Dichiarazioni del DG WHO, abstract delle comunicazioni giornaliere del WHO
DPCM del 31 Gennaio 2020
WHO Director-General's opening remarks at the media briefing on COVID-19 - 29 April 2020
29 April 2020
Good morning, good afternoon and good evening.
As of tomorrow, it will be three months since I declared a public health emergency of international concern over the outbreak of novel coronavirus. Today I’d like to take a few moments to look back at the period preceding that announcement, to be clear about what WHO knew, and what we did.
On the 31st of December, WHO’s Epidemic Intelligence System picked up a report about a cluster of cases of pneumonia of unknown cause in Wuhan, China.
The following day, New Year’s Day, WHO asked China for more information under the International Health Regulations, and activated our Incident Management Support Team, to coordinate the response across headquarters, and our regional and country offices.
On the 2nd of January, WHO informed the Global Outbreak Alert and Response Network – or GOARN – which includes more than 260 institutions in more than 70 countries.
On the 3rd of January, China provided information to WHO through a face-to-face meeting in Beijing, and through WHO’s Event Information System established under the International Health Regulations.
On the 4th of January, WHO reported the cluster of cases on Twitter. At that stage, no deaths were reported.
On the 5th of January, WHO shared detailed technical information through its Event Information System. This included advice to all Member States and IHR contact points to take precautions to reduce the risk of acute respiratory infections – providing guidance on the basis that there could be human-to-human transmission.
On the same day, WHO also issued its first public Disease Outbreak News, publishing technical information for the scientific and public health communities, as well as the world’s media.
On the 10th and 11th of January, WHO published a comprehensive package of guidance on how to detect, test for and manage cases, and protect health workers from potential human-to-human transmission, based on our previous experience with coronaviruses.
We also published a readiness checklist to help countries assess their capacities and gaps for detection and response.
Because Wuhan is a major domestic and international transport hub, WHO also advised that the risk of cases being reported from outside Wuhan was increased.
On the 11th of January, China shared the genetic sequence of the virus for countries to use in developing testing kits.
On the same day, China reported the first death from the new coronavirus.
On the 13th of January, the first case was reported outside China, in Thailand.
That day, working with partners, WHO published the first instructions for how to make PCR-based diagnostic test kits, enabling the world to find cases.
On the 14th of January, WHO tweeted reports from China that preliminary investigations by Chinese authorities had found no clear evidence that human-to-human transmission was occurring.
This is in line with our practice of reporting to the world information that countries report to us. We post country reports as is.
However, earlier the same day, WHO held a press briefing at which we said that, based on our past experience with coronaviruses, human-to-human transmission was likely. Our senior experts participated in that press conference, and that news was carried by mainstream media.
On the 20th and 21st of January, WHO staff visited Wuhan, and on the 22nd, reported that the evidence suggested human-to-human transmission was occurring.
On the 22nd and 23rd of January, I convened the Emergency Committee, consisting of 15 independent experts from around the world. At the time, 581 cases had been reported, and only 10 cases outside China. The Emergency Committee was divided in its opinion, and did not advise that I declare a public health emergency of international concern.
The Committee asked to be reconvened in 10 days or less to allow time for more information and evidence to be collected and considered.
On the 27th of January, I traveled to Beijing with WHO’s chief of emergencies, Dr Mike Ryan, and other senior WHO staff, and met with President Xi Jinping and other leaders to learn more about the response and offer WHO’s assistance.
We discussed the seriousness of the situation, and agreed that an international team of scientists should travel to China to look into the outbreak and the response, including experts from China, Germany, Japan, the Republic of Korea, Nigeria, the Russian Federation, Singapore and the United States of America.
On the 30th of January, I reconvened the Emergency Committee and after receiving their advice, because of the new information gathered they had a consensus, I declared a global public health emergency – WHO’s highest level of alarm.
At the time, as you may remember, there were less than 100 cases and no deaths outside China. To be specific, we had 82 cases outside China, and no deaths, when we declared the highest level of international emergency.
From the beginning, WHO has acted quickly and decisively to respond and to warn the world.
We sounded the alarm early, and we sounded it often.
We said repeatedly that the world had a window of opportunity to prepare and to prevent widespread community transmission.
