In defense of WHO

During COVID-19 China and WHO have been the most vilified, even by people critical of their own governments’ responses.  There are many accusations and anger against China, most if not all nonsensical and unjustified (6/3/2020 blog).  But being a human is being emotional, so some of it is understandable.  Just hope emotion doesn’t turn humans into rabid animals.  Yet WHO becoming a target is simply out of the blue.  Even reasonable people express doubt about WHO: Dr Fauci said WHO is not perfect.  Sure, but is there an example of any organization is perfect?

What is WHO?  It is part of the UN and the premier health organization in the world.  It gathers disease information from member states and then gives advice and recommendations. All the information WHO has on diseases is open for the whole world to see, but WHO can’t dictate any government to act in any certain way.  Every country has its own CDC, Health Ministry, healthcare system, and government, which ultimately decide its own polices. 

For analogy, say the public is a patient.  He has an illness and goes to see a doctor, in this case the combination of the healthcare system and government.  At most WHO is a medical textbook, albeit one capable of updating.  If the patient is not satisfied with the treatment outcome, by common sense he is angry with the doctor and will sue the doctor, but has it been reported that a patient sues a medical textbook?  Here one can see the pure absurdity of attacking WHO.

Abstraction aside, below are a few things WHO is being demonized by some politicians and media.

The first is WHO is too good to China, even praising China’s effort to contain COVID-19 after a mid Feb inspection by WHO of multiple cities including Wuhan.  Or too late to declare COVID-19 whatever.  But compared to previous outbreaks like 2009 swine flu, WHO took the same steps, and timeline even shorter in 2020.  In terms of praising China, let’s see what could have gone wrong.  An obvious one is that COVID-19 in China was not really going well at all, and WHO painted a false picture.  Much of China reopened a few weeks later, and Wuhan on April 8; new confirmed cases nationwide dropped to essentially 0 since mid March.  Almost four months later, does anybody still think WHO was fooled by China?  

Another hit on the praise is, OK, maybe WHO should praise another country?  Here lies the gist: there was no another country at the time.  China was the only one fighting an endemic up until Feb 20.  Wuhan lockdown was unprecedented, even WHO was shocked.  If another country does any better later, maybe WHO could reserve the praise, but this is where the praise 4 months ago looks so farsighted and even poetic: should WHO praise the UK or US instead?  All the more surprising since China was flying blind for 2/3 of Jan and trying everything anew during much of Feb.  Humans know peculiarly little more about COVID-19 now than on Feb 20, when other countries experienced their first outbreaks.  There are a few countries in Europe and other continents handling COVID-19 well, yet the best success stories are in East and SE Asia.  Warmer weather may help (6/6/2020 blog), but even these countries aren’t standing out compared to individual Chinese provinces outside Hubei. 

So the WHO-China guilty association is anything but.  Next, move on to another specific charge: WHO gave conflicting messages: saying no mask all along then mask in May/June.  The Chinese wore masks in Jan, but WHO never recommended it for months, so maybe China and WHO aren’t the same thing after all?  But importantly, WHO doesn’t tell governments what to do.  WHO has no teeth.  Every government is completely free to decide wearing masks or not.  Is there any country that wanted to wear mask but didn’t because WHO said no?  Most criticisms, however, come from the West, which is utterly disingenuous.  WHO produced the COVID-19 testing instructions in mid Jan, but the American CDC decided to do it alone, with well-known consequences.  Furthermore and critically, it was the Western medical community’s consensus that wearing masks by the public was not only unnecessary but even counterproductive.  The West changed its tune only in April.  How could anybody in the West blame WHO, dominated by experts from the West, no less?  Does anybody have a memory any more?  Could it be that WHO wanted to see if mask wearing in the West helped, and after a few weeks decided it did, then WHO changed its advice?  In any case, plenty of countries wear masks earlier.

Last comes this WHO statement about asymptomatic transmission (6/9/2020 blog), used as a new charge against an incompetent WHO, even though it was technically feasible and might guide a new thinking of COVID-19.  

