HHS ASPR: Major Earthquakes & Cascading Events - Potential Health & Medical Implications

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When a major earthquake strikes, a CAT 5 hurricane makes landfall, or a `Carrington'-class CME slams into our planet, the initial destruction sets into motion innumerable cascading events that can either do more damage, or can significantly hinder recovery efforts. 

A simple example comes from our recent bout of major hurricanes. Thousands of downed trees and flooding across roadways can prevent emergency vehicles from reaching the trapped or injured.

But of course, it is always more complicated than that.

In Puerto Rico, damaged port facilities and other infrastructure after hurricane Maria significantly disrupted recovery efforts.  Power was out, roads and bridges were washed away, and communications were down all over the island.

While many people think they only need to make it through the storm, or the initial shaking of an earthquake, the real test comes surviving in the aftermath. As Hurricanes Maria and Katrina have showed us, even achieving some semblance of normalcy after a major disaster can take months, or sometimes even years (see Post-Disaster Sequelae).

Although destroyed infrastructure is the most obvious impediment to recovery, there can be cascading events even without physical destruction. 

A severe pandemic wouldn't level buildings or collapse bridges, but a high enough infection or fatality rate could either prevent (through attrition) or dissuade (due to fear, or lack of effective PPEs) medical personnel from working, police or fire departments from responding, or utilities workers from keeping the water and power on.

As the number of available responders drop, and the work load increases, the odds of a systemic collapse increases.

Study: Burnout & PTSD Among Nurses Working During A Large MERS-CoV Outbreak - Korea, 2015

Study: Willingness of Physicians To Work During A Severe Pandemic

The likely collapse of the economy, manufacturing capacity, just-in-time deliveries (food, medicine, fuel), and the inevitable short supply of medical resources, would only exacerbate the situation. And being a global problem, unlike with a localized natural disaster, help won't be pouring in from unaffected regions. 

NIOSH: Options To Maximize The Supply of Respirators During A Pandemic

Supply Chain Of Fools (Revisited)

Last May, Johns Hopkins held a day-long pandemic table top exercise (see CLADE X: Archived Video & Recap). If you don't have the time to watch the entire 8 hour exercise, I would urge you to at least view the 5 minute wrap up video. It will give you some idea of the possible impact of a severe - but not necessarily `worst case' - pandemic.

While the mechanisms of destruction may vary, major disasters all have the ability to produce cascading events that must be overcome before recovery can commence.  

The HHS's office for ASPR (Assistant Secretary for Preparedness and Response) is charged with preparing for Public Health and Medical Emergency Support during any crisis or emergency.

As such, they must plan for a wide variety of disasters, including pandemics, radiological emergencies, tsunamis, and earthquakes. Each of these scenarios can produce unique, wide ranging, and challenging cascading events, which must be addressed as well.

One of the reasons I stress personal, family, and neighborhood preparedness so much in this blog is that in a big enough disaster, emergency responders may be overwhelmed, and people may have to fend for themselves for days or weeks without power, water, groceries, r accessible medical care.

I've been perusing some of the preparedness documents on ASPR's TRACIE website (Technical Resources, Assistance Center, and Information Exchange), and the following 56-page document on the challenges likely to occur after a major earthquake provides an excellent glimpse at the kind of planning that must be done in advance of any major disaster.

While this report is written for local officials tasked with dealing directly with the aftermath of an earthquake, it should also provide some food for thought for anyone living in earthquake country on what challenges they might have to face following such a disaster. 

And while most of the scenarios in today's document are earthquake specific, the impacts (loss of power, water, communications, limited access to food resupply, diminished medical care, etc.) can occur across a wide range of disasters. 

Anyone who is tasked with corporate or business disaster recovery planning can probably glean some ideas from this report as well.
 
Since we can't know what the next disaster will be, preparedness should be geared primarily for the impacts, not for the cause.  Obviously, with 56 pages, I can't excerpt a meaningful amount in the blog.