We started our early press conference. People were saying the world will be tired of you if you’re making a press conference every day, but we didn’t mind. We wanted to make sure the world understands what WHO is saying.
WHO is committed to transparency and accountability.
ABSTRACT DEI REPORT CHE SI POSSONO CONSULTARE SUL SITO DEL WHO
Pneumonia of unknown cause – China
Disease outbreak news
5 January 2020
On 31 December 2019, the WHO China Country Office was informed of cases of pneumonia of unknown etiology (unknown cause) detected in Wuhan City, Hubei Province of China. As of 3 January 2020, a total of 44 patients with pneumonia of unknown etiology have been reported to WHO by the national authorities in China. Of the 44 cases reported, 11 are severely ill, while the remaining 33 patients are in stable condition. According to media reports, the concerned market in Wuhan was closed on 1 January 2020 for environmental sanitation and disinfection.
The causal agent has not yet been identified or confirmed. On 1 January 2020, WHO requested further information from national authorities to assess the risk.
National authorities report that all patients are isolated and receiving treatment in Wuhan medical institutions. The clinical signs and symptoms are mainly fever, with a few patients having difficulty in breathing, and chest radiographs showing invasive lesions of both lungs.
According to the authorities, some patients were operating dealers or vendors in the Huanan Seafood market. Based on the preliminary information from the Chinese investigation team, no evidence of significant human-to-human transmission and no health care worker infections have been reported.
Public Health Response
National authorities have reported the following response measures:
- One hundred and twenty-one close contacts have been identified and are under medical observation;
- The follow-up of close contacts is ongoing;
- Pathogen identification and the tracing of the cause are underway;
- Wuhan Municipal Health Commission carried out active case finding, and retrospective investigations have been completed;
- Environmental sanitation and further hygiene investigations are under way.
WHO is closely monitoring the situation and is in close contact with national authorities in China.
WHO risk assessment
There is limited information to determine the overall risk of this reported cluster of pneumonia of unknown etiology. The reported link to a wholesale fish and live animal market could indicate an exposure link to animals. The symptoms reported among the patients are common to several respiratory diseases, and pneumonia is common in the winter season; however, the occurrence of 44 cases of pneumonia requiring hospitalization clustered in space and time should be handled prudently.
Wuhan city, with a population of 19 million, is the capital city of Hubei province, with a population of 58 million people. WHO has requested further information on the laboratory tests performed and the differential diagnoses considered.
Based on information provided by national authorities, WHO’s recommendations on public health measures and surveillance of influenza and severe acute respiratory infections still apply.
WHO does not recommend any specific measures for travellers. In case of symptoms suggestive of respiratory illness either during or after travel, travellers are encouraged to seek medical attention and share travel history with their healthcare provider.
WHO advises against the application of any travel or trade restrictions on China based on the current information available on this event.
Novel Coronavirus – China
12 January 2020
On 11 and 12 January 2020, WHO received further detailed information from the National Health Commission about the outbreak.
WHO is reassured of the quality of the ongoing investigations and the response measures implemented in Wuhan, and the commitment to share information regularly.
The evidence is highly suggestive that the outbreak is associated with exposures in one seafood market in Wuhan. The market was closed on 1 January 2020. At this stage, there is no infection among healthcare workers, and no clear evidence of human to human transmission. The Chinese authorities continue their work of intensive surveillance and follow up measures, as well as further epidemiological investigations.
Among the 41 confirmed cases, there has been one death. This death occurred in a patient with serious underlying medical conditions.
China shared the genetic sequence of the novel coronavirus on 12 January, which will be of great importance for other countries to use in developing specific diagnostic kits.
The cluster was initially reported on 31 December 2019, when the WHO China Country Office was informed. The Chinese authorities identified a new type of coronavirus (novel coronavirus, nCoV), which was isolated on 7 January 2020. Laboratory testing was conducted on all suspected cases identified through active case finding and retrospective review. Other respiratory pathogens such as influenza, avian influenza, adenovirus, Severe Acute Respiratory Syndrome coronavirus (SARS-CoV), Middle East Respiratory Syndrome coronavirus (MERS-CoV) were ruled out as the cause.
