A pedestrian wearing a protective mask stands on Mission Street in San Francisco, California, on Thursday, Feb. 27, 2020. California is monitoring 8,400 people for signs of the virus after they traveled to Asia.
Enlarge / A pedestrian wearing a protective mask stands on Mission Street in San Francisco, California, on Thursday, Feb. 27, 2020. California is monitoring 8,400 people for signs of the virus after they traveled to Asia.

With the dizzying international spread of the novel coronavirus, the World Health Organization Friday announced that the global threat of COVID-19 has increased. The risk of spread and risk of impact has now risen from “high” to “very high” on a global scale, according to the organization’s latest assessments.

Between Thursday and Friday, five additional countries identified their first cases—Belarus, Lithuania, Netherlands, New Zealand, and Nigeria—and large outbreaks in Italy (888 cases) and Iran (388 cases) continue to export cases. So far, at least 24 cases in 14 countries link back to Italy and at least 97 cases in 11 countries link back to Iran, WHO reported Friday.

Worldwide, there are more than 85,400 cases and 2,924 deaths, with 53 countries reporting cases in addition to China, as of Saturday morning. While China still has over 90 percent of those cases, the daily case counts outside of China are now exceeding those within.

On Friday, China reported 331 new cases, while there were 1,027 cases reported elsewhere, according the WHO’s latest situation report. The largest outbreak outside of China is currently in South Korea, which has reported 3,150 cases. Italy has the second-largest cluster of cases, followed by the outbreak aboard the Diamond Princess, which has now reached 705 cases.

The continued spread and rising case counts outside China are “clearly of concern,” WHO Director-General Tedros Adhanom Ghebreyesus said Friday in a media briefing.

Wake up

Yet, while that spread ratchets up risk, he and his fellow experts at WHO also saw reason to be hopeful: most of the cases cropping up in new places can be clearly linked back to known contacts and clusters of cases—such as those from Italy and Iran.

“We do not see evidence as yet that the virus is spreading freely in communities,” the director-general, who goes by Dr. Tedros, said Friday. “As long as that’s the case, we still have a chance of containing this virus—if robust action is taken to detect cases early, isolate and care for patients, and trace contacts.”

And there’s clear evidence that containment can work. In addition to China’s dramatic decline in cases over this month, eight countries with identified cases have gone two weeks without reporting new cases, Dr. Tedros said. And, as of the time of publication Saturday, 15 of the 53 countries with cases were reporting only one new case. Another 19 countries with cases tallied 10 or fewer.

Moreover, Dr. Tedros made a point of putting the global cases in perspective: there are 6,000 or so cases among the more than 6 billion people outside of China.

This virus is serious and dangerous, but it can be contained, Dr. Tedros emphasized.

In fact, the move to increase the threat level should get that very point across, Dr. Michael Ryan, executive director of WHO’s Health Emergencies Program, said in the briefing.

“This is a reality check for every government on the planet: Wake up. Get ready. This virus may be on its way and you need to be ready. You have a duty to your citizens, you have a duty to the world, to be ready, and I think that’s what this alert says. It says we can avoid the worst of this, but our level of concern is at its highest.”

Not ready

Such readiness to avoid the worst has, unfortunately, not been on display in the United States, so far.

As of Saturday morning, the United States has reported four COVID-19 cases that may represent instances of community spread. That is, the four people may have picked up the infection from people in their own community as the virus spread undetected through the general public. In all four cases, the infected people had no known exposure through travel and had no contact with a person known to be infected.

It’s an alarming sign that the US—despite its prominence on the world stage and the time it has had to prepare—is failing to detect and contain the virus.

Among the four cases, two are in California, one is in Oregon, and another is in Washington state. Three of the cases (excluding one in California) are considered presumptive for now, meaning that health authorities in the individual states have tested the patients and found them positive, but final confirmation from CDC testing is pending.

The cases, if all are confirmed, bring the country’s tally to at least 66. Of those, 44 are in passengers repatriated from the Diamond Princess, and three are in people repatriated from Wuhan, China, where the outbreak began in December.

Thirteen cases appear to be travel-related, and two additional cases were contracted from person-to-person spread in the US from a known travel-related case.

