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expert reaction to COVID-19 cases in Italy, Iran and South Korea

There have been further confirmed cases of COVID-19 in Italy, Iran and South Korea.


Monday 24th February

Dr Simon Clarke, Associate Professor in Cellular Microbiology, University of Reading, said:

“Over the weekend we’ve seen new cases of coronavirus infection across Asia and now in Europe.  Worryingly, it seems that the virus can pass from person-to-person without symptoms, making it extremely difficult track, regardless of what health authorities do.  While it remains the case that most people who become infected will have light symptoms or none at all, such uncontrollable spread would present a serious risk to vulnerable individuals.”


Sunday 23rd February

Dr Nathalie MacDermott, NIHR Academic Clinical Lecturer, King’s College London, said: 

“The evolving situation in South Korea, Iran and Italy is very concerning. There has been the expectation that some countries might develop person to person transmission of SARS-COV2 following an imported case of infection from an affected country. What is concerning is the lack of clear contact with such an individual in initiating clusters in these three countries, and particularly in Iran and Italy. This suggests that there has potentially been transmission from an asymptomatic or minimally symptomatic individual who had not been tested for SARS-COV2. If such a situation is true, then the chance of significant transmission from asymptomatic or minimally symptomatic individuals occurring within these populations for a period of time before the first cases were identified increases. This is reflected in the significant jumps in numbers of confirmed cases we have seen over the last 48 hours in each country. It is imperative that other countries take into account these situations and increase their monitoring of individuals from affected regions (whether they have symptoms or not) and that affected nations take prompt action to try and contain these clusters before there is dissemination to large proportions of the population. If this were to occur the already significant challenges in containing disease spread of COVID-19 may become insurmountable.”


Prof Devi Sridhar, Director of the Global Health Governance Programme, University of Edinburgh Medical School, said: 

“The increasing number of people infected with SARSCoV2 in various countries across the world means the window of opportunity to contain the outbreak is closing quickly. There has been a profound shift in the direction that COVID-19 is taking over the past 48 hours. The WHO and its member state governments now need to be thinking about transitioning from containment to mitigation, ie. reducing the negative impacts of continued transmission. 

“What is happening in Italy and South Korea and Iran could happen anywhere in the world. The public health response will be social distancing through closing schools, nurseries, sporting events, work places, and asking people to stay home & avoid public transport and to wash hands repeatedly throughout the day. Health systems need to be bracing for the impact that increasing COVID-19 patients will have on intensive care services, and ensure that systems are in place to keep up services for the other range of health challenges facing their populations. This is most worrisome in low resource countries which already struggle to provide basic primary healthcare to their populations and the knock-on effects of maternal health, vaccination campaigns and childhood diseases.”


Prof Paul Hunter, Professor in Medicine, University of East Anglia (UEA), said:

 “Despite the continuing decline in reported cases from China the last two days have seen extremely concerning developments elsewhere in the world. The dramatic increase in case in South Korea most of which are associated with a religious sect has been unprecedented so far in the epidemic. Although far less dramatic Japan is the country with most cases after China and South Korea and is also experiencing a growing epidemic. The number of new cases being reported each day from Japan is growing even after excluding the Diamond Princess cases. The identification of the large cluster of cases in Italy yesterday is a big worry for Europe and we can expect there to by quite a few more cases identified in the next few days.

 “Finally, the situation in Iran has major implications for the Middle East. It is unlikely that Iran will have the resources and facilities to adequately identify cases and adequately manage them if case numbers are large. A further problem with the Iranian cases is wider armed conflicts in the region. During armed conflicts borders between countries become porous and urban and health care facilities are often targeted and destroyed. As we have seen with Ebola in the Democratic Republic and Poliomyelitis in Syria, war facilitates the spread of infectious disease and hampers public health responses.

 “The Director General of the WHO has recently spoken of a narrowing of the window of opportunity to control the current epidemic. The tipping point after which our ability to prevent a global pandemic seems a lot closer after the past 24 hours.”


Saturday 22nd February

Prof Andrew Tatem, Professor within Geography and Environmental Science, University of Southampton, said:

 “Prior to the recent news of apparent outbreaks in South Korea, Italy and Iran, it seemed like the relatively low number of cases outside of China and with no link to travelling there pointed to hope that the virus could be contained.  This recent news, particularly regarding Iran, is especially worrying, and Dr Ghebreyesus’ assessment that the window of opportunity for containing the outbreak is narrowing is certainly correct.  The fact that cases have been confirmed in both Canada and Lebanon that seem to have come from Iran suggests that a significant outbreak is ongoing there and may have been occurring for some time.  Given the relative rarity of international travel across a whole national population typically, especially a country like Iran where international travel may be rarer per-capita than for high income countries like in North America and Europe, exported cases seen internationally can often represent the tip of an iceberg of something occurring in the origin country.  Iran normally has some strong travel connections to countries where health systems may be weaker, such as Afghanistan, Iraq and Pakistan – importations and outbreaks here would be particularly concerning in terms of capacities to detect the virus and contain spread.”


Dr Robin Thompson, Junior Research Fellow in Mathematical Epidemiology, University of Oxford, said:

 “Case numbers in Italy have doubled since yesterday.  Countries throughout Europe, including Italy, have been preparing for the possibility of domestic transmission.  This is an important stage of the coronavirus outbreak.  Fast isolation of even mild cases in affected areas is important for preventing substantial person-to-person transmission in Europe.  It is critical that public health guidelines are followed.”


All our previous output on this subject can be seen at this weblink:


The SMC also produced a Factsheet on COVID-19 which is available here:


Declared interests

None received.

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