Monday, January 27, 2020

2019–20 Wuhan coronavirus outbreak

2019–20 Wuhan coronavirus outbreak


2019–20 Wuhan coronavirus outbreak
2019–20 Wuhan coronavirus outbreak is located in China
2019–20 Wuhan coronavirus outbreak
Location of Wuhan, the centre of the outbreak, in China
Date8 December 2019[1] – ongoing
(1 month, 3 weeks and 6 days)
LocationFirst identified in
Wuhan, Hubei, China
Casualties
As of 28 January 2020:
4,581 confirmed cases with 106 deaths
File:2019-nCoV Confirmed Cases Animated Map of China.webm
Confirmed 2019-nCoV cases spreading from January 25

2019-nCoV cases in Mainland China, Hong Kong, Macau, and Taiwan[neutrality is disputed]
  Suspected
  Confirmed 1–9
  Confirmed 10–99
  Confirmed 100–999
  Confirmed ≥1000
Infected people in Mainland China according to the
National Health Commission daily reports[2][3]
2020-01-16
 
45
2020-01-17
 
62
2020-01-18
 
121
2020-01-19
 
198
2020-01-20
 
291
2020-01-21
 
440
2020-01-22
 
571
2020-01-23
 
830
2020-01-24
 
1,287
2020-01-25
 
1,975
2020-01-26
 
2,744
2020-01-27
 
4,515

People queueing outside a Wuhan pharmacy to buy face masks and medical supplies
A new coronavirus, designated 
2019-nCoV,[4] was identified in Wuhan, Hubei province, China, after people developed pneumonia without a clear cause and for which existing vaccines or treatments were not effective. The virus has shown evidence of human-to-human transmission and its transmission rate (rate of infection)[5] appeared to escalate in mid-January 2020,[6] with several countries other than China reporting cases. The incubation period (time from exposure to developing symptoms) of the virus is between 2 and 14 days and it remains contagious during this time.[7][8] Symptoms include fever, coughing and breathing difficulties and it can be fatal.[9]
Wuhan was placed under quarantine on January 23, in which all public transport in and out has been suspended.[10][11] Thereafter, transportation in at least 15 other cities in Hubei province have also been halted in a similar fashion.[12] Many New Year events were closed over fear of transmission, including the Forbidden City in Beijing, traditional temple fairs, and other celebratory gatherings.[13] Hong Kong also raised their infectious disease response level to the highest level and declared an emergency, closed its schools until mid-February and cancelled its New Year celebrations.[14][15]
A number of countries have put out travel advisories warning against travel to Wuhan and/or Hubei province.[16] Travelers who have visited Mainland China have been requested to monitor their health for at least two weeks and contact their healthcare provider to report any symptoms of the virus.[17] Anyone who suspects themselves to carry the virus are advised to wear a protective mask and seek medical advice by calling a doctor rather than directly visiting the clinic in person.[18] The travel sector has been providing refunds and no-fee cancellation for reservations in China or by people from China.[19] Airports and train stations have implemented temperature checks, health declarations and information signage in an attempt to identify carriers of the virus.[20]
Chinese scientists were able to isolate a strain of the new coronavirus quickly, with the genetic sequence being made available for laboratories across the world to independently develop PCR tests that can confirm infection in a person.[21][22][23][24] Of the first 41 people confirmed by real-time RT-PCR and next-generation sequencing to have been infected, two-thirds were found to have a link with the Huanan Seafood Wholesale Market, which also sold live animals.[25][26][27][28] The seventh member of the coronavirus family to infect humans, 2019-nCoV's genome sequence has been reported to be 75- to 80-percent identical to SARS-CoV, and more than 85-percent similar to several bat coronaviruses.[29][30] Whether this virus is of the same severity or lethality as SARS is unclear.[21][22][23][24]
Extensive testing in mid-to-late January has revealed over 2,800 confirmed cases in China, some of whom were working in healthcare.[31][32] Confirmed cases have been reported by several countries across Asia,[31] Oceania,[33] Europe,[34] and North America.[35] The first confirmed death from the coronavirus infection occurred on 9 January.[36] By 28 January, the number of deaths due to 2019-nCoV stood at more than 100, all in China.[37]

