The World Health Organization (WHO) said on Thursday that it was "too early" to declare the outbreak of the novel coronavirus in China a public health emergency of international concern (PHEIC), while warning that the number of cases may rise as many about the virus remain unknown.
"I am not declaring a public health emergency of the international concern today. As it was yesterday, the Emergency Committee was divided over whether the outbreak of novel coronavirus represents a PHEIC or not," said WHO Director-General Tedros Adhanom Ghebreyesus at a press conference after a closed-door meeting of the Emergency Committee (EC).
"Make no mistake, though, this is an emergency in China. But it has not yet become a global health emergency. It may yet become one," Tedros said, adding that WHO's risk assessment is that the outbreak is a very high risk in China, and a high risk regionally and globally.
"I wish to reiterate that the fact I am not declaring a PHEIC today should not be taken as a sign that WHO does not think the situation is serious, or that we are not taking it seriously," the WHO chief said.
The UN health agency extended its Emergency Committee discussions on whether to declare a PHEIC from Wednesday to Thursday.
The PHEIC is defined by the WHO as an extraordinary event that is determined to constitute a public health risk to other states through the international spread of disease and to potentially require a coordinated international response.
Tedros said that 584 cases have now been reported to WHO, including 17 deaths. A total of 575 of those cases and all of the deaths have been reported in China, with other cases reported in Japan, the Republic of Korea, Singapore, Thailand, the United States and Vietnam.
Tedros said China has taken measures it believes appropriate to contain the spread of coronavirus in Wuhan, where the virus appears to have originated, and other cities, and WHO hoped that they will be both effective and short in their duration.
He thanked the Chinese government for its cooperation and transparency. The government has been successful in isolating and sequencing the virus very quickly and has shared that genetic sequence with the WHO and the international community.
For the moment, WHO does not recommend any broader restrictions on travel or trade, and recommends exit screening at airports as part of a comprehensive set of containment measures. All countries should have in place measures to detect cases of coronavirus, including at health facilities, Tedros said.
"The advice to the DG (Director-General) is that now it is not the time. It is too early to consider this event is a public health emergency of international concern," said Didier Houssin, chair of the EC and an adviser to France's national health security agency.
According to Houssin, the WHO received from health authorities in China very precise information about the evolution of the epidemic. The WHO had learned that the public transport suspension in Wuhan and some neighboring cities was not directly related to a specific evolution of the epidemic.
Researchers at the University of Illinois (UI) have estimated the mortality costs associated with air pollution in the United States by developing and applying a novel machine learning-based method to estimate the life-years lost and cost associated with air pollution exposure.
By exploiting the daily variation in acute fine particulate pollution exposure driven by changes in wind direction, the researchers found significant effects of exposure on mortality, hospitalizations and medical spending.
About 25 percent of the elderly Medicare population was vulnerable to acute pollution shocks, according to a news release posted on the UI's website this week.
"Our analysis shows that the most vulnerable Medicare beneficiaries are those who suffer from chronic conditions and have high health care spending," said Julian Reif, a UI professor of finance and a faculty member of the Institute of Government and Public Affairs. "We estimate that members of the most vulnerable group -- those with a life expectancy of less than one year -- are over 30 times more likely to die from pollution than the typical Medicare beneficiary."
The scholars also found that increases in particulate matter lead to more emergency room visits, hospitalizations and higher patient spending.
They calculated that the reduction in particulate matter experienced between 1999 and 2013 resulted in elderly mortality reductions worth 24 billion U.S. dollars annually by the end of that period.
"Mortality is only one of many potential costs of air pollution," said David Molitor, another UI professor of finance. "The elderly who aren't dying may engage in other costly activities such as going to the hospital for preventive or emergency care. Those steps may help them avoid death, but it doesn't mean that pollution has no cost to their health or finances."
Notably, the researchers also found that the failure to adjust for the pre-existing health of those who die from an acute pollution event tends to overstate the mortality-reduction benefits of decreasing air pollution.
"Another way of thinking about our characterization of who dies from pollution is as an index of vulnerability," Molitor said. "By understanding who is most vulnerable to pollution, local policies and actions can be designed to better protect lives and to improve population resilience to pollution events."
