By Reuters and Ellalyn De Vera-Ruiz
ZURICH/ GENEVA — The World Health Organization (WHO) warned on Wednesday that countries emerging from restrictions to halt the new coronavirus must proceed “extremely carefully” or risk a rapid rise in new cases.
Director-General Tedros Adhanom Ghebreyesus said countries needed to ensure they had adequate measures to control the spread of the COVID-19 respiratory disease like tracking systems and quarantine provision.
“The risk of returning to lockdown remains very real if countries do not manage the transition extremely carefully and in a phased approach,” he said at a virtual briefing in Geneva.
WHO epidemiologist Maria Van Kerkhove supported his concerns about the disease which has infected 3.71 million globally and killed more than 258,000 people, according to a Reuters tally.
“If lockdown measures are lifted too quickly, the virus can take off,” Van Kerkhove told the briefing. Government-ordered lockdowns have become increasingly unpopular as countries suffer rising unemployment and economic activity grinds to a halt.
The eurozone economy will contract by a record 7.7% this year because of the pandemic, while US private employers laid off 20.2 million workers last month as business shut their doors.
Some countries, like Germany, Spain, and Italy have started to relax restrictions, while the US President Trump has said his focus is on opening up the country again.
Soccer authorities have also started to consider how they can salvage interrupted competitions, with Germany’s Bundesliga getting permission to restart later this month.
Fire raging WHO official Mike Ryan said it was up to governments and sporting federations to decide how and when to restart, adding the UN organizaton would offer risk management advice if needed.
Tedros, who has come under fire mainly from the Trump administration for his handling of the outbreak, said that he would conduct an assessment of the WHO’s actions when the pandemic recedes.
“While the fire is raging I think our focus should not be divided,” he said.
Tedros also defended the WHO’s record on warning about the potential for human-to-human transmission of the new coronavirus, saying it informed the world in the first half of January.
The Geneva-based body has been accused of being “China- centric” by top donor the United States which has cut off funding to the body.
US Secretary of State Mike Pompeo renewed his criticism on China on Wednesday, blaming the country for the deaths the outbreak has caused and demanding Beijing share information about the outbreak.
The WHO, which is preparing another mission to China to discover the animal origin of the virus, treated the country no differently to any of its 194 members, Tedros said.
“The rule we have in WHO and other UN agencies is that when a member state reports we post as is,” Tedros said.
“The most important thing is our guidance before, during and after 14 January included the likelihood of human to human transmission that helped countries to prepare, he added. “This is the whole truth.”
Youth may bring home COVID-19
In the Philippines, experts from the University of the Philippines (UP) said young people below 20 years old are highly likely to bring home COVID-19 infection to the more vulnerable members of their households should restrictions on physical interactions are relaxed.
The UP pandemic response team’s study specifically looked into the country-wide total age-group interactions per day and its implications on school opening and the mobility of older people.
It has simulated how children and teenagers interact with older adults who are 65 years old and above, considering older Filipinos usually live with their children and grandchildren under one roof.
The study showed that 56 percent of interaction with all age groups are among those below 20 years old, compared to only 1 percent among those aged 65 and over.
Moreover, it found that 49 percent of the interaction of 65 years and above happens with the age group of those 20 years old and below.
“This essentially means two things: Social interaction is highest among the young, and the same group accounts for the greatest amount of interaction with older people,” the team said.
The experts said that relaxing restrictions on physical interactions of children “does not bode well if matched with empirical data from DOH (Department of Health).”
As of May 1, the study noted that about 97 percent of those who tested positive for COVID-19 among those aged five to 20 years old are asymptomatic, have mild symptoms or have recovered indicating that this age group may be more resilient to the disease compared to older groups.
The number of deaths from COVID-19 generally increases with age, rising noticeably starting at age 50-54 and steadily increasing rather steeply thereafter. In all, 70 percent of the total deaths are from cases age 60 and over, it added.
“Putting together what we know about interactions by age group, the relative resilience of the young and the likelihood of severe disease among the old, the conclusion is that the young aged 0-20 who have the most interactions with all age groups, and especially with the old, have a high likelihood of bringing home the infection from school and from their other social contacts, being mostly asymptomatic or only showing mild symptoms, to the more vulnerable members of their households,” the team pointed out.
School opening implications
The study revealed that with the current testing detection rate and the scenario with 10,000 tests per day, physically opening all schools in the National Capital Region may increase the transmission of COVID-19.
However, continued physical closure of all schools up to the end of the year, considering the model assumptions, may continue to lower the cases of coronavirus, it noted.
Implications on the movement of older people
The study found that the transmission potential of older adults were relatively less within their group than the younger individuals.
However, senior citizens had been highly transmissive before the March 15 enhanced community quarantine but during the quarantine period, older persons were less transmissive to other younger counterparts.
As of April 30, the team said that older people account for about threefourths of total COVID-19 fatalities but there is also evidence that it is not just advanced age per se that is associated with the higher risk of dying from COVID-19. The presence of underlying medical conditions, such as hypertension, heart disease, chronic respiratory illness, and other diseases also compromise the immune system.
“Since older people are more likely to have these co-morbidities, they have the highest case fatality rates of all ages,” it noted.
The Philippine data showed that underlying health conditions, such as hypertension, diabetes and asthma,raises COVID-19 total mortality by as much as 30 percent.
It was also observed that the increase in mortality is evident at all ages, as young people 19 years old and below with co-morbidities are also very vulnerable to dying from COVID-19.
Citing the results of the study, the team reiterated the decision of the Inter-Agency Task Force for the Management of Emerging Infectious Diseases (IATF) that senior citizens should limit their mobility and do their part to help contain the spread of COVID-19.
“Cognizant of the heterogeneity of the senior citizen population, exemptions to the stay at home order has been made for older people who need to go out ‘(to obtain) essential goods and services or (to) work in permitted industries and offices,’ including those who are living alone,” it said.
The UP experts suggest the IATFEID to issue clear operational guidelines as to how stay-at-home orders are to be implemented on the ground.
The team recommended that schools under enhanced community quarantine must remain closed, while areas under general community quarantine should consider a flexible schedule that limits physical interaction of children.
School activities that entail a gathering of crowds must be postponed, it also suggested.
To ensure continuity, various forms of distance learning must be explored, and in areas where such is not possible, low-cost technologies can be put in place to facilitate connectivity, it added.