Context

See also: Timeline of the 2019–20 Wuhan coronavirus outbreak
Wuhan is the capital of Hubei province and is the seventh-largest city in China, with a population of more than 11 million people. It is a major transportation hub of the country, long known as the "Nine Provinces' Thoroughfare" (九省通衢).[38] It is approximately 1,100 km (700 mi) south of Beijing,[39] 800 km (500 mi) west of Shanghai, and 970 km (600 mi) north of Hong Kong[40] and the Wuhan Railway Hub is one of the four most important railway hubs in China. Direct flights from Wuhan also connect it with Paris, London, and Rome.[41]
In Wuhan, during December 2019, an inaugural cluster of cases displaying the symptoms of a "pneumonia of unknown cause" was linked to Huanan Seafood Wholesale Market, which had a thousand stalls selling fish, chickens, pheasants, bats, marmots, venomous snakes, spotted deer and the organs of rabbits and other wild animals (ye wei, bushmeat). The immediate hypothesis was that this was a novel coronavirus from an animal source (a zoonosis).[22][42][43][44]
Coronaviruses mainly circulate among animals but have been known to evolve and infect humans as in the cases of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) together with four further coronaviruses that cause mild respiratory symptoms similar to the common cold. All coronaviruses known to infect humans have been shown to spread from human to human.[45][46]
In 2002 an outbreak of SARS that started in China resulted in more than 700 deaths worldwide. The virus originated in horseshoe bats, then passed to humans via civets from live animal markets and with the help of a few super-spreaders and international air travel, reached as far as Canada and the United States. The last case of SARS occurred in 2004.[45][47][48] At the time, China was criticised by the World Health Organization (WHO) for its handling of the epidemic;[49] since 2000, the WHO has coordinated international reactions against this and other new diseases including MERS and the 2009 swine flu. Ten years after the onset of SARS, the dromedary-camel-related coronavirus, MERS, has resulted in more than 850 deaths in 27 countries.[50]
The Wuhan outbreak's association with a large seafood and animal market has led to the presumption of the illness having an animal source.[46] This has resulted in the fear that it would be similar to the previous SARS outbreak,[47][51] a concern exacerbated by the expectation of a high number of travellers for Chinese New Year, which began on 25 January 2020.[52]

Phylogenetics

Main article: Novel coronavirus (2019-nCoV)
Genomic information
2019-nCoV genome.svg
Genome organisation (click to enlarge)
NCBI genome IDMN908947
Genome size30473 bp
Year of completion2020
Phylogenetic studies of 2019-nCoV examine the evolutionary history of the virus and its relationships with other organisms. The seventh member of the family of coronaviruses that can infect humans, 2019-nCoV has been reported to have a genome sequence 75% to 80% identical to the SARS-CoV and to have more similarities to several bat coronaviruses.[29][30] At least five genomes of the novel coronavirus have been isolated and reported.[53][54][55] These show that the virus is genetically distinct from other known coronaviruses such as Severe acute respiratory syndrome-related coronavirus (SARS-CoV) and Middle East respiratory syndrome-related coronavirus (MERS-CoV).[53] Like SARS-CoV, it is a member of Beta-CoV lineage B.[56]

Transmission

Before the 2019-20 outbreak, a study from 2015 published in Nature Medicine warned about potential risk of SARS-CoV re-emergence from viruses circulating in Chinese bat populations.[57] Using the SARS-CoV reverse genetics system, Ralph Baric's team generated and characterized a chimeric virus expressing the spike of bat coronavirus SHC014 in a mouse-adapted SARS-CoV backbone. Both monoclonal antibody and vaccine approaches failed to neutralize and protect from infection with this CoV using the novel spike protein.[58][clarification needed]

Basic reproduction number

The transmissibility of the virus between human-to-human has been variable, with some affected people not transmitting the virus to others while others have been able to spread the infection to several people.[28] The Basic reproduction number for the human-to-human transmission of the virus has been estimated as between 1.4 and 3.8 by several research groups. The number describes how many people a newly infected person is likely to pass the virus to in the population. The new coronavirus has been reportedly able to transmit down a chain of up to four people so far.[59]

