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Topic: WHO Statement...no public health emergency
Posted: July 17 2013 at 5:25pm

WHO Statement on the Second Meeting of the IHR Emergency Committee concerning MERS-CoV

WHO Statement
17 July 2013

The second meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] was held by teleconference on Wednesday, 17 July 2013, from 12:00 to 16:04 Geneva time (CET).

In addition to Members of the Emergency Committee, an expert advisor to the Committee1 participated in the meeting. During the informational session of the meeting, several affected States Parties were also on the teleconference. The States Parties on the teleconference were: France, Germany, Italy, Jordan, Kingdom of Saudi Arabia, Qatar, Tunisia, and the United Kingdom.

The Committee reviewed and deliberated on information on a range of aspects of MERS-CoV, which was prepared or coordinated by the Secretariat and States in response to questions presented by Members during the first meeting.

It is the unanimous decision of the Committee that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met.

While not considering the events currently to constitute a PHEIC, Members of the Committee did offer technical advice for consideration by WHO and Member States on a broad range of issues, including the following:

Improvements in surveillance, lab capacity, contact tracing and serological investigation
Infection prevention and control and clinical management
Travel-related guidance
Risk communications
Research studies (epidemiological, clinical and animal)
Improved data collection and the need to ensure full and timely reporting of all confirmed and probable cases of MERS-CoV to WHO in accordance with the IHR (2005).

The WHO Secretariat will provide regular updates to the Members and will reconvene the Committee, in September, on a date to be determined. However, serious new developments may require an urgent re-convening of the Committee before then.

Based on these views and the currently available information, the Director-General accepted the Committee’s assessment that the current MERS-CoV situation is serious and of great concern, but does not constitute a PHEIC at this time.

The Director-General expressed her gratitude to the Committee on its wide range of advice on health actions for countries to implement, and advice on follow-up work by WHO.

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Posted: July 17 2013 at 5:56pm

MERS-CoV not an emergency, experts tell WHO

Filed Under: MERS-COV

Robert Roos | News Editor | CIDRAP News | Jul 17, 2013

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fukuda_who_20130717.jpg

The WHO's Keiji Fukuda

WHO

Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment, told reporters that declaring a global public health emergency over MERS now might do more harm than good.

The MERS-CoV (Middle East respiratory syndrome coronavirus) situation is "serious and of great concern" but doesn't rise to the level of a global public health emergency, an international committee of experts organized by the World Health Organization (WHO) decided today.

The committee felt that the "dramatic action" of declaring an emergency would be disproportionate and might do more harm than good, said Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment. The panel's recommendation was unanimous.

At a press conference, Fukuda also said the WHO does not plan to recommend any travel restrictions over MERS-CoV, but it will issue some travel-related advice within a few days.

The WHO announcement came hours after Saudi Arabia reported two more confirmed MERS-CoV cases, both of them mild. They involve a 26-year-old Saudi man and a 42-year-old female "resident," both of them living in the southwestern province of Asir.

The man had contact with a previous case-patient, and the woman works in the health sector, the Saudi Ministry of Health (MOH) said in a statement. Neither patient was hospitalized.

A previous MERS case in Asir involved a 66-year-old man and was reported by the MOH on Jul 8. The MOH said it has tested 1,460 people for the virus in the past few weeks.

The two newest cases raise the global count to 84 cases, with 45 deaths, according to the US Centers for Disease Control and Prevention (CDC). (The WHO has not yet acknowledged the two cases.) Of the total, 68 cases and 38 deaths have occurred in Saudi Arabia.

Four-hour teleconference

The WHO's emergency committee on MERS-CoV concluded that "the conditions for a Public Health Emergency of International Concern have not at prevent been met," the WHO announced in a statement.

The decision came after a 4-hour teleconference. It was the second meeting of the panel, which was convened under the International Health Regulations (IHR).

