COVID-19 is now a pandemic: What next?

As COVID-19 moves from epidemic to pandemic status, we discuss what implications this may have for all of us and describe how experts have reacted. We also share some coping strategies for anxiety.

The CDC recommend that all people wear cloth face masks in public places where it is difficult to maintain a 6-foot distance from others. This will help slow the spread of the virus from asymptomatic people or people who do not know they have contracted the virus. Cloth face masks should be worn while continuing to practice social distancing. Instructions for making masks at home can be found here. Note: It is critical that surgical masks and N95 respirators are reserved for healthcare workers.

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On March 11, 2020, the World Health Organization (WHO) officially changed their classification of COVID-19 from a public health emergency of international concern to a pandemic.

COVID-19 is the name of the respiratory illness caused by the new coronavirus, SARS-CoV-2.

What does this change in classification mean?

In a press briefing yesterday afternoon, Dr. Tedros Adhanom Ghebreyesus, Director-General of the WHO, explained that the organization “has been assessing this outbreak around the clock, and we are deeply concerned, both by the alarming levels of spread and severity and by the alarming levels of inaction. We have therefore made the assessment that COVID-19 can be characterized as a pandemic.”

“Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear or unjustified acceptance that the fight is over, leading to unnecessary suffering and death,” Dr. Tedros went on to explain.

So, if the plan is business as usual, can we expect any major changes imminently, and what can we do as individuals to navigate the challenges that we may face going forward?

The Centers for Disease Control and Prevention (CDC) use the word “epidemic” when talking about “an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.”

“Pandemic” is an escalation and “refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people.”

Many people may be familiar with the term pandemic in the context of flu.

The CDC explain that a flu pandemic happens when a new version of the influenza virus infects people easily and spreads efficiently from person to person in a sustainable way.

During the 20th century, the world saw three flu pandemics.

Estimates put the number of deaths from Spanish flu, in 1918, at around 50 million worldwide. Asian flu, in 1957–1958, caused around 1.1 million deaths, and the 1968 Hong Kong flu pandemic caused about 1 million.

The most recent flu pandemic was in 2009, when a novel influenza strain called (H1N1)pdm09, more commonly referred to as swine flu, spread around the globe.

In the first year after the virus emerged, it resulted in around 60.8 million illnesses, 274,304 hospitalizations, and 12,469 deaths in the United States, according to CDC estimates.

Across the globe, during this period, the CDC estimate the number of deaths to have been in the region of 151,700–575,400.

At the time, school closures and social distancing took place in an effort to slow the spread of the virus within and across communities.

Vaccine development was extraordinarily fast, with the Food and Drug Administration (FDA) approving four H1N1 influenza vaccines by September 2009.

COVID-19 is the first pandemic caused by a coronavirus. Yet, while this change in status may leave us feeling worried, the WHO and other experts are taking a measured look at the term.

Dr. Tedros was clear in his assessment of the situation:

“Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”

“We cannot say this loudly enough, or clearly enough, or often enough: All countries can still change the course of this pandemic,” he went on to say.

So, how have other experts reacted to the situation?

“[The WHO] have decided that the SARS-CoV-2 epidemic now warrants being referred to as a pandemic,” Nathalie MacDermott, Ph.D., an academic clinical lecturer in pediatric infectious diseases at King’s College London, in the United Kingdom, noted, adding, “This decision will likely have been made on the basis of the majority of the world’s continents now seeing significant and ongoing person-to-person spread of SARS-CoV-2.”

“The change of term does not alter anything practically, as the world has been advised for the last few weeks to prepare for a potential pandemic, which has hopefully been taken seriously by all countries,” she continued.

Yet, she adds that “The use of this term, however, highlights the importance of countries throughout the world working cooperatively and openly with one another and coming together as a united front in our efforts to bring this situation under control.”

Meanwhile, Prof. Mark Woolhouse, Chair of Infectious Disease Epidemiology at the University of Edinburgh, in the U.K., explained that COVID-19 is likely here to stay for some time.

“[The WHO have] now confirmed that COVID-19 is a pandemic. The statement also says that this does not change their advice on how to respond and that ‘urgent and aggressive’ action is required by countries with significant outbreaks,” he said.

“An important word missing from that statement is ‘sustainable.’ It is now clear that COVID-19 is going to be with us for a considerable length of time, and the actions that we take must be actions that we can live with for a prolonged period.”

Dr. Tedros had some very clear messages for countries around the world in his press briefing.

“Even those countries with community transmission or large clusters can turn the tide on this virus. Several countries have demonstrated that this virus can be suppressed and controlled,” he observed.

“The challenge for many countries who are now dealing with large clusters or community transmission is not whether they can do the same — it’s whether they will,” he continued.

“Some countries are struggling with a lack of capacity. Some countries are struggling with a lack of resources. Some countries are struggling with a lack of resolve.”

Michael Head, Ph.D., a senior research fellow in global health at the University of Southampton, in the U.K., weighed in on this, noting, “[The WHO] stated that some countries are struggling with a lack of resources, but also ‘a lack of resolve.’ This is clearly a direct indication that they consider many countries have been slow to scale up their responses.”

He continued, “The characterization of the situation as a pandemic may mean that we see countries feel incentivized to implement further, larger interventions, such as banning of public gatherings, sooner than would they were otherwise planning to.”

Dr. Tedros chose these words for the final part of his press briefing: “There’s been so much attention on one word. Let me give you some other words that matter much more and that are much more actionable.”

“Prevention. Preparedness. Public health. Political leadership. And most of all: people. We’re in this together — to do the right things with calm and protect the citizens of the world. It’s doable,” he concluded.

Governments around the world have taken different approaches to preventing the spread of SARS-CoV-2.

While the U.S. is due to restrict entry for visitors traveling from many European countries from midnight on Friday, officials in China believe that the peak of new cases in China has passed and that the pandemic may be over by the middle of summer.

In Italy, social distancing measures are in full swing, with much of the country on lockdown. Ireland has today announced the closure of all schools, colleges, and daycare centers, along with museums, galleries, and tourist sites until March 29.

Schools are also closed in several districts across Washington state.

In light of the speed of these events, it’s not surprising that levels of anxiety have risen significantly for many people. The WHO issued guidance on mental health considerations during the COVID-19 pandemic earlier this week.

For the general public they recommend, among other things, to:

Avoid watching, reading, or listening to news that causes you to feel anxious or distressed. Seek information mainly to take practical steps — to make plans and protect yourself and loved ones. Seek information updates at specific times, once or twice during the day — a sudden, near-constant stream of news about an outbreak can cause anyone to feel worried. Get the facts — gather information at regular intervals from the WHO website and local health authorities, to help distinguish facts from rumors.

We echo some of these in our Spotlight feature “Anxious about the news? Our top tips on how to cope,” in which we delve deeper into coping strategies.

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