Anyway there are other examples but I deliberately picked some of the worst ones (ones with longest date ranges between seeking treatment and getting diagnosed, most number of visits to different healthcare facilities during that time, etc). Many others were tested and found to be infected much more quickly than the ones I've listed. Point is, these particular cases were eventually spotted, but the criteria for who you suspect could have Covid-19 limits the ability to detect every case. ie No travel to certain regions or known contacts at the time, means they arent even looking for coronavirus in that patient. Presumably it was only a combination of persistence by the ill person, or a cluster/other cases being detected in the meantime that the new ill person can be linked to, that lead to eventual identification of these cases. For those in whom illness remains mild, there is unlikely to be the same level of persistence in seeking medical help, although some of them could still be picked up via contact tracing eventually. And its the same story in most other countries (though this will change eventually, as countries broaden the criteria in response to general community spread).
Todays press conference remarks by WHO director-general include useful information that Singapore has already switched to looking for cases far more broadly. I dont know when this switch happened, though it is not surprising as they are one of the countries that has spoken of a possible new phase, and we have seen this change elsewhere recently too.
Yesterday I spoke to Singapore’s Minister of Health and we are very impressed with the efforts they are making to find every case, follow up with contacts, and stop transmission.
Singapore is leaving no stone unturned, testing every case of influenza-like illness and pneumonia. So far they have not found evidence of community transmission.
From
WHO Director-General's remarks at the media briefing on COVID-19 outbreak on 18 February 2020
The Singapore cases which I previously listed as examples of opportunities missed to spot these cases much earlier, should be much less likely to take so long to spot in future, because of this change.
As for the remark that 'they have not found evidence of community transmission', I would prefer a phrase such as 'sustained community transmission' or 'wider community transmission'. Because there have been a number of clusters in Singapore that featured human to human transmission, as well as a handful of cases that they havent been able to link to known clusters/locations/infected contacts.
It may seem like a minor point but language and terminology around this point matters because its the amount and nature of any community spread that will dictate whether this is a pandemic or not.
A WHO quote from yesterday does use an additional word to qualify that sort of remark:
Dr. Mike Ryan, head of WHO’s emergencies program, said: “The real issue is whether we are seeing efficient community transmission outside of China and at the present time we are not observing that.”
From
'Every scenario on the table' in China virus outbreak: WHO's Tedros
And rather conveniently I can illustrate these stages using the 2009 H1N1 pandemic.
Here is a comment from early May 2009:
Dr Ryan, meanwhile, said that there was "no evidence of sustained community spread outside of North America".
He did go on to suggest a pandemic was imminent back then, in May 2009, but at the time he was giving those quotes the threshold had not been crossed. The degree of community transmission in countries in a different region to the one where the outbreak began was a key indicator they used, and it took until June 11th 2009 to declare the pandemic. It was obvious to most people that it was a pandemic some time before then, but then we can always argue about exactly where the threshold should be.
For example, I dont know how many, or which, countries exactly would need to show sustained community transmission of this coronavirus in order for a pandemic to be declared. If it happens in Hong Kong, there is the 'thats still China' angle. If it happens in Singapore or Japan, there is the argument that is still the same region, and they might try to stretch things out until the same thing happens much further away. Or maybe the timing will render this question sort of irrelevant, if a bunch of places start to detect the same spread emerging at about the same time. Or maybe this focus of mine will turn out to be pointless because a pandemic wont happen after all (I havent quite given up on this possibility yet!).
It is a pretty safe bet that if my own personal threshold for that stuff is crossed, I will keep calling this a pandemic even if its not officially one yet. It's unlikely I will be far out on a limb if this happens though, my threshold shouldnt be wacky or paranoid, its just the WHO ones tend to be a tad too conservative/lag behind a touch.
So far there is no large disconnect between my own opinion of the situation and phase, and what the WHO says. Just a difference in mood music and emphasis, some of which stems from me being a lone human with no diplomatic or sugar-coating responsibilities.
www3.nhk.or.jp
www.nhs.uk