So follow the link to download the PDF, and while you are on the ASPR TRACIE site, you might want to look around at some of the other documents available.

Major Earthquakes & Cascading Events: Potential Health and Medical Implications

October 2018

This ASPR TRACIE resource provides an overview of the potential significant health and medical response and recovery needs facing areas affected by a major earthquake with or without additional cascading events.

The list of considerations is not exhaustive, but does reflect a thorough scan of publications and resources available that describe past incident effects and response. Earthquakes do not pose a significant risk for every community and those communities that could be affected by earthquakes have different risk levels, different hazards or cascading events, and different levels of existing community  preparedness and mitigation. Those faced with planning for—and leading the response to and recovery from—an earthquake may use this document as a reference. Planners and responders should integrate jurisdiction-specific risk assessments and issues specific to their communities in their planning efforts.

Please note that the focus of this document is on human health and the healthcare system response to earthquakes, however, the health of people, animals, and the environment are all  interconnected, so general considerations for animals and the environment are included,
where applicable to human health or to the overall mission of Emergency Support Function 8.

For additional resources specific to earthquakes and related health effects, please access the ASPR TRACIE Natural Disasters Topic Collection. The ASPR TRACIE Hazard Vulnerability/Risk Assessment Topic Collection and the Evaluation of Hazard Vulnerability  Assessment Tools can assist with performing a jurisdiction-specific risk assessment.

 

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And for some recent disaster preparedness and recovery blogs, you may wish to revisit:

#NatlPrep: Revisiting The Lloyds Blackout Scenario

#NatlPrep : Because Pandemics Happen

Disaster Planning For Major Events

All Disaster Responses Are Local

DHS: NIAC Cyber Threat Report - August 2017

 

WHO Update & Risk Assessment On Ebola In The DRC

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Earlier this week the World Health Organization's IHR Emergency Committee met to discuss whether the ongoing outbreak of Ebola in the DRC constituted a PHEIC (Public Health Emergency of International Concern). 

While the threat level remains very high regionally, the WHO IHR Emergency Committee decided the outbreak did not rise to the level of a global threat (see WHO IHR Committee Determines DRC Ebola Outbreak Is Not Currently A PHEIC).

Overnight the WHO posted a new update and risk assessment, citing some recent improvements seen on the ground while cautioning that many challenges remain ahead.

I've only posted some excerpts from a much longer report. Follow the link below to read it in its entirety.

Ebola virus disease – Democratic Republic of the Congo

Disease outbreak news: Update
18 October 2018

The response to the Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo has seen significant improvements over the past weeks, including strong performances by field teams conducting vaccinations, and improved community engagement and risk communication in priority areas.

However, as new cases continue to emerge from Beni and appear closer to security ‘red zones’, it is clear that risks remain and that strong response measures need to be prioritized. The virus’ spread is partly due to security conditions that severely impact frontline and health workers, at times forcing the suspension of response activities and increasing the risk that the virus may spread to neighbouring provinces and countries. The MoH, WHO and partners continue to rapidly adapt to these challenging circumstances, scaling up all pillars of the response: surveillance, contact tracing, community engagement, laboratory testing, infection prevention and control, safe and dignified burials, vaccination, and therapeutics.

Due to the challenges faced in Democratic Republic of the Congo, the 1st Meeting of the 2018 International Health Regulations (IHR) Emergency Committee for Ebola Viral Disease in the Democratic Republic of the Congo took place on 17 October. Due primarily to the strength and tempo of current response operations, it was the view of the Committee that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met. The Committee further concluded that the current outbreak has several characteristics of particular concern: the risk of more rapid spread given EVD presence in urban environments; that there are several outbreaks in remote and hard to reach areas; and that health care staff have been infected. Risk of international spread also remains very high due to the outbreak’s proximity to significant regional traffic. Logistical challenges due to poor infrastructure continue to affect surveillance, case detection and confirmation, contact tracing, and access to vaccines and therapeutics.

