Coronavirus: Could it become pandemic?
New coronavirus has now reached more than 65 countries from China, where the epidemic or disease outbreak began over a month ago. Experts are worried about how much further it could spread and how many people will get sick. A truly global outbreak or pandemic has not been declared yet.
But officials are preparing for the possibility that this could be the next pandemic that the world will have to face. The description is reserved for an infectious disease threatening lots of people all over the world simultaneously. A recent example was the 2009 swine flu pandemic, which experts think killed hundreds of thousands of people.
Pandemics are more likely if a virus is brand new, able to infect people easily and can spread from person to person in an efficient and sustained way. Coronavirus appears to tick all of those boxes. With no vaccine or treatment that can prevent it yet, containing its spread is vital.
According to the World Health Organization's (WHO) description of pandemic phases, coronavirus is only a step away from being a pandemic. It is spreading between people and has been seen in many of China's neighbouring countries, as well as further afield. If we start seeing sustained community-level outbreaks in multiple parts of the world, then it will be a pandemic.
It is still unclear how severe the disease is, and how far it will spread. Some scientists were even arguing two weeks ago that we had already entered the earliest stages of a pandemic. All this tells us there is some wiggle-room around the word. The developments in South Korea, Italy and Iran are the reason why people are drifting closer to calling the coronavirus outbreak a pandemic.
South Korea is piling on hundreds of new cases, showing how contagious the virus is. Italy and Iran now have substantial outbreaks. There are almost certainly far more cases in these countries than have been reported - and the connection with China has not yet been established.
"The virus is spreading around the world and the link with China is becoming less strong," says Prof Whitworth. And Prof Devi Sridhar, from the University of Edinburgh, said her perspective "has definitely changed" over the past couple of days.
"This has largely been a Chinese emergency, now we are seeing it progress it South Korea, Japan, Iran and now Italy," she says. "It's a highly infectious virus and spreading very quickly." She does not think we are in a pandemic yet and is waiting to see long chains of transmission in countries outside of China.
"We don't have the evidence to say we're in one, but I'm pretty sure we'll have the evidence in next couple of days. "If it's in Italy and Iran, then it can be anywhere." Researchers have described the cases in Iran as the most worrying for efforts to contain the global spread of the virus and prevent it becoming a pandemic.
The number of deaths reported in the country, 65, is far more revealing than the number of reported cases, 61. Deaths are significant as the virus kills only a small proportion of people who are infected and it takes weeks to go from infection to death. Dr MacDermott said: "It suggests fairly large numbers of people with minimal symptoms, or who are asymptomatic, that aren't being tested or even being identified.
"Who knows how long it has been going on?" The country has already been linked to cases in Afghanistan, Kuwait, Bahrain, Iraq, Lebanon, Canada and Oman. She added: "Iraq and Afghanistan - that's two of the countries you don't want the virus in, healthcare is barely existent after decades of war and it's not safe for healthcare workers to travel there.
"I think we are teetering on the balance of a pandemic, in the next week or two we're likely to see it pop up in lots places and if it's on several different continents then we'd be approaching a pandemic." Officials now say the WHO will not formally "declare" a pandemic for the new coronavirus, though the term may still be used "colloquially".
In 2009, the organisation was criticised when it declared swine flu a pandemic. It based the decision on criteria it no longer uses. The virus did spread round the world - but it proved to be relatively mild, leading some to argue the organisation had been too hasty.