Evaluating the WHO’s framing and crisis management strategy during the early stage of COVID-19 outbreak

Figures & data

Figure 1. Number of confirmed cases (left axis) and deaths (right axis) due to COVID-19 outside China (January 13-March 31, 2020). Source: WHO situation reports (2020q).

Figure 2. Timelines of global events within the first three months of the H1N1 and COVID-19 outbreaks.

Table

Major decision of the WHO	Date	Decision makers	Mechanism for initiation	Statistics of COVID-19 outside China	Statistics of COVID-19 in China
Not to declare the Public Health Emergency of International Concern (PHEIC)	23-Jan	The International Health Regulations Emergency Committee (EC) and the Director-General of the WHO	The EC deliberated on the issue of PHEIC, however, there is no consensus among 15 members of the EC.	7 cases and no deaths; affected countries: 4	574 cases and 17 deaths
Declaration of the Public Health Emergency of International Concern (PHEIC)	30-Jan	The International Health Regulations Emergency Committee (EC) and the Director-General of the WHO	According to the International Health Regulations, the EC has to be convened to determine PHEIC. The EC reached almost unanimous decision and recommended declaration of PHEIC. The WHO Director-General declared PHEIC the same day.	82 cases and no deaths; affected countries: 18	7736 cases and 170 deaths
WHO risk assessment at regional level and global level was raised from “High” to “Very high”	28-Feb	Internal epidemiological specialists of the WHO	The internal risk assessment is made in light of risk of impact and risk of spread of the disease.	4691 cases and 67 deaths; affected countries: 51	78,961 cases and 2791 deaths
Characterization of the epidemic outbreak as “Pandemic”	11-Mar	WHO Director-General	Pandemic is a characterization of the epidemic outbreak, there is no provision in the International Health Regulations about this characterization. However, this change in characterization raises the alertness of the member states and the global community and galvanizes policy actions.	37,364 cases and 1130 deaths; affected countries, territories and areas: 113	80,955 cases and 3162 deaths

Sources: WHO (2020q); WHO (2020r); WHO International Health Regulations (2005b).

Table

	H1N1 pandemic of 2009	COVID-19 pandemic of 2020
Date of the first case outside the country of origin	Apr 14	Jan 13
Date of the WHO declaration of Public Health Emergency of International Concern (PHEIC)	Apr 25	Jan 30
Number of days between the first case outside the country of origin and the declaration of PHEIC	11 days	17 days
Date of the first death outside the country of origin	Apr 29	Feb 2
Date of the WHO announcement of “pandemic” status	Jun 11	Mar 11
Number of days between the declaration of PHEIC and the announcement of “pandemic”	47 days	41 days
Number of confirmed cases outside the country of origin two days prior to announcement of “pandemic”	26563	28673
Number of affected countries two days prior to announcement of “pandemic”	73 countries	104 countries, territories and areas

Sources: WHO (2011); WHO (2020q).

Table

Disease	Severity/mortality	Transmissivity
Ebola	High	Low, confined to close contacts
MERS	High	Low, confined to close contacts
SARS	High	Moderate
COVID-19	Moderate	High
Spanish flu of 1918-19	Moderate	High
H1N1 pandemic of 2009	Low	High
Seasonal influenza	Low	High
Measles	Low	High

The Reproductive number (R₀) of COVID-19 was estimated to be between 2.0 and 2.8 (Mackenzie and Smith 2020), whereas the case fatality rate of COVID-19 was about 1.4% (Leung and Wu 2020).

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