Reservoir and transmitting host

The natural wildlife reservoir of the 2019‐nCoV and intermediate host that transmitted the 2019-nCoV to humans has not been confirmed, and results of animal sampling from the market are not yet available.[60] However, it is likely that the primary reservoir for the virus is bats.[30]
An updated preprint paper published 23 January 2020 on bioRxiv from members of the Wuhan Institute of Virology, Wuhan Jinyintan hospital, University of Chinese Academy of Sciences and the Hubei Provincial Center for Disease Control and Prevention suggest that the 2019 novel coronavirus has possible bat origins, as their analysis shows that nCoV-2019 is 96% identical at the whole genome level to a bat coronavirus.[61]
On 22 January, scientists from Peking University, Guangxi Traditional Chinese Medical University, Ningbo University and Wuhan Biology Engineering College published an article, which after looking at "humans, bats, chickens, hedgehogs, pangolins, and two species of snakes",[62] concluded that the "2019‐nCoV appears to be a recombinant virus between the bat coronavirus and an origin‐unknown coronavirus" ... and ... "snake is the most probable wildlife animal reservoir for the 2019‐nCoV" which then transmitted to humans.[63][62][64] Others have also suggested that 2019-nCoV developed as a result of "viruses from bats and snakes combining".[63][62][64][65] Some have disputed the paper from Peking and argued that the reservoir must be bats and the intermediate host, bird or mammal, not snakes (as snakes, unlike humans, are poikilotherms).[65][66]

Chronology

Main article: Timeline of the 2019–20 Wuhan coronavirus outbreak

Wuhan coronavirus outbreak by country

Main article: 2019–20 Wuhan coronavirus outbreak by country and territory
Cases as of 28 January 2020:

Map of the 2019–20 Wuhan coronavirus outbreak (as of 28 January 2020):
  Region of origin (Mainland China)
  Confirmed cases reported
  Suspected cases reported
Country/regionConfirmed
cases		DeathsReference(s)
 Mainland China4,515106[67][68][69][70][71]
 Hong Kong80[72]
 Thailand80[73]
 Macau70[74][75][76][77]
 Australia50[78][79]
 Singapore50[80]
 Taiwan50[81]
 United States50[82][83][84]
 Japan40[85][86]
 Malaysia40[87]
 South Korea40[88][89]
 France30[90][91]
 Canada20[92][93]
 Vietnam20[94]
 Cambodia10[95]
 Germany10[96]
   Nepal10[97][98]
 Sri Lanka10[99][100][101]
Total4,581106

Epidemiology

Epidemiology studies of 2019-nCoV examines the distribution (who, when, and where), patterns and risk factors. The first 59 suspected cases at the end of December 2019 and early January 2020 were admitted to Jinyintan Hospital, which was specially designated to isolate them. 41 of the 59 were confirmed with the 2019-nCoV infection. Of these 41 cases, there was one group of family members, 30 (73%) were men and the average age was 49 years. Almost a third (32%) had an underlying medical condition including eight with diabetes, six with high blood pressure and six with heart disease. Two-thirds had a history of exposure to the Huanan Seafood Wholesale Market. The most frequently reported symptoms were 40 (98%) with fever, 31 (76%) with cough, and 18 (44%) with muscle aches and tiredness. Less frequent symptoms included coughing sputum or blood, headache and diarrhea. Around half of the cluster had shortness of breath and 13 were admitted to intensive care. CT scans of all 41 people revealed pneumonia. Complications included 12 with acute respiratory distress syndrome, five with acute cardiac injury and four with secondary infection.[25]
On 17 January, an Imperial College group in the UK published a Fermi estimate that there had been 1,723 cases (95% confidence interval, 427–4,471) with onset of symptoms by 12 January. This was based on the pattern of the initial spread to Thailand and Japan. They also concluded that "self-sustaining human-to-human transmission should not be ruled out",[102][103] which has since been confirmed as happening. As further cases came to light, they later recalculated that "4,000 cases of 2019-nCoV in Wuhan City... had onset of symptoms by 18 January 2020".[104][105] A Hong Kong University group has reached a similar conclusion as the earlier study, with additional detail on transport within China.[106]
On 20 January, China reported a sharp rise in cases with nearly 140 new patients, including two people in Beijing and one in Shenzhen.[107] On 25 January, the number of laboratory-confirmed cases stood at 2,062, including 2,016 in China, seven in Thailand, six in Hong Kong, five in Macau, five in Australia, four in Malaysia, four in Singapore, three in France, three in Japan, three in South Korea, three in Taiwan, three in the United States, two in Vietnam, and one in Nepal.[108][109]
Super-spreaders were suspected multiple times by different experts and media. A widely believed super-spreader patient was reported to have infected 14 different members of medical staff. On 25 January, Gao Fu, the head of China's CDC denied such claims and "dismissed a media report" claiming this, according to an announcement made to the official Xinhua News Agency.[110] Earlier the same day, however, China Newsweek (operated by another official news agency, China News Service), citing an expert from Peking University, claimed that the aforementioned patient could be considered a super-spreader already, and criticised the hospitals involved for not having properly protected the staff who came in contact with the patient. China Newsweek also criticised the government's censorship, saying all doctors and nurses, except those in the fever clinic, have "basically nothing but a mask" to protect themselves.[111]