The study was published in the American Economic Review
China moved to lock down at least three cities with a combined population of more than 18 million in an unprecedented effort to contain the deadly new virus that has sickened hundreds of people and spread to other parts of the world during the busy Lunar New Year holiday.
The open-ended lockdowns are unmatched in size, embracing more people than New York City, Los Angeles and Chicago put together.
The train station and airport in Wuhan, the epicenter of the outbreak, were shut down, and ferry, subway and bus service was halted. Normally bustling streets, shopping malls, restaurants and other public spaces in the city of 11 million were eerily quiet. Police checked all incoming vehicles but did not close off the roads.
Similar measures were being imposed Friday in the nearby cities of Huanggang and Ezhou. In Huanggang, theaters, internet cafes and other entertainment centers were also ordered closed.
In the capital, Beijing, major events were canceled indefinitely, including traditional temple fairs that are a staple of holiday celebrations, to stop the spread of the virus. The Forbidden City, the palace complex in Beijing that is now a museum, announced it will close indefinitely on Saturday.
China's National Health Commission said Friday morning the confirmed cases of the new coronavirus had risen to 830 with 25 deaths. The first death was also confirmed outside the central province of Hubei, where the capital, Wuhan, has been the epicenter of the outbreak. The health commission in Hebei, a northern province bordering Beijing, said an 80-year-old man died after returning from a two-month stay in Wuhan to see relatives.
The vast majority of cases have been in and around Wuhan or people with connections the city. Other cases have been confirmed in the United States, Japan, Taiwan, South Korea and Thailand. Singapore and Vietnam reported their first cases Thursday, and cases have also been confirmed in the Chinese territories of Hong Kong and Macao.
Many countries are screening travelers from China for symptoms of the virus, which can cause fever, coughing, breathing difficulties and pneumonia.
The World Health Organization has decided against declaring the outbreak a global emergency, a step that can bring more money and resources to fight a threat but that can also cause trade and travel restrictions and other economic damage, making the decision a politically fraught one.
The decision "should not be taken as a sign that WHO does not think the situation is serious or that we're not taking it seriously. Nothing could be further from the truth," WHO Director General Tedros Adhanom Ghebreyesus said. "WHO is following this outbreak every minute of every day."
Chinese officials have not said how long the shutdowns of the cities will last. While sweeping measures are typical of China's Communist Party-led government, large-scale quarantines are rare around the world, even in deadly epidemics, because of concerns about infringing on people's liberties. And the effectiveness of such measures is unclear.
"To my knowledge, trying to contain a city of 11 million people is new to science," said Gauden Galea, the WHO''s representative in China. "It has not been tried before as a public health measure. We cannot at this stage say it will or it will not work."
Jonathan Ball, a professor of virology at molecular virology at the University of Nottingham in Britain, said the lockdowns appear to be justified scientifically.
"Until there's a better understanding of what the situation is, I think it's not an unreasonable thing to do," he said. "Anything that limits people's travels during an outbreak would obviously work."
But Ball cautioned that any such quarantine should be strictly time-limited. He added: "You have to make sure you communicate effectively about why this is being done. Otherwise you will lose the goodwill of the people."
During the devastating West Africa Ebola outbreak in 2014, Sierra Leone imposed a national three-day quarantine as health workers went door to door, searching for hidden cases. Burial teams collecting corpses and people taking the sick to Ebola centers were the only ones allowed to move freely. Frustrated residents complained of food shortages.
In China, the illnesses from the newly identified coronavirus first appeared last month in Wuhan, an industrial and transportation hub. Local authorities demanded all residents wear masks in public places and urged civil servants wear them at work.
After the city was closed off Thursday, images showed long lines and empty shelves at supermarkets, as people stocked up. Trucks carrying supplies into the city are not being restricted, although many Chinese recall shortages in the years before the country's recent economic boom.
Analysts predicted cases will continue to multiply, although the jump in numbers is also attributable in part to increased monitoring.
"Even if (cases) are in the thousands, this would not surprise us," the WHO's Galea said, adding, however, that the number of infected is not an indicator of the outbreak's severity so long as the death rate remains low.
