Just a few months ago, Tom Inglesby helped gather top officials from governments, businesses and health organizations around the world to play a kind of war game.
"It was a scenario looking at global consequences of a major new epidemic," says Inglesby, who directs the Center for Health Security at Johns Hopkins University.
The simulation they devised, he adds, has turned out to be "shockingly" similar to the outbreak that is now unfolding in China — right down to the type of pathogen involved: a coronavirus. Many of the officials who participated in the exercise are also among those now at the forefront of responding to the current outbreak, including the director of China's Center for Disease Control and Prevention.
But one development that Inglesby says they did not anticipate was a massive transportation shutdown like the one that China has now imposed on Wuhan, the city where the new virus first emerged.
In a bid to halt further spread of the virus, Chinese authorities have suspended subways, buses, trains and flights out of Wuhan. Officials have also announced similar restrictions in several other cities.
"We didn't even contemplate the possibility of a quarantine on this scale because it hasn't really happened before," says Inglesby. "It's just such a departure from how we've been thinking about public health interventions."
Indeed, the move was so unusual that its announcement on Wednesday threw a wrench into the work of a committee of experts convened by the World Health Organization. The panel was charged with advising on whether the outbreak should be declared an international emergency. News of the transportation shutdown reached the panel just as members were about to render their judgment. They decided to defer a decision until they could get more information.
"We wanted to know if these measures taken in Wuhan were the result of some new evolution [in the virus' spread] that we had not been made aware of," the panel's chair, Didier Houssin, explained at a news conference in Geneva on Thursday.
Ultimately, he added, China was able to reassure the committee that there had not been a change in the outbreak's trajectory. For now, most of the 830 confirmed cases are occurring within families or in health workers who've had close contact with a sick person. In other words, officials are not observing the kind of spread you get with a virus like the flu, with people passing it on to strangers on, say, subways, or during other passing encounters.
Largely for that reason, the WHO's director general, Tedros Adhanom Ghebreyesus, says he has decided against declaring an international emergency for now.
Yet speaking at that same news conference, Tedros subtly signaled that the transportation shutdown is not the type of move the WHO would recommend.
While "China is a sovereign nation with the autonomy to take steps it believes in its interests," said Tedros, the WHO's role is to provide "rational and science-based" recommendations. He added that he hoped the transportation shutdown would be "short in duration."
Other health experts have been less diplomatic.
"I think it's really unwise," says Lawrence Gostin, director of the O'Neill Institute for National and Global Health Law at Georgetown University Law Center.
He cites the practical challenges and potential human rights violations involved with effectively locking down a city of 11 million people.
Then there's the fact that the virus has already spread well beyond Wuhan — suggesting that the transportation shutdown amounts to closing the stable door after the horse has bolted.
But worst of all, says Gostin, "there's very good reason to believe that it could actually backfire very badly."
People could easily start to see the government as oppressing them, sowing fear and mistrust, he says.
"The most important thing in public health is not to drive the population underground and make them fearful," says Gostin. "You want them to cooperate. You want them to report their symptoms. You want them to believe that the government is there to help them and not to violate their rights. It's very, very difficult to control an epidemic once you've lost the trust of the population."
Several recent smaller-scale quarantines have produced precisely that result, says Jeremy Konyndyk, a senior fellow at the Washington, D.C., think tank Center for Global Development.
"A very recent example of this is during the Ebola outbreak in West Africa in 2014," says Konyndyk. In Liberia and Sierra Leone, officials attempted to prevent people from leaving several neighborhoods and small localities. "People tried to flee the quarantine. And that actually then made things worse because it meant that cases were then invisible from view."
Konyndyk, who served as head of international disaster response in the administration of President Barack Obama, says it remains to be seen whether China's transportation shutdown will prove as heavy-handed, punitive and unproductive.
Still he agrees with Gostin that the most effective approach is likely to be a far more laborious method.
As Gostin puts it: "You need to go into communities where people have been infected. Isolate all cases. Then do contact tracing so that we know every single person that has been exposed."