Despite these challenges, the Committee also noted that the response of the government of the Democratic Republic of the Congo, WHO, and partners has been rapid and comprehensive. The Committee concluded that interventions already underway provide strong reason to believe that the outbreak can be brought under control, and that this vigorous response should be supported by the entire international community. A decline in the current level of response would cause the situation to deteriorate significantly. It is particularly important that there should be no international travel or trade restrictions, and that neighbouring countries should strengthen both preparedness and surveillance.

Since the last Disease Outbreak News (data as of 16 October), 26 new confirmed EVD cases were reported: 19 from Beni, three from Butembo, one from Mabalako, one from Kalungata, and two from Masereka Health Zones in North Kivu. Five of these confirmed cases have been linked to known cases or transmission chains within the respective communities, while 21 cases remain under investigation.

As of 16 October 2018, a total of 220 EVD cases (185 confirmed and 35 probable), including 142 deaths (107 confirmed and 35 probable)1, have been reported in seven health zones in North Kivu Province and three health zones in Ituri Province (Figure 1). An increasing trend in weekly case incidence has been observed (Figure 2). The rising trends are likely underestimated given expected delays in case reporting, the ongoing detection of sporadic cases, and security concerns which limit contact tracing and investigation of alerts. Of the 211 confirmed and probable cases for whom age and sex information is known, the majority (60%) are within the 15-44 years age range. Females (54%) accounted for a greater proportion of cases (Figure 3). A total of 20 healthcare workers have been affected (19 confirmed and one probable), of whom three have died.

The MoH, WHO and partners continue to closely monitor and investigate all alerts in affected areas, in other provinces in the Democratic Republic of the Congo, and in neighbouring countries. As of 16 October, 34 suspected cases in the Democratic Republic of the Congo are awaiting laboratory testing. Since 11 October, alerts have been investigated in several provinces of the Democratic Republic of the Congo, as well as in neighbouring countries. To date, EVD has been ruled out in all alerts from neighbouring provinces and countries. 

WHO risk assessment

This outbreak of EVD is affecting north-eastern provinces of the country, which borders Uganda, Rwanda and South Sudan. Potential risk factors for transmission of EVD at the national and regional levels include: transportation links between the affected areas, the rest of the country, and neighbouring countries; the internal displacement of populations; and the displacement of Congolese refugees to neighbouring countries. The country is concurrently experiencing other epidemics (e.g. cholera, vaccine-derived poliomyelitis), and a long-term humanitarian crisis. Additionally, the security situation in North Kivu and Ituri at times limits the implementation of response activities. WHO’s risk assessment for the outbreak is currently very high at the national and regional levels; the global risk level remains low. WHO continues to advise against any restriction of travel to, and trade with, the Democratic Republic of the Congo based on currently available information.

As the risk of national and regional spread is very high, it is important for neighbouring provinces and countries to enhance surveillance and preparedness activities. The Emergency Committee has advised that failing to intensify these preparedness and surveillance activities would lead to worsening conditions and further spread. WHO will continue to work with neighbouring countries and partners to ensure that health authorities are alerted and are operationally prepared to respond.

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Bulgaria: 2 Outbreaks Of Avian Flu - Vietnam: 1 Outbreak Of H5N6

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Bulgaria - which has has been plagued by scattered outbreaks of HPAI H5N8 in commercial poultry throughout the summer (see here, here, here, and here) - reports two more outbreaks (of presumably H5N8) in the southern province of Haskovo today. 

While Bulgaria's bird flu woes pale compared to Russia's summer surge in HPAI H5 (see Brief ESA Report On HPAI H5N2 & H5Nx In Russia), both Bulgaria and Western Russia lie under the migratory flyways that lead from Siberia to Europe, the Middle East, and Africa.

As we move into the colder months of fall and winter, the incidence of avian flu in the Northern Hemisphere is expected to increase.


This from Bulgaria's Food Safety Agency.