While ruling out an emergency declaration, the panel did offer technical advice for the WHO and member countries on various issues, the agency said. The advice relates to:

Improvements in surveillance, lab capacity, contact tracing, and serologic studies

Infection prevention and control and clinical management

Travel-related guidance

Risk communications

Epidemiologic, clinical, and animal research

Improved data collection and the need to ensure full and timely reporting of all confirmed and probable cases of MERS-CoV

The WHO statement said Director-General Margaret Chan, MD, "accepted the Committee's assessment that the current MERS-CoV situation is serious and of great concern, but does not constitute" an international health emergency.

MERS-CoV emerged last year in Jordan and Saudi Arabia, and the vast majority of cases have occurred in the Middle East. The United Kingdom, Germany, France, Italy, and Tunisia have had a few cases, but all of them were directly or indirectly related to cases in Middle Eastern countries.

The virus has shown an ability to spread among people in close contact in families and hospitals, but it has not achieved any sustained transmission in communities.

In considering an emergency declaration, Fukuda said, the committee weighed three main questions: the severity of the illness, whether the virus is spreading, and whether a declaration would yield net benefits.

"If the director-general goes ahead and declares a public health emergency of international concern, is that on balance going to be helpful?" he asked.

"In general, this is quite a heavy declaration," he added later. "Making such a declaration under the IHR would send a very strong political signal around the world, that this is something that needs the highest level of attention. You want to make those declarations when they are proportional to the event." Doing otherwise would endanger the WHO's credibility, he said.

Sending the wrong signal?

When he was asked if there was any concern that not declaring an emergency would wrongly signal that the MERS threat isn't serious, Fukuda said, "The emergency committee did a really good job in landing where I think many of us assess the situation to be. In essence they're not saying this is unimportant. They're saying you need to keep us updated, and there are a number of actions that you can countries should take. I think they're sending out a pretty balanced message."

Fukuda said the committee extensively discussed the travel issue, in part because of the upcoming Umrah and Hajj pilgrimages, which are expected to draw huge numbers of visitors to Saudi Arabia.

"WHO at this time does not have any plans to restrict travel, no plans to issue advisories for people not to go anywhere and not travel," he said. "But we recognize that it's a risk for people and there are steps that individual countries can take. For instance, people who have medical conditions should seek medical counseling or guidance from their physicians."

He promised that the WHO will issue some MERS-related travel recommendations "in the next few days."

Unanswered questions

In other comments, Fukuda allowed that major questions about MERS-CoV are still unanswered.

The incidence of mild and asymptomatic cases remains unclear, he said. "When we look at contacts of cases, we don't find that many people who are infected. On the other hand, we're pretty early in that kind of testing, and we don't have the kind of serologic studies we'd like to see."

The animal source of the virus also remains a mystery, though research teams in the Netherlands, the United States, and possibly elsewhere are testing samples from animals, he said.

Also unexplained is why travel-related cases have been detected in Europe but not in Latin America or most other parts of the world, he said. It's not clear whether cases elsewhere are escaping detection or if something else is going on.

Fukuda also was asked what the committee learned about the hospital outbreaks of MERS-CoV in Jordan and Saudi Arabia.

"Investigators talked about how difficult it was to tease out what might've come in from the community and what was person-to-person transmission taking place within hospitals," he replied.

"A second observation was that when infection control is applied, you can bring these hospital facility outbreaks under good control, and it doesn't take extraordinary measures to do that."

He also commented that four or five serologic tests for MERS-CoV have been developed, but it's unknown whether they are detecting the same things and can be meaningfully compared.

See also:

Jul 17 WHO statement on committee decision

Jul 17 Saudi MOH statement

Saudi MERS-CoV overview page with case count

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Posted: July 17 2013 at 6:05pm

Most honored Henry Niman's commentary ...

Commentary

Asir Mild MERS Cluster Raises Pandemic Concerns

Recombinomics Commentary 16:30

July 17, 2013

"It will be interesting to see if the emergency committee acknowledges the sustained transmission, or merely extends the WHO fairy tale on community transmission"

The first case is for a 26-old-year Saudi male in Asir, who was in contact with one of the confirmed cases. The second case is for a 42-year-old female resident working at the health sector in Asir. Both cases have mild symptoms that not required admitting to hospital.