According to information conveyed to WHO by Chinese authorities on 11 and 12 January, 41 cases with novel coronavirus infection have been preliminarily diagnosed in Wuhan City. Of the 41 cases reported, seven are severely ill. This is when the one death, mentioned above, was reported, in a patient with other underlying health conditions. Six patients have been discharged from hospital. Symptom onset of the 41 confirmed nCoV cases ranges from 8 December 2019 to 2 January 2020. No additional cases have been detected since 3 January 2020.
The clinical signs and symptoms reported are mainly fever, with a few cases having difficulty in breathing, and chest radiographs showing invasive pneumonic infiltrates in both lungs. National authorities report that patients have been isolated and are receiving treatment in Wuhan medical institutions.
According to the preliminary epidemiological investigation, most cases worked at or were handlers and frequent visitors to the Huanan Seafood Wholesale Market. The government reports that there is no clear evidence that the virus passes easily from person to person.
Currently, no case with infection of this novel coronavirus has been reported elsewhere other than Wuhan.
Novel Coronavirus – THAILAND (ex-China)
14 January 2020
On 13 January 2020, the Ministry of Public Health (MoPH), Thailand reported the first imported case of lab-confirmed novel coronavirus (2019-nCoV) from Wuhan, Hubei Province, China.
The case is a 61-year-old Chinese woman living in Wuhan City, Hubei Province, China. On 5 January 2020, she developed fever with chills, sore throat and headache. On 8 January 2020, she took a direct flight to Thailand from Wuhan City together with five family members in a tour group of 16 people. The traveler with febrile illness was detected on the same day by thermal surveillance at Suvarnabhumi Airport (BKK), Thailand, and was hospitalized the same day. After temperature check and initial assessment, she was transferred to the hospital for further investigations and treatment.
The patient’s full exposure history is under investigation. She reported a history of visiting a local fresh market in Wuhan on regular basis prior to the onset of illness on 5 January 2020; however, she did not report visiting the Huanan South China Seafood Market from where most of the cases were detected. Samples tested positive for coronaviruses by reverse transcriptase-polymerase chain reaction (RT-PCR) on 12 January 2020. The genomic sequencing analysis performed by Emerging Infectious Diseases Health Science Center, the Thai Red Cross Society (EID-TRC) and the Thai National Institute of Health (Thai NIH), Department of Medical Sciences confirmed that the patient was infected with the novel coronavirus (2019-nCoV) which was isolated in Wuhan, China (for more information, please see the Disease Outbreak News published on 12 January 2020 ).
As of this writing, the patient is in a stable condition and in hospital.
Public health response
Novel Coronavirus – JAPAN (ex-China)
16 January 2020
The Japanese Ministry of Health, Labour and Welfare, today informed the World Health Organization (WHO) of a confirmed case of a novel coronavirus (2019-nCoV) in a person who travelled to Wuhan, China. This is the second confirmed case of 2019-nCoV that has been detected outside of China, following confirmation of a case in Thailand on 13 January. Considering global travel patterns, additional cases in other countries are likely.
Coronaviruses are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome. 2019-nCoV is a new strain that has not been previously identified in humans.
Much remains to be understood about the new coronavirus, which was first identified in China earlier this month. Not enough is known about 2019-nCoV to draw definitive conclusions about how it is transmitted, clinical features of disease, or the extent to which it has spread. The source also remains unknown.
WHO encourages all countries to continue preparedness activities. On 10 January, WHO published information on how to monitor for cases, treat patients, prevent onward transmission in health care facilities, maintain necessary supplies, and communicate with the public about 2019-nCoV. The information includes advice on how to maintain hand and respiratory hygiene, and safe food and market practices. WHO is developing and updating this information in consultation with networks of experts across the globe.
WHO’s interim guidance and other information on coronaviruses can be found here
WHO advises against the application of any travel or trade restrictions based on the information available. If travellers develop respiratory illness before, during or after travel, they should seek medical attention and share travel history with their health care provider.
Novel Coronavirus – Republic of KOREA (ex-China)
21 January 2020
On 20 January 2020, National IHR Focal Point (NFP) for Republic of Korea reported the first case of novel coronavirus in the Republic of Korea. The case is a 35-year-old female, Chinese national, residing in Wuhan, Hubei province in China.