That's what ultimately ended other recent disease outbreaks, says Gostin.
And that's what's going to put an end to this one.
ARI SHAPIRO, HOST:
It's too early to declare the outbreak of a new coronavirus in China an international health emergency. That's according to the World Health Organization. The decision was made after an extraordinary two-day meeting by a panel of experts. At a press conference in Geneva, the director-general of the WHO explained that most of the hundreds of people who've been infected so far are in China. But he also had this to say.
(SOUNDBITE OF ARCHIVED RECORDING)
TEDROS ADHANOM GHEBREYESUS: Make no mistake, this is an emergency in China. It has not yet become a global health emergency. It may yet become one.
SHAPIRO: Officials have shut down transportation out of the city of 11 million people where the virus first emerged, Wuhan. NPR's global health correspondent Nurith Aizenman is here in the studio.
NURITH AIZENMAN, BYLINE: Hi, Ari.
SHAPIRO: Tell us more about this transportation shutdown in Wuhan. How is it playing out?
AIZENMAN: Yeah. So this is basically the equivalent of locking down Chicago two days before Thanksgiving. It's hard to overstate how drastic a step this is. I mean, Wuhan is a city of 11 million people. It's the transportation hub of central China.
And Chinese authorities have now suspended subways, buses, trains, flights. And they're doing this at a time when literally tens of millions of people are on the move within China as families gather to celebrate a major holiday there, the Lunar New Year. Also, it's possible we're going to see more of these shutdowns because today they've announced similar restrictions in two other cities.
SHAPIRO: And does the World Health Organization support these moves? I know there's been some criticism.
AIZENMAN: Yeah. A number of public health experts that I've spoken to say this is a terrible idea. It could cause panic, drive people underground, basically backfire. Also, the virus has now spread beyond Wuhan to lots of other cities in China. So it's kind of like closing the barn door after the horse has bolted.
Now, when I asked the WHO's director-general, Tedros Adhanom Ghebreyesus, about it, he was diplomatic. He stressed that this is China's right. But he also signaled that this is not the WHO's recommendation. He noted that the WHO's role is to provide, quote, "rational science-based public health guidance." And he said he hopes that this measure by China is, quote, "short in duration." Also, this decision by China really threw a wrench into the WHO's deliberations about whether to declare this outbreak a global emergency.
SHAPIRO: Describe what the implications of that declaration would be. Why does it matter whether WHO says this is a global health emergency?
AIZENMAN: So when the WHO declares an international health emergency, it's really a way for them to give expert recommendations on how countries and people can protect themselves. But it's a big deal. It can carry a lot of weight in terms of galvanizing action by countries. It's only been declared for a handful of prior epidemics. And this panel of experts was in the middle of meeting on the issue Wednesday when China blindsided them with a decision to shut down transportation in Wuhan.
It's such an unusual step that the chair of that advisory committee says, right before they were about to make the decision, they had to stop to get more information. They were wondering, you know, is this based on some dramatic change in the way the disease is spreading? Essentially, is there something China is not telling us? Then, this morning, he says China was able to reassure them that, no, that's not the case.
SHAPIRO: So as of now, the WHO says this is not a global health emergency. Have they said what might push it to that level?
AIZENMAN: Yeah. I mean, the things that Tedros pointed to were that even though the virus is spreading right now, that appears to be mostly within family groups or health workers - in other words, people who've had really close contact with someone who is sick. At this time, they're not seeing the kind of spread you would get with, say, a virus like the flu, where people are passing it on to strangers on, say, the subway.
Similarly, while travelers from China have shown up in other countries with the virus, including in the United States, that hasn't started new chains of transmission in those other countries. Also, so far, there haven't been that many deaths. But if any of those things change, then that would really escalate the alarm level. And, you know, the evidence is still coming in. This is still very much a situation in progress. And there are a lot of unanswered questions.
SHAPIRO: That is NPR global health correspondent Nurith Aizenman with the latest on the coronavirus out of China.
AIZENMAN: Glad to do it. Transcript provided by NPR, Copyright NPR.