The above description from the Kingdom of Saudi Arabia Ministry of Health (KSA-MoH) website cites the two most recent confirmed MERS-CoV cases, a contact of a confirmed case and an associated health care worker (HCW). Both cases are mild and recovered or are recovering without treatment of hospitalization. These cases extend a recent trend in KSA of confirmation of mild or asymptomatic contacts (which frequently included HCWs) of confirmed cases which have been reported throughout KSA (see map).

This latest cluster began with a confirmed case (66M) in a military hospital in Asir (see map). Media reports noted that there were three additional suspect cases in the area, and the above report confirms MERS-CoV in two. These two confirmed cases raise the official KSA numbers to 68 confirmed and 38 fatal cases, but these numbers are largely meaningless and are used to put out press reports for media stories which grossly misrepresent the true MERS-CoV distribution in the Middle East. MERES-CoV has attainedsustain community transmission throughout the region, which strong parallels with the SARS outbreak in 2003.

An announcement by a MERS emergency committee is expected today, to attempt to restore some credibility to WHO comments on the situation (and move beyond "seemingly sporadic"). Recently WHO has acknowledged the obvious (possible sustained community transmission), but has not formally confirmed community transmission.

The latest cases support community transmission since almost all confirmed cases are associated with onward transmission, which largely involves mild symptoms in contacts. KSA acknowledged these mild cases indirectly in the spring, when they noted that most of the mild cases were in Jeddah, when the only confirmed case was the first confirmed case, who was a resident of Bisha who was diagnosed and died in Jeddah in July of 2012. The only confirmed Jeddah case since the mild cases were announced was a child (2M) in a military hospital who also died. Thus, to date there have been no confirmed mild cases in Jeddah, although the KSA-MoH was well aware of the mild cases in the spring.

The recent mild and asymptomatic cases signal earlier gaming of the system, and invalidate WHO claims of no sustained community transmission.

It will be interesting to see if the emergency committee acknowledges the sustained transmission, or merely extends the WHO fairy tale on community transmission.

Media Link

Recombinomics Presentations

Recombinomics Publications

Recombinomics Paper at Nature Precedings

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Posted: July 17 2013 at 9:14pm

With 80 cases, it's obviously not sustained transmission. I like niman and he's a smart guy, but it's non sustained transmission and cases seem to be sporadic, at the moment. It also has not burned itself out, so although it's a slow moving boat, it's probably here to stay and will probably last a lot longer than SARS, if it hasn't already. It's already been 10 months I believe?

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Posted: July 17 2013 at 10:10pm

These words have so much impact..

"has not achieved any sustained transmission in communities"

I really hope their assessment is right and this virus lacks pandemic potential. I do however think that this decision is politically motivated and they are just waiting for more evidence. The boy WHO cried wolf was obviously a big part of their decision making. They are in fear of alerting the world of a non existent threat and creating unnecessary panic. They have suffered the communities indignation several times in the past.

I just watched the press conference Keiji Fukuda. It took about an hour to download (its a ridiculously large file). I have taken a rolling commentary of what was said:

The negative impact of declaring a health emergency was discussed. Credibility was one of the WHO's biggest issues. Again just reaffirmed the boy who cried wolf issue.

They discussed travel warnings which they are working on and will come out soon. The warnings will probably be more in the form of guidance as opposed to warnings. There was a focus on elderly and sick. He spoke specifically about Hajj and that special measures need to be taken. The Saudi government has a focus on this issue which is independent of WHO assessment. The Saudi government seems to be more concerned about MERS than the WHO. (The Saudi government maybe the ones to watch for more in-depth information?)

The committee did say that MERS is serious and needs to be watched very closely. The main action plan at the moment is to set up effective systems for monitoring and testing. This required coordination with the international community.

He discusses asymptomatic cases. 1500 samples tested and not many cases found. Keiji said they hadn't studied enough people and they didn't have a good picture of how it was spreading. He also discussed possible animal interaction. Still not enough known

The WHO is working with many countries to increase testing regime.

