As COVID-19 cases near 5 million, WHO sees long road ahead

Distrubuting masks in Brazil
Distrubuting masks in Brazil

Agência Brasília, Acacio Pinheiro / Flickr cc

As cases neared 5 million today, the World Health Organization (WHO) director-general said that a record daily high of 106,000 cases were reported over the past day. And with worries rising about cases in low- and middle-income countries, there's still a long road ahead with the pandemic.

The global total is at 4,955,312 cases, and 325,810 people have died from their infections, according to the Johns Hopkins online dashboard.

Concern over impact on poor

At a media briefing today, WHO Director-General Tedros Adhanom Ghebreyesus, PhD, thanked member states that took part in the World Health Assembly (WHA) this week for passing a consensus resolution that sets out a critical roadmap to sustain and speed the pandemic response at national and international levels.

One element of the resolution—which called for an independent review of the pandemic—drew a lot of attention, but the document also contained several other items, and Tedros said implementation of all the measures will result in a more coordinated response that factors in fairness and saves livelihoods and lives.

He emphasized four critical parts of the resolution: fair distribution of technology tools for battling the pandemic; international treaties when needed, such as those involving intellectual property; vaccines, classified as a common good for ending the pandemic; and collaboration on research and development.

In noting the biggest 1-day case rise, Tedros said that two thirds of the cases were reported in just four countries. Echoing concerns about pandemic activity rises in low- and middle-income countries, the head of the WHO's Pan American Health Organization (PAHO) yesterday warned of the impact on poor and indigenous groups in the Americas.

Carissa Etienne, MBBS, MSc, said the virus is surging across the Americas, where illnesses and deaths increased by 14% last week. "We are increasingly worried about the poor and other vulnerable groups at greatest risk of illness and death from the virus. The recent spike in cases and fatalities is partly due to the virus taking root in these groups," she said at a media briefing.

For example, in the Amazon basin, illness levels in isolated indigenous communities and more densely populated areas are twice as high as in other provinces within the same countries. Vulnerable groups in other large cities have also been hit hard, she said, with women—who are on the health frontlines of the Americas—disproportionately affected by COVID-19. A Reuters story today described a fishing village in Ecuador, where likely COVID-19 cases and deaths were reported in April, but its doctor was called away to help respond to a large outbreak in Guayaquil.

Also, she added that people of African descent in the Americas struggle to get care even in nonpandemic settings, reflecting structural inequalities, putting them at greater risk for COVID-19 and its most severe consequences.

Changes in case presentation?

Two reports today described potential changes in COVID-19 clinical symptoms in patients. One report from epidemiologists in Iran, flagged by ProMED Mail, said patients recently sickened by COVID-19 are now showing gastrointestinal (GI) symptoms, rather than respiratory symptoms. They said the GI symptoms they're seeing often come with no fever or a low fever, leading to delays in diagnosis and further spread of the virus.

Iran was one of the hardest-hit countries earlier in the pandemic and is still reporting a steady stream of new infections. Dr Mohammad-Reza Mahboubfar, part of Iran's COVID-19 task force, said diarrhea, abdominal spasms, stomachache, nausea, vomiting, loss of appetite, low fever, and loss of taste and smell are now the main symptoms across different age-groups.

He said that the virus is spreading again where it had previously declined and that Iran is experiencing a second wave of activity.

Elsewhere, news reports from China are describing possible clinical changes seen in Jilin province in the northeast, where health officials are battling some newly emerging clusters. Qui Haibo, a critical care expert with China's National Health Commission, said the incubation period in the newly infected patients in the northeast is longer than what was seen for patients infected earlier in Wuhan's outbreak, Reuters reported. He said a longer incubation period when patients don't have symptoms can lead to greater spread of the virus, resulting in family clusters. He said the newly infected patients also seem to be shedding the virus for a longer period.

Among other changes, Qui said fevers are rare and organ damage is mainly limited to lungs, rather than other body systems.

At the WHO's media briefing today, Maria Van Kerkhove, PhD, the group's technical lead for COVID-19, said experts are still learning a lot about the new virus, and officials are grateful for reports from clinicians who help fill in gaps about what's known about the clinical spectrum. She said the WHO is in constant contact with its clinicians' network, and efforts have been under way since early in the outbreak to collect standardized data on patients with COVID-19 to help sort out the clinical picture.

So far, GI issues, including nausea and vomiting, are relatively rare, seen in about 3% to 5% of patients.

Mike Ryan, MD, who leads the WHO's health emergencies program, said that, as cases pile up, with the world approaching 5 million cases, some of the rarer symptoms can become visible. He added that it's important to track in real time the transmission dynamics, genetic sequences, and clinical syndromes, putting all of the detective work together.

Countries harness mass testing to avert 2nd waves

In other outbreak developments, the city of Wuhan, China—home to about 11 million people—is making headway in testing all city residents, part of an effort to identify asymptomatic cases and prevent a flare-up in the country's original hot spot. Yesterday, health officials tested 856,128 people, up sharply from 467,847, Reuters reported. The identification of a cluster at a residential complex prompted the testing, which began on May 14.

China today reported five new cases, an imported illness from Inner Mongolia and four in Jilin province, according to a daily report from the NHC. Officials also reported 16 more asymptomatic cases, one of them imported.

Elsewhere, Luxembourg has announced that it will test its entire population to prevent a second wave of virus activity following the easing of lockdown measures, Reuters reported. The testing is voluntary, and the goal is to test a total of 600,000 people.

In other international developments:

  • South Korea has closed schools in the city of Incheon, west of Seoul, the first day after reopening, after two cases were found among the student body, CNN The illnesses are part of a nightclub cluster, and the students had visited karaoke rooms where other infected students had been.

  • The Dutch agriculture ministry said today that an employee working at a mink farm was probably infected with SARS-CoV-2 by a mink and that the mink may have had a subclinical infection. The ministry said it will expand antibody testing of minks to all mink farms and that cats might be playing a role in the spread of the virus between mink farms. In late April, officials reported finding the virus in symptomatic minks at two farms, adding that the animals probably contracted those infections from farm workers who had been sick.

  • World Bank President David Malpass yesterday during a press call warned that the COVID-19 pandemic could push up to 60 million people into extreme poverty. His comments came as the World Bank launched a $160 billion 15-month emergency financing program targeting 100 countries.

  • The International Committee of the Red Cross said yesterday that it's seeing a worrying increase in attacks on healthcare workers and health facilities that are part of the COVID-19 response, with more than 200 reported so far. It also said the pandemic shows wide differences in healthcare between developed and developing countries. "Strengthening health systems in developing and conflict-affected countries must now become a global priority," it said.

This week's top reads