Identification

Signs and symptoms


Symptoms of 2019-nCoV (Wuhan coronavirus).

A doctor in a protective bunny suit sees a patient in a Wuhan hospital.
Reported symptoms have included fever in 90% of cases,[21] fatigue and a dry cough in 80%,[21][112] and shortness of breath in 20%, with respiratory distress in 15%.[42][113][112] Chest x-rays have revealed signs in both lungs.[42][113] Vital signs were generally stable at the time of admission of those hospitalised.[112] Blood tests have commonly shown low white blood cell counts (leucopenia and lymphopenia).[21]

Testing protocol

On 15 January 2020, the WHO published a protocol on diagnostic testing for 2019-nCoV, developed by a virology team from Charité Hospital in Germany.[114]

Concerns of underreporting

There are concerns on whether adequate medical personnel and equipment are available in regions affected by the outbreak for hospitals to correctly identify coronavirus cases instead of mis-diagnosing suspected cases as "severe pneumonia".[115][116][117] Many of those experiencing symptoms may decide to self-quarantine at home instead of going to a hospital due to long wait-times and cramped conditions.[118][failed verification]

Estimates

Based on cases reported and assuming a 10-day delay between infection and detection, researchers at Northeastern University and Imperial College London estimated that the number of actual infections may be 10 times higher than those confirmed at the time of reporting. Imperial College estimated 4,000 cases with 440 confirmed by 21 January 2020, Northeastern University estimated 21,300 infections by 26 January, increasing to 26,200 infections by 27 January (with a confidence of 95% within the interval 19,200-34,800).[119][120][121]

Prevention and management


Infrared cameras were installed in Wuhan railway station to check passengers' body temperature before they board the trains.
2019-nCoV does not have an effective medicine treatment or vaccine, though efforts to develop some are underway.[122][123] Its symptoms include, among others, fever, breathing difficulties and coughing,[124] which have been described as "flu-like".[125] To prevent infection, the WHO recommends "regular hand washing, covering mouth and nose when coughing and sneezing… [and] avoid[ing] close contact with anyone showing symptoms of respiratory illness (such as coughing and sneezing)."[53]
Though there are no specific treatments for general human coronaviruses, the US CDC provides generic advice that an infected person can relieve their symptoms by taking regular flu medications, drinking fluids and resting.[126] Some countries require people to report flu-like symptoms to their doctor, especially if they have visited China.[127]

Domestic responses

File:航拍武汉中心城区机动车禁行后道路：少有车辆踪影-Wg-8rMZAsY0.webm
'Aerial photography of roads after motor vehicles are banned in central urban areas of Wuhan: few vehicle traces' - Video news from China News Service

Passengers wearing masks going though an extra body temperature check as part of airport security. Captured on 26 January in NE China's Changchun Airport