The travel potential of the virus was of concern to the committee. They couldn't explain why the virus could end up in Europe but wasn't being detected/spread to Latin America. The comment was made maybe its detection or maybe something else is going on. Basically they don't understand what's happening yet.

MY own comment here is: I see them as being under informed and under resourced in several locations (this is an observation). I think they needed to be more forthright with their approach especially with their public statements. Being more aggressive would elicit a better response from the international community. They are battleing in a heated political environment and the squeaky wheel ain't getting any oil. I understand this is a real catch 22 for the WHO. If they go out hard on this they risk a media storm. If they go soft they risk lack of action. Personally I find their approach weak.

Maybe this is why i'm a dope commenting on a forum and not working for the WHO???

Some one asked what a deceleration would have meant if it was announced today? Its considered to be a heavy deceleration which would bring forward the highest level of attention internationally. It was deemed not necessary at this point. There again was another question which was unanswered about the WHO being concerned about saving face. The press representative didn't push the point and moved on to another question.

Serum testing was discussed. Keiji said, there are issues with current testing. His comment was, are these tests accurate and can they be comparable across countries? There is an issue with quantity of serum available which was affecting consistent results. This was being worked on.

The question about the WHO's decision being based around saving face was posed several times. This is a concern. My own stereotypical (racial) view is this director is Japanese. He seems to be living up to one of the Japanese character traits of must save face at all costs. Only a silly observation...

My final point of view on MERS is the same as the WHO's. We need to keep this virus front and center as it's a serious threat, but now in not the time to panic.

Keep observing!

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Pixie Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Group Joined: June 05 2006 Location: United States Status: Offline Points: 19668	Post Options Post Reply Quote Pixie Report Post Thanks(0) Quote Reply Topic: WHO Statement...no public health emergency Posted: July 17 2013 at 5:25pm
	WHO Statement on the Second Meeting of the IHR Emergency Committee concerning MERS-CoV WHO Statement 17 July 2013 The second meeting of the Emergency Committee convened by the Director-General under the International Health Regulations (2005) [IHR (2005)] was held by teleconference on Wednesday, 17 July 2013, from 12:00 to 16:04 Geneva time (CET). In addition to Members of the Emergency Committee, an expert advisor to the Committee1 participated in the meeting. During the informational session of the meeting, several affected States Parties were also on the teleconference. The States Parties on the teleconference were: France, Germany, Italy, Jordan, Kingdom of Saudi Arabia, Qatar, Tunisia, and the United Kingdom. The Committee reviewed and deliberated on information on a range of aspects of MERS-CoV, which was prepared or coordinated by the Secretariat and States in response to questions presented by Members during the first meeting. It is the unanimous decision of the Committee that, with the information now available, and using a risk-assessment approach, the conditions for a Public Health Emergency of International Concern (PHEIC) have not at present been met. While not considering the events currently to constitute a PHEIC, Members of the Committee did offer technical advice for consideration by WHO and Member States on a broad range of issues, including the following: Improvements in surveillance, lab capacity, contact tracing and serological investigation Infection prevention and control and clinical management Travel-related guidance Risk communications Research studies (epidemiological, clinical and animal) Improved data collection and the need to ensure full and timely reporting of all confirmed and probable cases of MERS-CoV to WHO in accordance with the IHR (2005). The WHO Secretariat will provide regular updates to the Members and will reconvene the Committee, in September, on a date to be determined. However, serious new developments may require an urgent re-convening of the Committee before then. Based on these views and the currently available information, the Director-General accepted the Committee’s assessment that the current MERS-CoV situation is serious and of great concern, but does not constitute a PHEIC at this time. The Director-General expressed her gratitude to the Committee on its wide range of advice on health actions for countries to implement, and advice on follow-up work by WHO.

