact tracing appear to have been a model of such work. Globally there are 76,775 cases of this novel coronavirus; of course, the vast majority of these are in China, where the total number of new cases has slowed.
Although the World Health Organization has declared this to be a Public Health Emergency of International Concern, its director and the organization as a whole have been careful to avoid using the word pandemic. Given that Korea and Singapore report ongoing infections, and there is evidence of community circulation in Iran, we have likely reached the tipping point at which it is no longer reasonable to not call this a pandemic. For most major trading countries, travel restrictions at the national level will become increasingly challenging to manage as a tool. There will be widely differing case fatality rates, much as there was with the 1918 influenza pandemic. It will be interesting to see if there are three waves to this pandemic, as was the case in 1918. If so, this pandemic might last for perhaps eighteen months, before it becomes endemic, a second flu.
For me personally, this is a sad moment, as I think about what is to come, and how many people outside China will also suffer because this virus touches their lives. I especially worry for peoples in institutions, from prisons to mental health facilities, and people in slums where there are dense populations, and poor access to health care. It is deeply frustrating that restrictions were not kept on live markets in China after the 2003 SARS pandemic, and that the wild animal trade in these markets was not ended. So much suffering might have been avoided.
Expect WHO to officially announce a pandemic in the next week.