Hong Kong residents queueing to refund their bullet train tickets to the mainland in West Kowloon railway station
On 20 January, Chinese Communist Party general secretary Xi Jinping made his first public remark on the outbreak and "spoke of the need for the timely release of information," according to state-run News Agency.[128][129] Chinese premier Li Keqiang also urged efforts to prevent and control the epidemic.[130] One day later, the Central Political and Legal Affairs Commission of the Chinese Communist Party, the most powerful political organ in China overseeing legal enforcements and the police, wrote "self-deception will only make the epidemic worse and turn a natural disaster that was controllable into a man-made disaster at great cost," and "only openness can minimise panic to the greatest extent." The commission then added, "anyone who deliberately delays and hides the reporting of cases out of self-interest will be nailed on a pillar of shame for eternity."[131][132]
On 25 January, Politburo of the Communist Party of China met to discuss novel coronavirus prevention and control. Chinese Communist Party general secretary Xi Jinping stated that the country is facing a "grave situation" as the number of infected people is accelerating.[133] In the evening, the authorities banned the use of private vehicles in Wuhan. Only vehicles which are transporting critical supplies or emergency response vehicles are allowed to move within the city.[134]
On 26 January, a leading group on the prevention and control of the novel coronavirus outbreak was established, led by Premier Li Keqiang.[135] The leading group has decided to extend Spring Festival holiday to contain coronavirus outbreak.
China Customs started to require all passengers entering and exiting China to fill out an extra health declaration form starting 26 January. The health declaration form was mentioned in China's Frontier Health and Quarantine Law, granting the customs rights to require it if needed. The customs said it will "restart this system" as it was not a requirement before.[136][137][138]
On 27 January, Premier Li Keqiang visited Wuhan to direct the epidemic prevention work.[139]
Authorities across China announced school closures and delayed the spring semester, which normally begins in late February and early March. All schools ranging from kindergartens to universities in the whole of Hubei province will have their winter break prolonged and the exact date of the new semester will be announced later, according to a statement made on 24 January.[140] China's Ministry of Education also asked all schools to halt public assemblies and delay major exams. Some universities with open campuses also banned the public from visiting.[141] Education department in Hunan province, which neighbours the centre of the outbreak Hubei province, stressed on the official newspaper Hunan Daily on 23 January, claiming it will strictly ban off-school tutors and restrict unapproved student gatherings, which are all common practices in China for students to get better grades.[142] Education departments in Shanghai and Shenzhen also imposed bans on off-school tutoring and ask schools to track and report students who have been to Wuhan or Hubei province during the winter break.[143][144] Several universities, including China's top-ranking Peking University and Tsinghua University announced the spring semesters will be delayed on 26 January.[145] The semi-autonomous regions Hong Kong and Macau also announced adjustments on schooling schedules. Hong Kong's Chief Executive Carrie Lam Cheng Yuet-ngor declared an emergency at a press conference on 25 January, saying the government will close primary and secondary schools for two more weeks on top of the previously scheduled Lunar New Year holiday, pushing the date for school reopenings to 17 February.[146][147] Macau closed several museums and libraries, and prolonged the Lunar New Year holiday break to 11 February for higher education institutions and 10 February for others.[148] The University of Macau said they will track the physical conditions of students who have been to Wuhan during the Lunar New Year break.[149]
On 27 January, the General Office of the State Council of China, one of the top governing bodies of the People's Republic, officially declared a nation-wide extension on the Lunar New Year holiday and the postponement of the coming spring semester. The Office extended the previously scheduled public holiday from 30 January to 2 February, while it said school openings for the spring semester will be announced in the future.[150]
After the Chinese Lunar New Year on 25 January, there would be another peak of people traveling back from their hometowns to workplaces as a part of Chunyun. Several provinces and cities started to encourage people to stay in their hometowns and not travel back. Eastern China's Suzhou also encouraged remote working via the internet and further prolonged the spring festival break.[151]
The Civil Aviation Administration of China and the China State Railway Group, which regulates China's civil aviation and operates rail services, announced on 24 January that passengers could have full refunds for their plane and train tickets without any additional surcharges, regardless of whether their flight or train will go through Wuhan or not. Some hotel chains and online travel agencies also allowed more flexibility in cancellations and changes.[152][153] China's Ministry of Culture and Tourism ordered travel agencies and online tourism firms to suspend package tours and stop offering "flight+hotel" bundles.[154][151]
More provinces and cities outside the most contaminated Hubei started to restrict travel. Beijing suspended all intercity bus coaches on 25 January,[155] with several others follow suit. Shanghai, Tianjin, Shandong, Xi'an, and Sanya all announced suspension of intercity or interprovince bus services on 26 January.[151]