BVBH found Avian influenza in two livestock farms in the village of Voyvodovo, Haskovo municipality, Haskovo district

18.10.2018

The Bulgarian Food Safety Agency (BNSA) has identified two outbreaks of the Avian Influenza (influenza) disease in livestock farms intended for breeding broodstocks and chicken broilers located in the village of Voyvodovo, Haskovo municipality, Haskovo district. The disease was confirmed by a laboratory test report.

For the control and eradication of the disease, NVS started implementing all measures in accordance with current legislation. Humane killing and destruction of all birds kept in the affected sites is undertaken, followed by cleansing and disinfection. The 3-kilometer protection zones and 10-kilometer surveillance zones around the outbreaks have been identified. The movement of birds and their products into and out of the protection and surveillance zones is prohibited. In both areas, the marketing and movement of domestic, wild and other breeding birds and eggs, as well as the displacement of birds for the renewal of the wild game stock, are prohibited. Daily clinical examinations of birds kept in other settlements in the protection zone are performed.

Enhanced surveillance and biosecurity measures in poultry farms as well as in water basins where the wild bird population is heavily concentrated.

There is an epizootic study of the causes of the disease.

The NVS reminds that feed should be kept indoors as well as feedstocks - thus avoiding the possibility of wild feathered birds infesting the feed, and hence the hosts being infected with the virus.

At this stage there are no people affected and there is no danger to consumers. Influenza virus can cause mild respiratory disease. Possible infection can occur when inhaled contaminated farm dust or in direct contact with people with infected birds.

Meanwhile, Vietnam reports to the OIE today on another outbreak of HPAI H5N6 in poultry  - that country's 5th reported outbreak since September.  Unlike neighboring China, Vietnam has never reported a human infection with H5N6.

South Korea Finds More Environmental AI - Clarifies H5N2 As LPAI

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With migratory birds now arriving in South Korea on the southbound leg of their annual migration, we are starting to get reports of Avian Influenza (AI) detection in wild bird feces (see here), including one identified as H5N2.

Today in a follow up to those blogs, MAFRA reports that the H5N2 sample tested - as expected - as LPAI, along with several more AI virus samples which are being analyzed. 

The first (translated) report finds more infected feces collected in Paju, and clarifies that the H5N2 virus announced yesterday was LPAI. 

Detection of H5-type avian influenza (AI) antigen in feces of wild birds in Paju, Gyeonggi-do, Korea

2018.10.18 11:00:23

Agriculture, Forestry, Animal Husbandry and Food ( Minister : yigaeho ) is 10.8 days Jeonbuk Gunsan Mangyeong estuary and 10.15 days North Chungcheong Province Cheongju Miho Stream taken from the wild bird feces on the test results , 10.17 days H5 type AI antigen detection have been announced .

❍ According to the AI ​​Emergency Action Guideline (SOP)

① Set up a 10-km radius as "wild bird's water prospecting area," ② forecast, inspect, control and disinfect poultry and birds in the area, ③ strengthen preventive measures against nearby farms such as migratory birds and small rivers, ④ The local governments have taken preventive measures such as disinfection every day by mobilizing the anti-pollution vehicles such as the wide-area fire extinguisher.

※ It takes 3 ~ 4 days for the final judgment,

In addition, the feces of wild algae collected from the mouth of the Han River in Paju, Gyeonggi province, on October 11, were confirmed by the Ministry of Agriculture, Forestry and Livestock Quarantine Headquarters as a result of 10.17 days of low-pathogenic AI (H5N2 type).

A second (translated) report today finds more AI positive samples collected from the Southwest and center of the country. 

Detection of H5 type avian influenza (AI) antigen in feces of wild algae in Chunbuk Gunsan (Mangyeong River) and Chungbuk Cheongju (Mihocheon)
 
    2018.10.18 11:23:10 

The Ministry of Agriculture, Forestry and Livestock Food and Beverage (Minister of Agriculture and Rural Affairs) said on 10.17, H5 type AI was detected in the feces of wild algae collected from the Mt. Mangyeong River Estuary in Jeonbuk Province on Oct. 10 and Cheongju Mihocheon in Chungbuk Province on October 15.