The coronavirus family includes the common cold as well as viruses that cause more serious illnesses, such as the SARS outbreak that spread from China to more than a dozen countries in 2002-03 and killed about 800 people, and Middle Eastern respiratory syndrome, or MERS, which is thought to have originated from camels.
China is keen to avoid repeating mistakes with its handling of SARS. For months, even after the illness had spread around the world, China parked patients in hotels and drove them around in ambulances to conceal the true number of cases and avoid WHO experts. This time, China has been credited with sharing information rapidly, and President Xi Jinping has emphasized that as a priority.
Health authorities are taking extraordinary measures to prevent the spread of the virus, placing those believed infected in plastic tubes and wheeled boxes, with air passed through filters.
The first cases in the Wuhan outbreak were connected to people who worked at or visited a seafood market, now closed for an investigation. Experts suspect that the virus was first transmitted from wild animals but that it may also be mutating. Mutations can make it deadlier or more contagious.
Eight hundred Central American migrants were rounded up and hauled onto buses by Mexican national guardsmen and immigration agents after crossing into the country early Thursday and walking for hours along a rural highway.
The migrants had stopped for the day at a shaded crossroads when hundreds of national guard troops advanced their lines to within 100 yards (meters) of the migrants.
A brief negotiation stalled after Mexican authorities said the migrants "demanded permits for free transit through Mexico to the United States."
The migrants knelt to the ground in prayer and began to chant "we want to pass."
National guardsmen in riot gear advanced banging their plastic shields with batons and engaged the migrants. There was shoving and pepper spray as migrants were rounded up.
Many of the people allowed themselves to be escorted to 20 waiting buses without resistance. Women cradling small children or holding kids' hands wept as they walked toward the buses.
Others resisted and were subdued by guardsmen. One man dragged by four guardsmen shouted "they killed my brother, I don't want to die," presumably in reference to the possibility of being returned to his country.
A woman crying as she walked toward a bus said, "I have a great need for my children."
A paramedic attended to an injured woman lying on the highway shoulder.
The road was left littered with water bottles, plastic bags and clothing. An irate man in a blue shirt yelled at the agents "this is a war against the Hondurans," gesturing angrily.
It was a sudden climax after the day had seemed to be winding down.
Carrying U.S. and Honduran flags at the head of the procession, the migrants had been walking on a highway toward hundreds of national guardsmen since crossing the Suchiate river from Guatemala at dawn.
Jose Luis Morales, a Salvadoran de facto spokesman for the caravan, said the migrants wanted to negotiate to be allowed to pass peacefully.
The migrants halted late in the morning on the roadside about 6 miles (10 kilometers) north of the river border city of Ciudad Hidalgo, and a few miles (kilometers) from where a large deployment of security forces was waiting.
Federal officials arrived and began negotiating with Morales.
He said afterward that authorities' initial proposal was that they turn themselves in for detention while being processed for refuge — what he called "always the same policy." Instead, they planned to stay put until Friday, Morales said.
Mexico has cracked down on the large caravans seen previously following intense pressure from Washington last year.
Aníbal, who declined to give his last name for fear of reprisal from immigration authorities, joined the majority Honduran caravan from his hometown of Santa Rosa, Guatemala. He and others rested in the shade of a tree Thursday morning after walking for hours along the highway.
He was determined to get to the U.S., no matter where, and work to save money and return to his wife and three kids. Back home he worked part time gigs as a laborer, machinist, selling used clothing, but there wasn't enough work.
"They need to let us pass," he said.
Asked about assertions from Mexico's president that migration must be regular and orderly, he said: "He needs to have a little more compassion ... we're going out of necessity. We're not going for ambition."
Thursday's movement was a resurgence of a migrant caravan that had been diminishing since its last concerted attempt to cross the border Monday was turned back by Mexican National Guardsmen posted along the Suchiate R iver, which forms the border here.
The migrants awoke with a plan Thursday. By 4:30 a.m. they had all packed their belongings and were just awaiting the call to move. They would not cross where Mexican authorities were posted across the river.
They prayed for about an hour before leaving and then walked upriver on the Guatemala side in the dark to near another bridge that handles commercial traffic between the two countries. There were no Mexican authorities on the opposite bank.