Pixie Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Group Joined: June 05 2006 Location: United States Status: Offline Points: 19668	Post Options Post Reply Quote Pixie Report Post Thanks(0) Quote Reply Posted: July 17 2013 at 5:56pm
	MERS-CoV not an emergency, experts tell WHO Filed Under: MERS-COV Robert Roos \| News Editor \| CIDRAP News \| Jul 17, 2013 Share Tweet Email Print & PDF fukuda_who_20130717.jpg The WHO's Keiji Fukuda WHO Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment, told reporters that declaring a global public health emergency over MERS now might do more harm than good. The MERS-CoV (Middle East respiratory syndrome coronavirus) situation is "serious and of great concern" but doesn't rise to the level of a global public health emergency, an international committee of experts organized by the World Health Organization (WHO) decided today. The committee felt that the "dramatic action" of declaring an emergency would be disproportionate and might do more harm than good, said Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment. The panel's recommendation was unanimous. At a press conference, Fukuda also said the WHO does not plan to recommend any travel restrictions over MERS-CoV, but it will issue some travel-related advice within a few days. The WHO announcement came hours after Saudi Arabia reported two more confirmed MERS-CoV cases, both of them mild. They involve a 26-year-old Saudi man and a 42-year-old female "resident," both of them living in the southwestern province of Asir. The man had contact with a previous case-patient, and the woman works in the health sector, the Saudi Ministry of Health (MOH) said in a statement. Neither patient was hospitalized. A previous MERS case in Asir involved a 66-year-old man and was reported by the MOH on Jul 8. The MOH said it has tested 1,460 people for the virus in the past few weeks. The two newest cases raise the global count to 84 cases, with 45 deaths, according to the US Centers for Disease Control and Prevention (CDC). (The WHO has not yet acknowledged the two cases.) Of the total, 68 cases and 38 deaths have occurred in Saudi Arabia. Four-hour teleconference The WHO's emergency committee on MERS-CoV concluded that "the conditions for a Public Health Emergency of International Concern have not at prevent been met," the WHO announced in a statement. The decision came after a 4-hour teleconference. It was the second meeting of the panel, which was convened under the International Health Regulations (IHR). While ruling out an emergency declaration, the panel did offer technical advice for the WHO and member countries on various issues, the agency said. The advice relates to: Improvements in surveillance, lab capacity, contact tracing, and serologic studies Infection prevention and control and clinical management Travel-related guidance Risk communications Epidemiologic, clinical, and animal research Improved data collection and the need to ensure full and timely reporting of all confirmed and probable cases of MERS-CoV The WHO statement said Director-General Margaret Chan, MD, "accepted the Committee's assessment that the current MERS-CoV situation is serious and of great concern, but does not constitute" an international health emergency. MERS-CoV emerged last year in Jordan and Saudi Arabia, and the vast majority of cases have occurred in the Middle East. The United Kingdom, Germany, France, Italy, and Tunisia have had a few cases, but all of them were directly or indirectly related to cases in Middle Eastern countries. The virus has shown an ability to spread among people in close contact in families and hospitals, but it has not achieved any sustained transmission in communities. In considering an emergency declaration, Fukuda said, the committee weighed three main questions: the severity of the illness, whether the virus is spreading, and whether a declaration would yield net benefits. "If the director-general goes ahead and declares a public health emergency of international concern, is that on balance going to be helpful?" he asked. "In general, this is quite a heavy declaration," he added later. "Making such a declaration under the IHR would send a very strong political signal around the world, that this is something that needs the highest level of attention. You want to make those declarations when they are proportional to the event." Doing otherwise would endanger the WHO's credibility, he said. Sending the wrong signal? When he was asked if there was any concern that not declaring an emergency would wrongly signal that the MERS threat isn't serious, Fukuda said, "The emergency committee did a really good job in landing where I think many of us assess the situation to be. In essence they're not saying this is unimportant. They're saying you need to keep us updated, and there are a number of actions that you can countries should take. I think they're sending out a pretty balanced message." Fukuda said the committee extensively discussed the travel issue, in part because of the upcoming Umrah and Hajj pilgrimages, which are expected to draw huge numbers of visitors to Saudi Arabia. "WHO at this time does not have any plans to restrict travel, no plans to issue advisories for people not to go anywhere and not travel," he said. "But we recognize that it's a risk for people and there are steps that individual countries can take. For instance, people who have medical conditions should seek medical counseling or guidance from their physicians." He promised that the WHO will issue some MERS-related travel recommendations "in the next few days." Unanswered questions In other comments, Fukuda allowed that major questions about MERS-CoV are still unanswered. The incidence of mild and asymptomatic cases remains unclear, he said. "When we look at contacts of cases, we don't find that many people who are infected. On the other hand, we're pretty early in that kind of testing, and we don't have the kind of serologic studies we'd like to see." The animal source of the virus also remains a mystery, though research teams in the Netherlands, the United States, and possibly elsewhere are testing samples from animals, he said. Also unexplained is why travel-related cases have been detected in Europe but not in Latin America or most other parts of the world, he said. It's not clear whether cases elsewhere are escaping detection or if something else is going on. Fukuda also was asked what the committee learned about the hospital outbreaks of MERS-CoV in Jordan and Saudi Arabia. "Investigators talked about how difficult it was to tease out what might've come in from the community and what was person-to-person transmission taking place within hospitals," he replied. "A second observation was that when infection control is applied, you can bring these hospital facility outbreaks under good control, and it doesn't take extraordinary measures to do that." He also commented that four or five serologic tests for MERS-CoV have been developed, but it's unknown whether they are detecting the same things and can be meaningfully compared. See also: Jul 17 WHO statement on committee decision Jul 17 Saudi MOH statement Saudi MERS-CoV overview page with case count