  ❍ According to the AI ​​Emergency Action Guideline (SOP)

   ① Set up a 10-km radius as "wild bird's water prospecting area," ② forecast, inspect, control and disinfect poultry and birds in the area, ③ strengthen preventive measures against nearby farms such as migratory birds and small rivers, ④ The local governments have taken preventive measures such as disinfection every day by mobilizing the anti-pollution vehicles such as the wide-area fire extinguisher.

    ※ It takes 3 ~ 4 days for the final judgment,

The Ministry of Agriculture and Fisheries explained that AI was continuously detected in the feces of wild birds in Paju (Han river estuary), Jeonbuk Gunsan (Mangyeong River estuary) and Cheongju (Mihocheon)

  ❍ In recent years, the risk of AI has been increased due to the arrival of birds in Korea in earnest. So, the farmers and livestock facilities have been requested to thoroughly prevent the occurrence of AI.

The poultry farmers thoroughly disinfected by applying quicklime between the farm access road and the barn to prevent AI outbreaks, thoroughly check for damage to the network of the poultry house,

  ❍ Each local government and producers' group also requested that the poultry farmers strengthen their education and publicity in order to strictly adhere to the rules of prevention and abatement.

So far, South Korea hasn't reported any infected poultry this fall and Japan's Ministry of Environment hasn't reported any AI detections since last spring.

JIDC: Atypical Presentation Of MERS-CoV In A Lebanese Patient

Credit WHO

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The MERS coronavirus continues to simmer in the Middle East with the latest WHO EMRO report showing 118 cases reported (through Sept 30th) in 2018.  Since 2012, 2260 confirmed cases of MERS - including 803 fatalities - have been reported globally.

While MERS has yet to take off in a big way, it has proven itself to be more easily spread among humans than either of the two major avian flu viruses (H5N1, H7N9) we've been following for years. 

There are also legitimate questions over just how well surveillance systems are picking up infections, and the role - if any - of asymptomatic or mildly symptomatic cases in spreading the virus in the community.

Recently, in Evaluation of a Visual Triage for the Screening of MERS-CoV Patients - we looked at a review by prolific MERS researcher and former KSA Deputy Minister of Health,  Ziad Memish, MD et al. of the visual triage & scoring system developed by the Saudis in 2017 to alert Health Care workers of possible MERS infection in their patients.

After evaluating the sensitivity and selectivity of this method, their conclusion:

The sensitivity and specificity of the scoring system was low and further refinement of the score is needed for better prediction of MERS-CoV infection.

The authors were particularly blunt in their assessment (bolding mine) of the current system. 

The  current  study  conducted  on  a  large  number  of  patients  shows  that  clinical  scoring  is not predictive  of  MERS  infection. 

Our  results  are  robust  and  confirm  that  MERS  cannot  be distinguished from other respiratory infections based on  risk factors  and clinical features.  Thus all  patients with  non-specific  symptoms  in  a  MERS  endemic  area  will  have  to  be  isolated  until MERS can be ruled out by rapid PCR testing.

In addition to seeing as steady stream of `community acquired' cases in KSA without a known risk exposure, we've seen other analyses that have concluded that only a fraction of MERS cases are likely diagnosed, including:

• In November of 2013, we looked at a study published in The Lancet Infectious Diseases, that estimated for every case identified, there are likely 5 to 10 that go undetected.
• In 2015, when Saudi Arabia had recorded fewer than 1200 MERS cases, a seroprevalence study (see Presence of Middle East respiratory syndrome coronavirus antibodies in Saudi Arabia: a nationwide, cross-sectional, serological study by Drosten & Memish et al.,) suggested nearly 45,000 might have been infected. 
• And a 2016 study (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016) suggested that as much as 60% of severe Saudi MERS cases go undiagnosed. 

Today we've a recently published review of an atypical presentation of MERS-CoV in a previously healthy adult, who may have contracted the virus from an undiagnosed, asymptomatic (or mildly symptomatic) patient in a hospital.