The case-patient had developed fever, chill, and muscle pain on 18 January while in Wuhan. She visited a local hospital in Wuhan and was initially diagnosed with a cold. On 19 January , the case-patient was detected with fever (38.3 °C) upon arrival at the Incheon International Airport. The case-patient was transferred to a national designated isolation hospital for testing and treatment. She was tested positive for pancoronavirus reverse transcriptase-polymerase chain reaction (RT-PCR) assay, and subsequently was confirmed positive for novel coronavirus (2019-nCoV) on 20 January by sequencing at the Korea Centers for Disease Control and Prevention (KCDC). Upon detection, the patient had chills, runny nose, and muscle pain.
The case-patient did not report visiting any markets, including Huanan Seafood Wholesale Market, nor did she have known contact with confirmed 2019-nCoV cases or wild animals in Wuhan city.
The case-patient is currently under isolation, receiving treatment and is in a stable condition.
Public health response
Data as reported by: 21 January 2020:
• As of 21 January 2020, a total of 314 confirmed cases have been reported for novel coronavirus (2019-nCoV) globally; • Of the 314 cases reported, 309 cases were reported from China, two from Thailand, one from Japan and one from the Republic of Korea;
• Cases in Thailand, Japan and the Republic of Korea were exported from Wuhan City, China;
• Of the 309 confirmed cases in China, 270 cases were confirmed from Wuhan;
• Of the 270 cases, 51 cases are severely ill1 and 12 are in critical condition2 ;
• Six deaths have been reported from Wuhan;
• Four of five deaths, with available epidemiological information, had underlying comorbidities;
• To date, sixteen health care workers have been infected.
II. PREPAREDNESS AND RESPONSE: WHO:
• WHO has been in regular and direct contact with Chinese as well as Japanese, Korean and Thai authorities since the reporting of these cases. The three countries have shared information with WHO under the International Health Regulations. WHO is also informing other countries about the situation and providing support as requested;
• On 2 January, the incident management system was activated across the three levels of WHO (country office, regional office and headquarters);
• Developed the surveillance case definitions for human infection with 2019-nCoV and is updating it as per the new information becomes available; • Developed interim guidance for laboratory diagnosis, clinical management, infection prevention and control in health care settings, home care for mild patients, risk communication and community engagement;
• Prepared disease commodity package for supplies necessary in identification and management of confirmed patients;
• Provided recommendations to reduce risk of transmission from animals to humans;
• Updated the travel advice for international travel in health in relation to the outbreak of pneumonia caused by a new coronavirus in China;
• Utilizing global expert networks and partnerships for laboratory, infection prevention and control, clinical management and mathematical modelling;
• Activation of R&D blueprint to accelerate diagnostics, vaccines, and therapeutics;
• WHO is working with our networks of researchers and other experts to coordinate global work on surveillance, epidemiology, modelling, diagnostics, clinical care and treatment, and 5 other ways to identify, manage the disease and limit onward transmission. WHO has issued interim guidance for cIII.
• National authorities are conducting active case finding in all provinces;
• Since 14 January 2020, 35 infrared thermometers have been installed in airports, railway stations, long-distance bus stations, and ferry terminals; • Search expanded for additional cases within and outside of Wuhan City;
• Active / retroactive case finding in medical institutions in Wuhan City;
• The Huanan Seafood Wholesale Market in Wuhan city was closed on 1 January 2020 for environmental sanitation and disinfection. Market inspection in expansion to other markets;
• Public education on disease prevention and environmental hygiene further strengthened in public places across the city, farmers’ markets in particular.
• The Department of Disease Control has been implementing its surveillance protocol by fever screening of travellers from all direct flights from Wuhan to the Suvarnabhumi, Don Mueang, Chiang Mai, Phuket and Krabi airports, with the screening protocol starting at Krabi Airport started on 17 January 2020;
• From 3 to 20 January 2020, among 116 flights, 18,383 passengers and aircrew members were screened for respiratory symptoms and febrile illness;
• As of 20 January 2020, the Department of Disease Control, Ministry of Public Health, Thailand has scaled up the Emergency Operations Center to Level 2 to closely monitor the ongoing situation both at the national and international levels;
• Risk communication guidance has been shared with the public and a hotline has been established by the Department of Disease Control for people returning from the affected area in China with related symptoms.
