Robust health system best shield against epidemics, says WHO’s Margaret Harris

The novel coronavirus outbreak took many countries by surprise, causing delays in lockdown measures that are resulting in thousands of deaths. But how unexpected, really, was the appearance of SARS-CoV-2 and how seriously do we need to take various “miracle cures” being touted by certain media and politicians?

Kathimerini turned to Dr Margaret Harris, a member of the World Health Organization’s (WHO) coronavirus response team and one of its spokespeople, for some answers to these and other questions pertaining to the pandemic.

WHO has been talking about a disease X for some time. Is Covid-19 it? Does it have the potential to become that? Why were so many countries so ill-prepared given that they should have expected it?

Disease X represents the potential for a serious international epidemic to be caused by a pathogen currently unknown to cause human disease. Covid-19 is indeed an infectious disease caused by a newly discovered, very transmissible coronavirus that has sparked a pandemic.

WHO is committed to working with countries to strengthen preparedness. The best defense against health emergencies is investing in strong health systems. Universal health coverage and health security are two sides of the same coin.

Virologists and influenza specialists have for years argued that there are 30- to 40-year cycles in flu pandemics and that we should be prepared for that. Should we expect a similar cyclical pattern with the coronaviruses?

Influenza patterns have tended to be cyclical as these depend on antigenic shift. There are three large groupings or types of seasonal influenza viruses, labeled A, B and C. Currently, influenza A(H1N1) and A(H3N2) are the circulating seasonal influenza A virus subtypes. This seasonal A(H1N1) virus is the same virus that caused the 2009 influenza pandemic, as it is now circulating seasonally. In addition, there are two type B viruses that are also circulating as seasonal influenza viruses, which are named after the areas where they were first identified. Type C influenza causes milder infections and is associated with sporadic cases and minor localized outbreaks.

A pandemic occurs when an influenza virus which was not previously circulating among humans and to which most people don’t have immunity emerges and transmits among humans. These viruses may emerge, circulate and cause large outbreaks outside of the normal influenza season. As the majority of the population has no immunity to these viruses, the proportion of people in a population getting infected may be quite large.

Coronaviruses are very different from influenza viruses. Although they cause some of the same symptoms in humans, they have a different, not well understood natural history. That is one area of urgent research needed identified when WHO held a research forum on Covid-19 in early February.

Some countries like South Korea and Germany are trying to beat the virus by testing, others by carpet measures and quarantines. Which approach is best?

To defeat the virus, countries need aggressive and targeted tactics. Aggressive measures to find, isolate, test, treat and trace are not only the best and fastest way out of extreme social and economic restrictions – they’re also the best way to prevent them.

Quarantining has been used effectively in this outbreak to contain the outbreak in several countries. It is one of several interventions that together can be part of an effective strategy to help quickly detect, isolate and stop outbreaks. While the decision as to when to implement quarantine is up to individual countries, doing so early in an outbreak has been shown to slow the spread of Covid-19.

Physical distancing measures can slow down the virus, so the healthcare system can cope; but they will not stop this pandemic purely in their own right. To turn the pandemic around, countries need to invest in a comprehensive and blended approach.

There’s a lot of talk about “miracle cures” like chloroquine, plasma transfusions etc, mainly from people who want to give the crisis a silver lining. Can you put the scientific advancements concerning SARS-CoV-2 into perspective?

No pharmaceutical products have yet been shown to be safe and effective for the treatment of Covid-19. However, a number of medicines have been suggested as potential investigational therapies, many of which are now being or will soon be studied in clinical trials, including the Solidarity trial co-sponsored by WHO and participating countries.

The Solidarity trial was launched by WHO and partners to generate data on most effective treatments; 74 countries have joined the trial or will soon, and 200 patients have been randomly assigned to one of the study arms. Each new patient who joins the trial gets us one step closer to knowing which drugs work.

Recent research into the virus is coming up with new findings that challenge previous wisdom, like the MIT study that concluded that 2 meters social distancing is not enough. Is the WHO updating its advice accordingly?

WHO recommends maintaining at least 1 meter (3 feet) distance between yourself and anyone who is coughing or sneezing. WHO recently issued a scientific brief on the modes of transmission of Covid-19, including detailed information on appropriate distances. According to current evidence, Covid-19 virus is primarily transmitted between people through respiratory droplets and contact routes. Droplet transmission occurs when a person is in in close contact (within 1 m) with someone who has respiratory symptoms; airborne transmission is different from droplet transmission as it refers to the presence of microbes within droplet nuclei, which can remain in the air for long periods of time and be transmitted to others over distances greater than 1 meter.