More than 2,000 cases of the new coronavirus have been identified outside of China. An outbreak is blooming in Italy, where 370 cases have been confirmed. The number of cases in Iran has surged, resulting in 19 deaths. South Korea has had more than 1,200 cases. The Centers for Disease Control and Prevention announced Tuesday that the United States likely isn’t far off from a true outbreak of its own.
But on Monday, Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, assured reporters that despite the numerous outbreaks in various countries, the organization would not change COVID-19’s classification from “global health emergency” to pandemic. “Does this virus have pandemic potential?” he said. “Absolutely, it has. Are we there yet? From our assessment, not yet.”
WHO, which has maintained this stance as of Wednesday, further explained that it is holding off on describing COVID-19 as a pandemic because it does not believe it has spread in an uncontained way that meets its pandemic threshold, and because it hasn’t yet caused “large-scale severe disease or death.”
And yet, some health officials, disagreeing with WHO’s reasoning, are calling it a pandemic anyway. Why?
Part of the problem is that a pandemic has no universal definition. And yet, the public has learned to conceptualize pandemics through pop culture and past outbreaks (especially flu outbreaks). As a result, the current situation seems a lot like a pandemic, and so plenty of people are calling it a pandemic, even though it technically isn’t one.
“I actually think that we are in a pandemic,” Lauren Sauer, director of operations with the Johns Hopkins Office of Critical Event Preparedness and Response, said. If we understand a pandemic to be a global spread of an epidemic, she suggests, “we’re very much there.” And she adds that she thinks WHO officials have “done themselves a bit of a disservice” by not calling it a one. “It actually has generated a lot more conversations, right, about—’what is a pandemic? Why are we not calling this a pandemic? What would a pandemic be?’ ”
A pandemic, under the WHO definition, takes the form of self-sustaining outbreaks all around the globe. That vagueness may be intentional: WHO can manage its messaging by making subjective calls as the situation plays out, rather than running up against an objective set of conditions that force its hand. Even though Europe, the Middle East, and all of Eastern and Southeast Asia have outbreaks, the Americas, Australia, and Africa have so far kept their numbers largely in check. As a result, WHO can still hold back—and could continue to do so until it becomes unavoidable (presumably that will be when the entire global population has been exposed).
WHO does not represent all researchers, though, and plenty of experts operate under a much more open understanding of the term that doesn’t require the pathogen to be entirely novel to count as a pandemic. Some viruses, such as HIV, and diseases, such as tuberculosis, are thought of by some as ongoing pandemics. (Tuberculosis has been around since antiquity and the AIDS epidemic started four decades ago, but they’re still killing humans in huge numbers higher than what could be considered a standard background rate, hence, pandemic.) Some health officials might not even consider the infectious part of a more traditional definition to be necessary: For some, obesity is a pandemic.
The public understanding of a pandemic probably falls between the two perspectives. The most basic way to think about this might just be: A pandemic is an epidemic that crosses borders and infects a large number of people. Under that definition, with 10 or more cases each in 20 different countries, and confirmed cases in more than 40, it’s hard not to see it as a pandemic.
Does the gap between a pandemic, as scientists understand it and a pandemic, as the public understands it, matter? Technically, no—nothing would change in how WHO is responding if they named it a pandemic. But the split in the public health community is also just kind of confusing. And most officials aren’t talking about how to prepare for the disease when they’re debating whether it’s a pandemic.
The average person likely pictures something very deadly and very disruptive when they do hear the word pandemic. This, according to Tedros, is the reason to hold off—the label would increase the general public’s level of panic. But that might be fine—the CDC has said that there’s a strong chance the coronavirus will be disruptive. We might see some temporary school closures, people might be urged to work from home, events may be canceled. But it’s not expected to be particularly dangerous to the average American (if you are wondering if it is time to panic, please read this), and it’s certainly not going to pave the way for the kind of chaos depicted in apocalyptic pandemic movies.
The last time the world experienced a pandemic, as acknowledged by WHO, was during the 2009 H1N1 outbreak. WHO appears to have become more cautious because of its experience, when some chastised the organization for inciting fear disproportionate to just how bad the flu turned out to be (not that bad). After that epidemic, WHO moved away from an old system of six phases to describe pandemic influenza, and even moved away from calling anything other than an influenza outbreak a pandemic.
“I think it’s OK to say that pandemics are scary, and that it’s a scary word,” Sauer said. But she added that there’s a merit to acknowledging, by employing terms like global health emergency and pandemic, that we can’t fully stop some diseases from spreading, even if we try. “Once you apply them, it’s like ripping the Band-Aid off. Now we can say, ‘The time for containment is over. Now it’s time for mitigation strategies. And we have done this before.’ ”