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(CNN) - When the World Health Organization declared that the outbreak of the new coronavirus was a public health emergency of international concern, it did so for fear of the difficulties that smaller or less developed countries have to contain the virus.
Influenza-like respiratory disease is highly contagious and the outbreak has overwhelmed hospitals in the Chinese city of Wuhan, where it was first identified. The Chinese authorities closed entire cities, suspended public transport and closed schools, businesses and factories in an effort to contain it.
"Our biggest concern is the possibility that the virus will spread to countries with weaker health systems and that are not prepared to face it," said WHO Director-General Tedros Adhanom Ghebreyesus, when he announced the decision on January 30 .
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Since then, the number of confirmed cases reported in mainland China has more than quadrupled to more than 44,653. As of Wednesday morning, more than 1,100 people had died from the virus, while 4,740 patients had recovered and had been discharged from the hospital.
The virus has spread throughout Asia, Europe and the United States, with more than 500 confirmed cases in more than two dozen countries and territories, with only two deaths outside of mainland China.
While most cases outside of mainland China have so far connected with travelers from China, or those who have been there recently, a small but growing number of patients have contracted the virus locally.
That is worrisome, because if self-sustaining outbreaks begin to occur in countries with poor health systems, the impact could be devastating.
"It's a huge concern," said Jeremy Konyndyk, principal investigator at the Center for Global Development.
"We still don't have a clear idea of how likely that is, but given the dynamics of transmissions in China and the speed with which cases have arisen in other countries, the global spread seems very plausible."
If China is fighting, how will they face other nations?
China ranks 51st among 195 countries worldwide for its preparedness to handle outbreaks, according to the Global Health Security Index. It is not on par with the richest countries in the world, but it is much higher than several low-income nations.
Authorities in China have suspended public transport and sealed entire cities at the epicenter of the outbreak, effectively putting 60 million people locked up. They have built two new hospitals in less than two weeks and sent thousands of medical workers to Wuhan.
However, despite these unprecedented efforts, the country is struggling to keep the outbreak, which is expanding rapidly, under control.
First-hand accounts of medical staff and patients in Wuhan show that China's already overloaded health system is on its knees. Hospitals, overwhelmed by the sick, are running out of beds and supplies. Exhausted doctors and nurses risk their lives and become infected with the virus.
People talk about sick relatives rejected from hospitals, delays in tests and rooms full of febrile patients and limited screening or quarantine tests.
“If China is struggling to contain this, weaker countries will have it even harder. And the type of transmission we are seeing in China suggests that it could be reflected soon in other places, ”said Konyndyk.
Where are the biggest concerns?
WHO asks to avoid speculation about coronavirus 2:14Countries near China in Southeast and East Asia have endured the worst part of infections outside the continent, with Japan, South Korea, Vietnam and Thailand recording local transmissions.
Some of those nations with coronavirus infections and their neighbors are among the poorest and most disaster-prone countries in the world.
Experts have expressed their fear that the health care infrastructure in these countries may fall apart under the weight of an outbreak, and seriously damage their economies, cause massive displacement and cause other deaths without viruses.
Natural disasters in the Philippines already cause millions of dollars in damage and displace thousands every year.
Powerful typhoons and a series of earthquakes hit the country in 2019, and this year a volcanic eruption in the south of Luzon Island still poses a threat to nearby residents. A dengue epidemic last summer killed more than 1,000 people and infected more than 250,000, demonstrating the strain on their health service.
To date, one person died in the Philippines from coronavirus, the first death outside of mainland China, and it was confirmed that three people contracted the virus.
The Asia-Pacific region is home to 60% of the world's population; Many of these countries are low-income or middle-income nations that are rapidly industrializing.
According to a “A World at Risk” report by the 2019 Global Preparedness Monitoring Board, rapid urbanization can accelerate the spread of the disease during an outbreak.
The population boom and the migration of millions of people from rural areas to overcrowded cities with underdeveloped infrastructure and lack of sanitation could further aggravate the spread of viruses.
India, with a population of 1.3 billion people, is one of the fastest developing countries in the world. By 2050, a United Nations report predicts that India will have 416 million additional urban residents. So far three cases of coronavirus have been confirmed in India, all three are students who had traveled from Wuhan.
While millions of people have emerged from poverty in India in the past 20 years, millions of people have been left behind.
The densely populated slums of the city, where thousands of people live very close to each other in conditions often below standard, could make it difficult to control a viral outbreak.
Smaller and sparsely populated nations in the Pacific Ocean are also extremely vulnerable to an outbreak, although the coronavirus has not been confirmed in any of these territories.
In Manila, students take their temperature before entering their university campus.
Samoa is still recovering from a measles epidemic that infected 5,707 people and killed 83, many of them children. The Samoa government declared a state of emergency in December and closed schools and government services by launching a mass vaccination campaign.
Samoa Prime Minister Tuilaepa Sailele Malielegaoi said recently that "another outbreak of infectious diseases will have catastrophic effects throughout Samoa."
Some countries have not yet reported any cases, including Indonesia, a nation of 264 million, which generally receives a large number of Chinese tourists. Also, no confirmed cases have been reported in Myanmar, which borders China, India, Bangladesh, Thailand and Laos.
An outbreak in Myanmar, for example, could affect a country that is still dealing with the legacy of decades of brutal military rule, where one in four people live in poverty, and infectious diseases such as tuberculosis are among the main Causes of death.
Frontline workers risk their lives
One of the biggest concerns of a worldwide spread would be the threat of contagion to frontline health workers, said Konyndyk of the Center for Global Development.
"Infection prevention procedures in the developing world tend to be poorly managed and with few resources," he said.
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During Ebola outbreaks in West Africa in 2014 and the Democratic Republic of the Congo in 2019, health workers were between 21 and 32 times more likely to become infected than people in the general population, according to a WHO report.
“Health worker infections are a big blow, because beyond increasing the case counts, they degrade the health system's ability to fight the outbreak and also undermine the health system's work in a range of other risks for the sector, ”said Konyndyk.
The distrust of the community in medical workers in some places could be disastrous, which could lead to more deaths and further spread the virus.
When Ebola struck last year in the DRC, fear, rumors and distrust of public health authorities and politicians meant that people stayed at home instead of going for treatment. Despite millions of dollars in funds and an effective experimental vaccine, Ebola spread to new provinces and reinfected areas that were believed to have eliminated the virus.
"The spread of this new coronavirus to such an area could easily overwhelm its testing and treatment capabilities without international assistance," said Courtney Kansler, senior health intelligence analyst at WorldAware.
"Venezuela is another good example, where there is an almost complete lack of basic medical services and health care infrastructure throughout the country," he said.
So far there is no evidence of confirmed cases of coronaviruses in the African continent or in South America.
A world not prepared for a pandemic
Medical staff in an improvised hospital in Wuhan.
WHO has called for a coordinated international response to help stop the spread of the outbreak, and for the richest countries to support those with weaker health systems.
But as more countries close their borders to Chinese travelers, there is concern that restrictions make it difficult to exchange public health data or disrupt supply chains.
WHO has not declared a pandemic, which is essentially when there is a sustained spread of the disease in many countries.
But although there have been great advances in transparency, data exchange and research tools, "the world is still not prepared for a dangerous pandemic," said Konyndyk.
"Our existing medical and public health systems would be quickly overwhelmed and there is no clear scenario in Plan B about what countries should do once that happens," he said.
coronavirus Wuhan coronavirus