There the water was deeper, coming to the waist of a grown man, so a number of young men entered the river first and formed a human chain to keep the women and children who followed from being pulled by the current. When the first migrants crossed at 6 a.m., it was still pitch black.
The national guardsmen awaited the caravan outside the community of Frontera Hidalgo, near Ciudad Hidalgo where the migrants crossed the Suchiate river at dawn.
Mexico began flying and busing members of the caravan back to Honduras on Tuesday.
Seven more buses left Mexico for Honduras on Wednesday, carrying 240 migrants back home, and two flights left with an additional 220 Hondurans, Mexico's National Immigration Institute said. By Wednesday, the number of people outside the Casa del Migrante in Tecun Uman was perhaps half of what it was at its peak Sunday night.
In previous caravans, Mexican authorities have allowed caravans to walk for awhile, seemingly to tire them out, and then closed their path.
While the migrants have been receiving steady local media coverage since they arrived at the border, they have not surpassed topics of security, economy or corruption in the public agenda.
On Thursday, a multi-day march for truth, justice and peace departed the central Mexico city of Cuernavaca bound for the capital. The leader of that march, anti-crime activist Javier Sicilia, said part of Mexico's problem were the "dozens of thousands of migrants treated without the dignity of human beings."
Meanwhile, Mexican President Andrés Manuel López Obrador's two-hour daily press conference was dominated by questions about the supply of cancer drugs as parents of children with cancer protested outside the national palace.
He has faced some criticism from the left for the more aggressive response to migrants, but seemingly not enough to blunt his high popularity.
North Korea has named as its new foreign minster a former senior army officer with little experience in dealings with the United States, in a possible indication it will take a harder line with Washington in stalled nuclear negotiations.
The new post for Ri Son Gwon was disclosed Friday in a Korean Central News Agency dispatch that said he attended a reception for foreign diplomats in Pyongyang on Thursday. South Korean and other outside media previously reported North Korea had recently informed foreign diplomats in Pyongyang of Ri's job.
In his speech at the banquet, "Comrade Ri Son Gwon said that the Korean people have turned out in the general offensive to break through head-on the barriers to the advance of socialist construction by dint of self-reliance ... and made public the foreign policy stand of the (North Korean) government," KCNA said.
Ri, an outspoken retired army colonel who recently headed a government body responsible for relations with South Korea, has taken part in numerous inter-Korean talks over the past 15 years. But he lacks experience in negotiations with the United States.
In South Korea, he's most known for what were seen as rude remarks to South Korean businessmen visiting Pyongyang in September 2018. While they were eating naengmyeon, Korean traditional cold noodles, Ri asked them: "Are naengmyeon going down your throats?" in apparent dissatisfaction with a lack of progress in efforts to promote inter-Korean economic projects. Many conservatives in South Korea strongly criticized him.
Ri replaced Ri Yong Ho, a career diplomat with broad experiences in dealings with both the United States and South Korea who had taken part in nuclear negotiations with the United States since early 2018. It wasn't immediately known what happened to Ri Yong Ho, whose name was last mentioned in KCNA last August.
Analyst Cheong Seong-Chang at South Korea's private Sejong Institute said Ri Son Gwon's appointment signaled North Korea would further harden its stance on the United States and bolster its push to cement its position as a nuclear state.
"From now on, it's difficult to expect meaningful progress in North Korea-U.S. diplomacy," Cheong said.
Nuclear talks between the United States and North Korea have progressed little since the breakdown of the second summit between President Donald Trump and North Korean leader Kim Jong Un in Vietnam in February 2019. Kim recently said North Korea would bolster its nuclear arsenal and unveil a new "strategic weapon" after the United States failed to meet a year-end deadline set by him to make concessions.
A senior State Department official told reporters Wednesday that Washington was aware of Ri Son Gwon's reported appointment and hopes North Korea will understand the importance of resuming diplomacy.
"There's nothing to be gained by not talking. It's only to their benefit, so we encourage them to talk," the official said on condition of anonymity because he wasn't authorized to speak publicly to the matter. "It is slow, patient, steady diplomacy. We're going to stick with that plan."