International responses

Since 31 December 2019, some regions and countries near China tightened their screening of selected travellers.[24] The US Centers for Disease Control and Prevention (CDC) later issued a Level 1 travel watch.[42][113] Guidances and risk assessments were shortly posted by others including the European Centre for Disease Prevention and Control and Public Health England.[156] In China, airports, railway stations and coach stations installed infrared thermometers. People with fevers are subsequently taken to medical institutions after being registered and given masks.[157] Real time Reverse Transcription-Polymerase Chain Reaction (rRT-PCR) test was used to confirm new cases of coronavirus infection.[158]
An analysis of air travel patterns was used to map out and predict patterns of spread and was published in the Journal of Travel Medicine in mid-January 2020. Based on information from the International Air Transport Association (2018), Bangkok, Hong Kong, Tokyo, and Taipei had the largest volume of travelers from Wuhan. Dubai, Sydney and Melbourne were also reported as popular destinations for people traveling from Wuhan. Using the validated tool, the Infectious Disease Vulnerability Index (IDVI), to assess the ability to manage a disease threat, Bali was reported as least able in preparedness, while cities in Australia were considered most able.[1][159]
The International Civil Aviation Organization blocked a Twitter user who argued that Taiwan should be included in planning of air travel logistics related to the outbreak and has since continued blocking other users asking about the initial block.[160]
On 22 January, the AFC announced that it would be moving the matches in the third round of the 2020 AFC Women's Olympic Qualifying Tournament from Wuhan to Nanjing, affecting the women's national team squads from Australia, China PR, Chinese Taipei and Thailand.[161] A few days later, the AFC announced that together with Football Federation Australia they would be moving the matches to Sydney.[162] The Asia-Pacific Olympic boxing qualifiers, which were originally set to be held in Wuhan from 3–14 February, were also cancelled,[163] were and moved to Amman, Jordan to be held between 3–11 March.[164]