• From 6 January, the Ministry requested local health governments to be aware of the respiratory illnesses in Wuhan by using the existing surveillance system for serious infectious illness with unknown etiology;
• Quarantine and screening measures have been enhanced for travelers from Wuhan at the point of entries since 7 January;
• National Institute of Infectious Disease (NIID) established an in-house PCR assay for nCoV on 16 January;
• The Japanese Government scaled up a whole-of-government coordination mechanism on the 16 January; 6
• As of 21 January, National Institute of Infectious Disease (NIID) announced it will conduct active epidemiological investigations for confirmed cases and close contacts;
• The Ministry of Health has strengthened surveillance for undiagnosed severe acute respiratory illnesses since the report of undiagnosed pneumonia in Wuhan;
• Revision of the risk assessment by NIID is being conducted, including case definition of close contacts;
• The public risk communication has been enhanced;
• A hotline has been established among the different ministries in the government;
• The MHLW is working closely with WHO and other related Member States to foster mutual investigations and information sharing.
Republic of Korea:
• Contact tracing and other epidemiological investigation are underway;
• The government has scaled up the national alert level from Blue (Level 1) to Yellow (Level 2 out of 4-level national crisis management system);
• The health authority strengthened surveillance for pneumonia cases in health facilities nationwide since 3 January 2020;
• Quarantine and screening measures have been enhanced for travelers from Wuhan at the point of entries (PoE) since 3 January 2020; • Public risk communication has been enhancedountries, updated to take into account the current situation.
III.Data as reported by: 24 January 2020
• A total of 846 confirmed cases have been reported for novel coronavirus (2019-nCoV) globally;
• Of the 846 cases reported, 830 cases were reported from China;
• Eleven confirmed cases have been reported outside of China in six countries (see table-1),
• Of these 11 confirmed cases, 10 had travel history to Wuhan;
• One confirmed case in Vietnam had no travel history to any part of China but was a family member of a confirmed case who visited Wuhan. This suggests an instance of human to human transmission that occurred in Vietnam.
• Of the 830 confirmed cases in China, 375 cases were confirmed from Hubei Province;
• Of the 830 cases, 177 cases have been reported as severely ill ;
• Twenty-five deaths have been reported to date
• On 24 January 2020, the number of reported confirmed cases of 2019-nCoV has increased by 265 cases since the last situation report published on 23 January 2020, including China which reported additional 259 confirmed cases.
New epidemiological information reinforces the evidence that the 2019-nCoV can be transmitted from one individual to another. During previous outbreaks due to other coronavirus (Middle-East Respiratory Syndrome (MERS) and the Severe Acute Respiratory Syndrome (SARS)), human to human transmission occurred through droplets, contact and fomites, suggesting that the transmission mode of the 2019-nCoV can be similar. The strategic objectives of the response are to interrupt the transmission of the virus from one person to another in China, to prevent exportation of cases from China to other countries and territories, and to prevent further transmission from exported case if they were to happen. This can be achieved through a combination of public health measures, such as rapid identification, diagnosis and management of the cases, identification and follow up of the contacts, infection prevention and control in healthcare settings, implementation of health measures for travellers, awareness raising in the population, risk communication.
Novel Coronavirus(2019-nCoV) Situation Report – 31 January 2020
• The Emergency Committee on the novel coronavirus (2019-nCoV) under the International Health Regulations (IHR 2005) was reconvened on 30 January. WHO declared the outbreak to be a public health emergency of international concern. The Emergency Committee has provided advice to WHO, to the People’s Republic of China, to all countries, and to the global community, on measures to control this outbreak. The Committee believes that it is still possible to interrupt virus spread, provided that countries put in place strong measures to detect disease early, isolate and treat cases, trace contacts, and promote social distancing measures commensurate with the risk. More details can be found here and in Annex to this situation report.
• Today, the first two confirmed cases of 2019-nCoV acute respiratory disease were reported in Italy; both had travel history to Wuhan City.
• WHO’s Risk Communication Team has launched a new information platform called WHO Information Network for Epidemics (EPI-WIN). EPI-WIN will use a series of amplifiers to share tailored information for specific target groups. EPIWIN began this week to establish connections to health care and travel and tourism sectors and will work with food and agriculture and business/employer sectors next w
SURVEILLANCE Table 1.