Pixie Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Group Joined: June 05 2006 Location: United States Status: Offline Points: 19668	Post Options Post Reply Quote Pixie Report Post Thanks(0) Quote Reply Posted: July 17 2013 at 6:05pm
	Most honored Henry Niman's commentary ... Commentary Asir Mild MERS Cluster Raises Pandemic Concerns Recombinomics Commentary 16:30 July 17, 2013 "It will be interesting to see if the emergency committee acknowledges the sustained transmission, or merely extends the WHO fairy tale on community transmission" The first case is for a 26-old-year Saudi male in Asir, who was in contact with one of the confirmed cases. The second case is for a 42-year-old female resident working at the health sector in Asir. Both cases have mild symptoms that not required admitting to hospital. The above description from the Kingdom of Saudi Arabia Ministry of Health (KSA-MoH) website cites the two most recent confirmed MERS-CoV cases, a contact of a confirmed case and an associated health care worker (HCW). Both cases are mild and recovered or are recovering without treatment of hospitalization. These cases extend a recent trend in KSA of confirmation of mild or asymptomatic contacts (which frequently included HCWs) of confirmed cases which have been reported throughout KSA (see map). This latest cluster began with a confirmed case (66M) in a military hospital in Asir (see map). Media reports noted that there were three additional suspect cases in the area, and the above report confirms MERS-CoV in two. These two confirmed cases raise the official KSA numbers to 68 confirmed and 38 fatal cases, but these numbers are largely meaningless and are used to put out press reports for media stories which grossly misrepresent the true MERS-CoV distribution in the Middle East. MERES-CoV has attainedsustain community transmission throughout the region, which strong parallels with the SARS outbreak in 2003. An announcement by a MERS emergency committee is expected today, to attempt to restore some credibility to WHO comments on the situation (and move beyond "seemingly sporadic"). Recently WHO has acknowledged the obvious (possible sustained community transmission), but has not formally confirmed community transmission. The latest cases support community transmission since almost all confirmed cases are associated with onward transmission, which largely involves mild symptoms in contacts. KSA acknowledged these mild cases indirectly in the spring, when they noted that most of the mild cases were in Jeddah, when the only confirmed case was the first confirmed case, who was a resident of Bisha who was diagnosed and died in Jeddah in July of 2012. The only confirmed Jeddah case since the mild cases were announced was a child (2M) in a military hospital who also died. Thus, to date there have been no confirmed mild cases in Jeddah, although the KSA-MoH was well aware of the mild cases in the spring. The recent mild and asymptomatic cases signal earlier gaming of the system, and invalidate WHO claims of no sustained community transmission. It will be interesting to see if the emergency committee acknowledges the sustained transmission, or merely extends the WHO fairy tale on community transmission. Media Link Recombinomics Presentations Recombinomics Publications Recombinomics Paper at Nature Precedings