The four remaining cases were possibly community spread. One of those cases—a California woman who lives in Solano County—was announced earlier this week. The news cycle was still reeling from it when, late on Friday, news broke of the other three cases.

Testing, testing

The Solano County woman’s case is particularly worrying because it highlights several weaknesses in the country’s COVID-19 preparedness. The woman reportedly checked into a local hospital with flu-like symptoms February 15. The patient was initially suspected of having COVID-19. But the woman wasn’t tested until February 25, largely due to a low availability of testing and federal recommendations that testing focus on people with known exposures (and she had no known exposure). Between that time, her condition deteriorated, and she was intubated and put on a ventilator.

The first clear weakness is the low availability of testing, which has mainly been done in labs run by the Centers for Disease Control and Prevention. The agency has sent testing kits to states, but some states reported problems with their kits. The CDC has been trying to work out an unspecified glitch in the kits, but the process has been slow. So far, the CDC has reported testing 459 people, which is just a fraction of the number of people that have been tested in other countries.

“This has not gone as smoothly as we would have liked,” Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said in a press briefing Friday. She reported that the CDC has come up with a workaround that will allow states to increase testing.

Increased testing capacity is critical for identifying new cases and preventing further spread of the virus within the US, particularly with the possibility of community spread—and the community in which the first case was identified points to another weakness.

Suspicious spread

The first case of potential community spread occurred in Solano County, California, which just happens to be were hundreds of repatriated citizens—at high risk of carrying the virus—have been quarantined. Repatriated citizens began arriving at Travis Air Force Base, located in Solano, at the beginning of February, a week or two before the woman developed symptoms. The potential community spread near where high-risk groups of people have been housed raises the possibility that the quarantine failed.

That concern was reinforced by news of a whistleblower allegation that the Department of Health and Human Services sent untrained personnel without proper protective gear to handle those high-risk repatriated citizens. If true, HHS put employees at risk of contracting the virus and then spreading it to their families and communities.

According to the whistleblower’s complaint, 13 unprepared employees were sent to Travis Air Force Base in Solano between February 2 and February 7, when planes loaded with repatriated citizens were arriving. The complaint alleges the employees were not tested for coronavirus afterward and returned to their normal offices and duties, with some taking commercial flights back to their stations in various, unspecified parts of the country.

The CDC did not respond to questions from Ars regarding the potential that the quarantine at Travis Air Force Base failed.

The three other, potentially community-spread cases appear to be unconnected to the Solano woman, according to The Washington Post. One case is in a 65-year-old woman from Santa Clara County, California. The case in Oregon was in a person from Washington County who had spent time in an elementary school near Portland. That school has now been closed for cleaning. The case in Washington state is in a high school student from Snohomish County, just north of Seattle. That student’s school has also been closed, and students with known contact are being isolated at home for 14 days.

The cases are an alarming sign that the US has failed its duty to be ready and has already lost control of the virus.

Communication breakdown

Last, reports this week raised concern of yet another weakness in the country’s preparedness—that information about the virus and the situation in the United States may be being censored by the Trump administration. According to a report Friday in The New York Times, all statements and appearances from federal officials regarding the coronavirus—including, it seems, those from CDC officials—must now be filtered through the office of Vice President Mike Pence, who President Trump appointed Wednesday to lead the coronavirus response.

The move has reportedly buttoned up leading experts, notably Dr. Anthony Fauci, one of the country’s foremost experts on viruses and infectious disease and the director of the National Institute of Allergy and Infectious Disease. According to the Times, Dr. Fauci has told colleagues that the White House instructed him not to say anything else without clearance.

Likewise, in the CDC’s briefing Friday, Dr. Messonnier’s comments sounded more carefully vetted than normal and included a conspicuous reference to President Trump. It marked the first time the CDC had referenced the president in a briefing on COVID-19 cases, according to transcripts of the briefings.

“As always, President Trump’s and our number-one priority is the health and safety of the American people,” Dr. Messonnier said in her opening remarks Friday.

The CDC declined to a request to comment from Ars on the reported censorship.

According to CDC’s archive of transcripts, Dr. Messonnier had only mentioned the word “trump” on one other occasion, on February 3, when she said, “And certainly, what I’ve seen in situations like this, science should trump everything else.”