Much of the confusion was caused by the media not reporting the correct context.  The percentage of asymptomatic in COVID-19 patients is all over the map, from <10% to 40, 80%, but 40% asymptomatic doesn’t mean 40% transmission was due to the asymptomatic.  The key is the definition of “asymptomatic”, and for WHO it means the Class 2 people (my 6/9/2020 blog), not the pre-symptomatic (Class 1).  In reality every COVID-19 patient must have been pre-symptomatic, because nobody gets the virus at 11:01 am and develop symptoms at 11:05 am.  Thus, based on public data, a country’s confirmed cases are the upper limit of the pre-symptomatic.  WHO classifies all RNA+ as confirmed.  China has a separate category of the asymptomatic, so once again, WHO and China are not the same thing.  No one needs to follow each other exactly.  

All these were good and well, until new Ab testing reveals many more potential prior infections than the previously confirmed cases, leading to new Class 4: people who were never tested before, but now RNA-, Ab+, and of course no symptoms and not contagious (6/9/2020 blog).  This is likely what WHO wants to understand.  One can assume that most Class 4 were asymptomatic or very mildly symptomatic, but the question is: how much did they transmit the virus?  The short answer is we don’t know.  One way to find out is to do a better tracing of close contacts of confirmed COVID-19 patients.  For example, a confirmed case infected 5 people (Ab+ later), and all 5 are asymptomatic.  But of the 5, only one leads to subsequent infections, while all contacts of the other 4 are Ab-.  Then asymptomatic transmission is 20%, if calculated this way. 

The best guess right now is that Class 4 is more a COVID-19 stopper than enhancer.  But even if Class 4 is as infectious as Class 1, it is still novel and important information obtained only through better examining the newly realized Class 4.  WHO’s position is defensible and ahead of time, and it shows that WHO is doing its job by wanting to understand new aspects of COVID-19. 

WHO being smeared in some countries reflects the anti-science tendency of the politicians.  The worse a country does, the more politicians want to skirt responsibility, so China and WHO become the scapegoats, and the media are ever faithfully the servile mouthpiece (May 1, 2012 blog).  With a new disease and an urgency all living souls on Earth have never seen before, can anyone promise he/she can do better?  Still, China and WHO get the blame not because they do something, but because they will get the blame regardless. WHO’s information and advice are all in the open and the same to everybody and every country.  Beyond this, WHO can’t force any country to do anything.  If what WHO says is decisive, every country should perform equally good or bad.  Then if certain countries do worse than other countries, what is the logic that WHO is to blame?  Defending WHO, therefore, is defending science, defending reason, and defending human decency. 

The WHO statement about asymptomatic transmission is been perceived eerily similarly to the statement on human-to-human-transmission by Chinese doctors on Jan 14, 2020: criticizing without considering the proper context or even the right words (my 6/9/2020 blog).  In retrospect, the Chinese said a lot of other things around the time that later turned out to be quite right but never brought up since.  One of them was that risk to children was low.  An explanation then was children usually don’t go to meat markets, but now the market in question is probably merely a place where a clustered transmission occurred.  Just like Wuhan hospitals are where many people first got infected, yet nobody says the hospitals were the origin of COVID-19.  At the time, from early to mid Jan, close contacts including family members of the patients were being monitored, and few exhibited symptoms yet.  This observation, the lag in RNA testing, and not knowing the importance of the pre- and asymptomatic, all led to misdiagnosis by the doctors.  But that children are less susceptible is a remarkably early and correct conclusion.  It is common knowledge now that young kids don’t get COVID-19 easily.  When they do, their symptoms are usually mild.  This view was not a given: kids get flu easily.  Looking back, a simple sentence on human-to-human-transmission was twisted beyond recognition, while everything else was ignored.  This is the same for China or WHO.  It is easy to remember the negative, especially when the well is poisoned, so even a few good people feel obligatory to bash WHO once in a while. 

Note on 7/8/2020: Media widely reported 239 scientists in an open letter urged WHO to stress the role of aerosol transmission (https://www.nature.com/articles/d41586-020-02058-1).  This is a reasonable debate.  The Chinese actually had a vivid discussion of aerosol in Feb 2020, with the earliest example(s) reported in China.  WHO never followed up, although it has never discounted aerosol completely either.  The current evidence indicates it would happen, but only very rarely.  The open letter calls for actions to combat airborne transmission, such as renovating buildings, which is frankly not possible at a large scale or in a timely manner.  In any case, nobody is perfect.  Being wrong doesn't equate being malicious.