How an outbreak became a pandemic: a chronological analysis of crucial junctures and international obligations in the early months of the COVID-19 pandemic

This article maps the chronology of documented actions against the obligations under the International Health Regulations to establish how systems functioned and to identify potential areas for improvement and further clarity in early outbreak alert and response.

SPS commentary:

The article notes that most countries instituted containment measures only after substantial intra-country spread was evident. With the benefit of hindsight, the precautionary principle was not sufficiently exercised in assessing human-to-human and asymptomatic transmission or in the declaration of a Public Health Emergency of International Concern (PHEIC), despite the obvious concern of many health jurisdictions. Instituting movement restrictions earlier would have helped to curb transmission. The evidence base for control measures was insufficient, and guidance around control measures were frequently inconsistent.

The authors propose a series of corresponding objectives to correct weaknesses in global preparedness for future potential high-impact respiratory pathogens with primary features similar to those of SARS-CoV-2.

The Lancet