I've excerpted a few passages from a much longer report. For more of the details on this case, you'll want to follow the link and read it in its entirety.

Atypical presentation of Middle East respiratory syndrome coronavirus in a Lebanese patient returning from Saudi Arabia

• Saeed El Zein American University of Beirut Medical Center, Beirut, Lebanon
• Jinane Khraibani American University of Beirut Medical Center, Beirut, Lebanon
• Nada Zahreddine American University of Beirut Medical Center, Beirut, Lebanon
• Rami Mahfouz American University of Beirut Medical Center, Beirut, Lebanon
• Nada Ghosn American University of Beirut Medical Center, Beirut, Lebanon
• Souha S Kanj American University of Beirut Medical Center, Beirut, Lebanon

DOI: https://doi.org/10.3855/jidc.9979 

Abstract

Around 2090 confirmed cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) from 27 countries have been reported to the World Health Organization (WHO) between September 2012 and October 2017, the majority of whom occurring in countries in the Arabian Peninsula, mainly in Saudi Arabia.

MERS- CoV can have atypical and misleading presentations resulting in delays in diagnosis and is associated with a high mortality rate especially in elderly patients with multiple comorbidities.

Herein, we present the first case of confirmed MERS-CoV infection diagnosed at the American University of Beirut Medical Center (AUBMC) - Lebanon in June 2017 presenting without any respiratory symptoms. This is the second confirmed case of MERS-CoV infection in Lebanon since 2014. The first case presented with a febrile respiratory infection with persistent symptoms despite antibiotic treatment.

(SNIP)

We report a case of MERS-CoV infection diagnosed in Lebanon, in a previously healthy patient resident of Riyadh, Kingdom of Saudi Arabia (KSA) presenting with fever and gastrointestinal symptoms.

The patient did not develop respiratory symptoms at any time throughout the course of the disease. To our knowledge, our case is the second documented case of MERS-CoV infection in Lebanon, and one of the few reported cases in the literature with complete absence of respiratory symptoms.

Case Report

The patient is a 40-year-old male, previously healthy gastroenterologist, resident of Riyadh (KSA) for the past 5 years. On June 8, 2017 while still in Riyadh, he developed high grade fever, anorexia and fatigue. At that time, a nasopharyngeal swab for MERS- CoV by Polymerase Chain Reaction (PCR) was negative.

The patient had no contact with dromedary camels and did not drink camel milk. He also had no documented contact with any confirmed MERS-CoV patients and is not practicing in a hospital with known MERS-CoV cases.

However, he reported that he examined patients returning from Mekkah for Umrah several days prior to his illness. He failed to improve on a 7-day course of oral ciprofloxacin started on June 9. The patient reported taking a 5-day course of metronidazole started on June 11 after developing diarrhea.

(SNIP)

There is still debate on the extent of infectivity of asymptomatic carriers of MERS-CoV [14]. Ongoing viral shedding for 6 weeks has been detected by PCR from an asymptomatic healthcare worker [15].

Our patient, similar to many others reported in the literature, had no direct contact with a confirmed infected case suggesting that acquisition from an asymptomatic or mildly symptomatic carrier could be an important contribution to ongoing transmission [15,16].

Interestingly, 60 new cases of MERS-CoV infection were reported to the WHO in KSA between April 21 and June 10, 38 of which being from Riyadh [17], coinciding with the period in which our patient is thought to have acquired the infection.

(SNIP)

Conclusion
 
MERS-CoV infection has a high fatality rate especially in elderly patients with multiple comorbidities. Human-to-Human transmission is well documented and asymptomatic carriers may play a big role in the transmission cycle. Our case proves that patients with confirmed MERS-CoV infection can have an atypical presentation with no respiratory symptoms making identification and adequate patient isolation a challenging task. 