Albert Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote Albert Thanks(0) Quote Reply Posted: July 17 2013 at 9:14pm
	With 80 cases, it's obviously not sustained transmission. I like niman and he's a smart guy, but it's non sustained transmission and cases seem to be sporadic, at the moment. It also has not burned itself out, so although it's a slow moving boat, it's probably here to stay and will probably last a lot longer than SARS, if it hasn't already. It's already been 10 months I believe?

cobber Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote cobber Thanks(0) Quote Reply Posted: July 17 2013 at 10:10pm
	These words have so much impact.. "has not achieved any sustained transmission in communities" I really hope their assessment is right and this virus lacks pandemic potential. I do however think that this decision is politically motivated and they are just waiting for more evidence. The boy WHO cried wolf was obviously a big part of their decision making. They are in fear of alerting the world of a non existent threat and creating unnecessary panic. They have suffered the communities indignation several times in the past. I just watched the press conference Keiji Fukuda. It took about an hour to download (its a ridiculously large file). I have taken a rolling commentary of what was said: The negative impact of declaring a health emergency was discussed. Credibility was one of the WHO's biggest issues. Again just reaffirmed the boy who cried wolf issue. They discussed travel warnings which they are working on and will come out soon. The warnings will probably be more in the form of guidance as opposed to warnings. There was a focus on elderly and sick. He spoke specifically about Hajj and that special measures need to be taken. The Saudi government has a focus on this issue which is independent of WHO assessment. The Saudi government seems to be more concerned about MERS than the WHO. (The Saudi government maybe the ones to watch for more in-depth information?) The committee did say that MERS is serious and needs to be watched very closely. The main action plan at the moment is to set up effective systems for monitoring and testing. This required coordination with the international community. He discusses asymptomatic cases. 1500 samples tested and not many cases found. Keiji said they hadn't studied enough people and they didn't have a good picture of how it was spreading. He also discussed possible animal interaction. Still not enough known The WHO is working with many countries to increase testing regime. The travel potential of the virus was of concern to the committee. They couldn't explain why the virus could end up in Europe but wasn't being detected/spread to Latin America. The comment was made maybe its detection or maybe something else is going on. Basically they don't understand what's happening yet. MY own comment here is: I see them as being under informed and under resourced in several locations (this is an observation). I think they needed to be more forthright with their approach especially with their public statements. Being more aggressive would elicit a better response from the international community. They are battleing in a heated political environment and the squeaky wheel ain't getting any oil. I understand this is a real catch 22 for the WHO. If they go out hard on this they risk a media storm. If they go soft they risk lack of action. Personally I find their approach weak. Maybe this is why i'm a dope commenting on a forum and not working for the WHO??? Some one asked what a deceleration would have meant if it was announced today? Its considered to be a heavy deceleration which would bring forward the highest level of attention internationally. It was deemed not necessary at this point. There again was another question which was unanswered about the WHO being concerned about saving face. The press representative didn't push the point and moved on to another question. Serum testing was discussed. Keiji said, there are issues with current testing. His comment was, are these tests accurate and can they be comparable across countries? There is an issue with quantity of serum available which was affecting consistent results. This was being worked on. The question about the WHO's decision being based around saving face was posed several times. This is a concern. My own stereotypical (racial) view is this director is Japanese. He seems to be living up to one of the Japanese character traits of must save face at all costs. Only a silly observation... My final point of view on MERS is the same as the WHO's. We need to keep this virus front and center as it's a serious threat, but now in not the time to panic. Keep observing!