Countries, territories or areas with reported confirmed cases of 2019-nCoV, 31 January 2020
China* 9720 Japan 14 Republic of Korea 11 Viet Nam 5 Singapore 13 Australia 9 Malaysia 8 Cambodia 1 Philippines 1
South-East Asia Thailand 14 Nepal 1 Sri Lanka 1 India 1
Region of the Americas United States of America 6 Canada 3
European Region France 6 Finland 1 Germany 5 Italy 2
ANNEX 1: Temporary Recommendations under the International Health Regulations associated with the declaration of the outbreak of 2019-nCoV as a Public Health Emergency of International Concern
To the People’s Republic of China Continue to:
• Implement a comprehensive risk communication strategy to regularly inform the population on the evolution of the outbreak, the prevention and protection measures for the population, and the response measures taken for its containment. • Enhance public health measures for containment of the current outbreak.
• Ensure the resilience of the health system and protect the health workforce.
• Enhance surveillance and active case finding across China.
• Collaborate with WHO and partners to conduct investigations to understand the epidemiology and the evolution of this outbreak and measures to contain it.
• Share relevant data on human cases.
• Continue to identify the zoonotic source of the outbreak, and particularly the potential for circulation with WHO as soon as it becomes available.
• Conduct exit screening at international airports and ports, with the aim of early detection of symptomatic travelers for further evaluation and treatment, while minimizing interference with international traffic.
To all countries
It is expected that further international exportation of cases may appear in any country. Thus, all countries should be prepared for containment, including active surveillance, early detection, isolation and case management, contact tracing and prevention of onward spread of 2019-nCoVinfection, and to share full data with WHO. Technical advice is available on the WHO website. Countries are reminded that they are legally required to share information with WHO under the IHR. Any detection of 2019-nCoV in an animal (including information about the species, diagnostic tests, and relevant epidemiological information) should be reported to the World Organization for Animal Health (OIE) as an emerging disease. Countries should place particular emphasis on reducing human infection, prevention of secondary transmission and international spread, and contributing to the international response though multi-sectoral communication and collaboration and active participation in increasing knowledge on the virus and the disease, as well as advancing research. The Committee does not recommend any travel or trade restriction based on the current information available. Countries must inform WHO about travel measures taken, as required by the IHR. Countries are cautioned against actions that promote stigma or discrimination, in line with the principles of Article 3 of the IHR
IL CONSIGLIO DEI MINISTRI
Nella riunione del 31 gennaio 2020
Visto il decreto legislativo 2 gennaio 2018, n. …
Ritenuto, pertanto, necessario provvedere tempestivamente a porre in essere tutte le iniziative di carattere straordinario sia sul territorio nazionale che internazionale, finalizzate a fronteggiare la grave situazione internazionale determinatasi;
Su proposta del Presidente del Consiglio dei ministri;
1) In considerazione di quanto esposto in premessa, ai sensi e per gli effetti dell'articolo 7, comma 1, lettera c), e dell'articolo 24, comma 1, del decreto legislativo 2 gennaio 2018, n. 1, e' dichiarato, per 6 mesi dalla data del presente provvedimento, lo stato di emergenza in conseguenza del rischio sanitario connesso all'insorgenza di patologie derivanti da agenti virali trasmissibili.
2) Per l'attuazione degli interventi di cui dell'articolo 25, comma 2, lettere a) e b) del decreto legislativo 2 gennaio 2018, n. 1, da effettuare nella vigenza dello stato di emergenza, si provvede con ordinanze, emanate dal Capo del Dipartimento della protezione civile in deroga a ogni disposizione vigente e nel rispetto dei principi generali dell'ordinamento giuridico, nei limiti delle risorse di cui al comma 3.
3) Per l'attuazione dei primi interventi, nelle more della valutazione dell'effettivo impatto dell'evento in rassegna, si provvede nel limite di euro 5.000.000,00 a valere sul Fondo per le emergenze nazionali di cui all'articolo 44, comma 1, del decreto legislativo 2 gennaio 2018, n. 1.
La presente delibera sara' pubblicata nella Gazzetta Ufficiale della Repubblica italiana.
Roma, 31 gennaio 2020
Il Presidente del Consiglio dei ministri