For a few days, the EU played it cool as news broke about the coronavirus outbreak that has sickened thousands and killed more than a hundred in China.

But as France reported four imported cases and Germany recorded the first local transmission of the virus on Tuesday, Italy’s Health Minister Roberto Speranza and the European Health Commissioner Stella Kyriakides called for an “extraordinary meeting” of health ministers to assess preparedness in case the virus spreads on the continent.

"We must not underestimate the situation and we need to mobilize all our tools," Kyriakides told reporters on Wednesday.

By Friday morning, the total number of confirmed cases of infections worldwide neared 9,800 — out of which some 9,700 were in China — and 213 deaths, all of them in China, according to the South China Morning Post.

There were 16 confirmed cases reported in Europe, as of Friday morning: six in France, five in Germany, two in England, two in Italy and one in Finland.

The situation is complex and evolving constantly, with the source of the infection still unknown, Kyriakides said. How “virulent and pathogenic” the virus is also remains a question, she said.

The number of infections surpassed the 5,200 cases of severe acute respiratory syndrome (SARS) coronavirus reported in mainland China during the outbreak 17 years ago, South China Morning Post reported. But the number of fatalities caused by this new strain of coronavirus is still far below the 774 recorded from SARS.

How the EU’s response system works

It was the SARS outbreak that led to the speedy creation of the European Centre for Disease Control and Prevention (ECDC), which became operational in 2005 and is now the body assessing the risk of the virus transmission in Europe.

To ensure the virus doesn’t spread across borders, the European Commission coordinates the response of EU countries based on ECDC intelligence, said Sergio Brusin, the ECDC Expert on Response and Emergency Operations.

The ECDC also manages the EU’s Early Warning and Response System, in which member countries have to report confirmed and probable cases of coronavirus, he said. The reporting requirement mandates a link to China, but if cases of local transmission proliferate, that could complicate detection since the symptoms for coronavirus are similar to those for regular flu.

“If we start seeing transmission in Europe, that can create problems, because we have a normal flu season with quite a lot of people with the seasonal flu,” said Brusin.

The European Commission has organized three conference calls with the national representatives in the Health Security Committee since the beginning of this outbreak, and it said countries seem well prepared — but gaps remain.

It's these gaps that Europe’s health chief wanted to discuss with health ministers in her proposed ad-hoc meeting. But that hasn't been decided upon yet, a spokeswoman for the Croatian presidency of the Council of the EU said.

"We follow the situation and wait for some further analysis and consultations within WHO," she said on Thursday. Later that day, the World Health Organization declared the outbreak a public health emergency of international concern.

Keep calm, carry on

Since SARS, there have been some well-known outbreaks of international concern, such as the 2009 flu pandemic, the 2014 Ebola outbreak in West Africa and the 2015-2016 Zika virus epidemic, which started in Brazil, among others.

However, unlike in some of those, “I don’t observe any hysteria, at least among the health authorities,” said Clemens Auer, Austria’s special envoy for health, who has seen four international outbreaks of infectious diseases while working in his country’s health ministry.

France and Germany have sought to reassure the public that the swift handling of these cases show the national emergency response system is effective. Other countries, from the U.K. to Italy to Romania, have held meetings over the past week to ensure they're prepared if the virus spreads to their territories. Romania's health minister said on Wednesday the country would buy some additional artificial ventilation machines for its hospitals.

Meanwhile, Italy on Friday declared a six-month-long state of emergency due to the risk from the virus.

“We all learned our lessons; the health authorities know what to do; we are much better at communication,” Austria’s Auer said.

“We activated our emergency plans and ... in Vienna it works very smoothly,” he said. He noted four suspected cases that “got isolated very quickly," adding that "everything worked fine, the lab tests were done, all four were negative."

This outlook stands in contrast to the 2009 swine flu outbreak, for example, when the WHO declared it a pandemic and countries bought a huge number of vaccine doses and antiviral medicines — which in the end didn't prove necessary, according to Auer.

European countries have adjusted their pandemic response plans since then, he said.

Overreaction to outbreaks can also have negative public health consequences on the long term. The WHO and French government behavior in the 2009 outbreak can help explain why France is now the most vaccine-skeptical country in the world, experts say.

“The public thought that the WHO highly inflated the scare," said Heidi Larson, the director of the Vaccine Confidence Project at the London School of Tropical Medicine and Hygiene, in a 2018 Telegraph interview. "They felt that the government was in bed with industry and creating unnecessary panic.”

Another example is the Pandemrix vaccine, which was used in the vaccination campaign triggered by the swine flu outbreak and later linked to the risk of developing narcolepsy in people younger than 20. Over the past decade, young adults who got narcolepsy after being vaccinated sued for compensation in the U.K. and Ireland. A case in the latter ended with a settlement in 2019, but without any admission of liability from the Irish government or the manufacturer.

The European Medicines Agency has maintained that the benefits of the vaccine outweighed the risks, but GSK let the vaccine authorization elapse.

The Pandemrix debacle didn’t stop calls during a European Parliament debate on Wednesday for a fast-track authorization procedure in case a potential vaccine against this coronavirus strain is developed. Brussels does have the power under a 2013 law to allow conditional approval of vaccines in case of an emergency.

Until then, “I am with those who say let’s not stir up panic; there are other health risks, such as influenza, which kills far more people at the moment than coronavirus,” said German MEP Peter Liese, of the European People's Party.

This article has been updated to note the latest number of cases and Italy’s state of emergency, as well as the WHO announcement Thursday.