It is possible that MERS-CoV is underdiagnosed in patients with the above clinical picture. Therefore, it is very important to keep a high index of suspicion in all patients who present with fever of unclear etiology and have a direct epidemiological link to a MERS-CoV endemic area even with no history of exposure to a confirmed case within the past 14 days prior to presentation. Successful diagnosis will help in early isolation of the patient to prevent potential transmission to household members, travelers and healthcare workers and to avoid unnecessary antibiotics use.

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While MERS-CoV hasn't embarked on a global tour the way that SARS did in 2003, we've seen analyses (see Study: A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia) suggesting the virus doesn't have all that far to evolve before it could pose a genuine global threat.

Earlier this year, in the WHO List Of Blueprint Priority Diseases, we saw MERS-CoV listed among the 8 disease threat in need of urgent accelerated research and development.

List of Blueprint priority diseases

(SNIP)

The second annual review occurred 6-7 February, 2018. Experts consider that given their potential to cause a public health emergency and the absence of efficacious drugs and/or vaccines, there is an urgent need for accelerated research and development for*:

• Crimean-Congo haemorrhagic fever (CCHF)
• Ebola virus disease and Marburg virus disease
• Lassa fever
• Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS)
• Nipah and henipaviral diseases
• Rift Valley fever (RVF)
• Zika
• Disease X

All of which makes gaining a better understanding of how - and how well - the MERS coronavirus continues to spread in the community a high priority.

WHO IHR Committee Determines DRC Ebola Outbreak Is Not Currently A PHEIC

WHO Twitter Announcement

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Earlier today the WHO convened an emergency session of their IHR Emergency Committee to determine if the ongoing outbreak of Ebola in the DRC constitutes a Public Health Emergency Of International Concern (PHEIC) - and if so, what measures to recommend. 

The designation of a PHEIC by the WHO was first proposed in the revised 2005 IHR, but the first time it was invoked was in 2009 with the H1N1 pandemic. 

While meetings have been convened several times in the past for both MERS-CoV and Yellow Fever, only 3 other PHEICs have been declared to date:

• 2014 Polio Declaration
• 2014 West Africa Ebola Outbreak
• 2016 Zika Declaration

The bar for declaring a PHEIC is purposefully set pretty high, as invoking one does have some down sides, particularly in regards to travel and trade for an affected region. 

Today, after considering the pros and cons, the decision was made (for now, at least) not to declare this Ebola outbreak a Public Health Emergency Of International Concern.

It is a concern, they say, but is currently believed to be more of a regional threat than a global one.  Below you'll find an excerpt, and a link to the full WHO statement.

Statement on the October 2018 meeting of the IHR Emergency Committee on the Ebola virus disease outbreak in the Democratic Republic of the Congo
17 October 2018

Statement

The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding the Ebola Virus Disease (EVD) outbreak in the Democratic Republic of the Congo took place on Wednesday, 17 October 2018, from 13:00 to 17:00 Geneva time (CET).

Conclusion

It was the view of the Committee that a Public Health Emergency of International Concern (PHEIC) should not be declared at this time. But the Committee remains deeply concerned by the outbreak and emphasized that response activities need to be intensified and ongoing vigilance is critical. The Committee also noted the very complex security situation. Additionally, the Committee has provided public health advice below.

Proceedings of the Meeting

Members and advisors of the Emergency Committee met by teleconference. Presentations were made by representatives of the Ministry of Health of the Democratic Republic of the Congo on the epidemiological situation, the response strategies, and recent adaptations, including implementation of rapid response teams at community level, with a focus on Beni. A representative of the Office of the Deputy Special Representative of the Secretary-General (MONUSCO) reported on the work of MONUSCO, including its logistics and security activities to support the response. During the informational session, the WHO Secretariat provided an update on the situation and the response to the current Ebola outbreak and preparedness activities in neighbouring countries.
The Committee’s role was to provide to the Director-General its views and perspectives on:

• Whether the event constitutes a Public Health Emergency of International Concern (PHEIC)
• If the event constitutes a PHEIC, what Temporary Recommendations should be made.

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Follow the link to read the full statement, which includes a assessment of the Current Situation and a list of Key Challenges.