National reporting advice

hide
National reporting advice
PolityAdviceAuthorityLast UpdatedLink
China"Seek prompt medical attention if you have symptoms of fever and respiratory infection".National Health Commission21 January 2020[165]
Hong Kong"When travelling outside Hong Kong, do not touch animals; do not eat game meat; and avoid visiting wet markets, live poultry markets or farms. After returning to Hong Kong, if you have a fever or other symptoms, wear a surgical mask, consult a doctor promptly and reveal your recent travel history".Centre for Health Protection23 January 2020[166]
United States"CDC recommends that travelers avoid all nonessential travel to Hubei Province, China, including Wuhan". Travellers who have been to Hubei province and "and feel sick with fever, cough, or difficulty breathing'" should "Seek medical care right away. Before you go to a doctor's office or emergency room, call ahead and tell them about your recent travel and your symptoms".Center for Disease Control and Prevention23 January 2020[167]
United Kingdom"Individuals should seek medical attention if they develop respiratory symptoms within 14 days of visiting Wuhan, either in China or on their return to the UK. They should phone ahead before attending any health services and mention their recent travel to the city".Public Health England22 January 2020[156]
Australia"If you become unwell and suspect you may have symptoms of coronavirus, you must seek medical attention.
Please ring ahead of time to book your appointment. This will help make your doctor aware of your symptoms and your travel history. Call 000 if you need urgent medical help".
Australian Government Department of Health25 January 2020[168]
Malaysia"The Ministry of Health Malaysia urges every Malaysian that wants to visit Wuhan, China to postpone their trip except for those with very important matters that cannot be avoided".Ministry of Health23 January 2020[169]
Singapore"Singaporeans are advised not to travel to the whole of Hubei Province"., "Wear a mask if you have respiratory symptoms such as a cough or runny nose;"" All travellers should monitor their health closely for two weeks upon return to Singapore and seek medical attention promptly if they feel unwell.  Travellers should inform their doctor of their travel history. If travellers have a fever or respiratory symptoms (e.g. cough, shortness of breath), they should wear a mask and call the clinic ahead of the visit".Ministry of Health24 January 2020[170]
Vietnam"The Ministry of Health Vietnam requests the presidents of the People's Committees of the provinces and cities to direct the implementation of epidemic prevention and control measures according to Decision No. 156 / QD-BYT of 20 January 2020 released by the Ministry of Health on the promulgation of the NCoV acute pneumonia response plan in Vietnam. The Vietnamese Department of Health collaborated with Pasteur Institute in Ho Chi Minh City to organise the investigation and make a list of cases in close contact with cases of disease to monitor health, guide implementation of isolation and prevention of infection, promptly notify the health facility of any manifestation of the disease".Ministry of Health24 January 2020[171]
IndiaTravellers are advised to report "the illness to the nearest health facility and also inform the treating doctor regarding your travel history".National Centre for Disease Control11 January 2020[172]
Israel"Israelis are advised to avoid non-urgent travels to China".Ministry Of Health26 January 2020[173]
Thailand"The Ministry of Public Health of Thailand needs the co-operation from the Thai public to follow its recommendations. With the people's co-operation, the situation will improve. The public is advised not to believe all of the circulating rumours from different sources. Please "Check before you Share" information about patients and the situation on online channels because incorrect information may cause widespread panic and individuals spreading fake information can be found guilty under Thailand's Computer Crime Act of 2017. Please follow the news from the Ministry of Public Health. If you have any questions, you can ask the Department of Disease Control hotline: 1422, 24 hours per day or the Ministry of Public Health website, LINE and Facebook".Ministry Of Public Health26 January 2020[174]
New Zealand"...travellers who become sick within a month of their arrival are encouraged to seek medical advice and contact Healthline (for free) 0800 611 116 or a doctor. It is important to mention recent travel to Wuhan and any known contact with someone with severe acute respiratory illness who has been in Wuhan."Ministry of Health27 January 2020[175]

City-wide quarantine measures


Residents of Wuhan waiting for the last train of the city's metro on 10 A.M., 22 January
On 23 January 2020, a quarantine on travel in and out of Wuhan was imposed in an effort to stop the spread of the virus out of Wuhan. Flights and trains in and out of Wuhan, public buses, the metro system and long-distances coaches were suspended until further notice. Large-scale gatherings and group tours were also required to be suspended.[176] By 24 January 2020, a total of 15 cities, including Wuhan, in Hubei, were placed under similar quarantine measures.[12] Thus, the entire Hubei province came under quarantine, save for the Shennongjia Forestry District.

Residents of Wuhan don masks rushed out to nearby markets on 23 January
Due to the unprecedented quarantine measures, residents rushed to stockpile on essential goods, food and fuel. The prices of goods were also significantly increased.[177][178][179] Medical staff faced difficulties in commuting to their hospitals, as they were now limited to walking and private cars.[180] Taxis and private hire vehicles would shun them upon knowing the destination.[180] 5,000,000 people left Wuhan, with 9,000,000 left in the city.[181]
Guan Yi, an epidemiologist and SARS virologist with teams consisting of medical specialists who just flew back to Hong Kong after their one-day inspection in Wuhan told correspondents that "the Wuhan outbreak is at least 10 times larger than that of SARS, calling people to stay away from Wuhan as soon as possible."[182][183][184][185]
Some posts on Weibo showed that hospitals in Wuhan have already been overloaded with thousands of people with fever and were highly critical of the reliability of the figures from the Chinese government although such posts are now deleted due to unknown reasons.[186]
On 26 January, the city of Shantou in Guangdong declared a partial lockdown,[187] though this was quickly reversed only two hours later.[188] This created chaos as residents rushed to supermarkets to stock food as soon as the lockdown was declared, and the surge of stockpiling didn't come to an end until the authorities reversed their decision. Caixin said the wording of Shantou's initial declaration was "unprecedentedly strict" and will severely affect residents' lives if implemented as is. Shantou's department for outbreak control later clarified they will not restrict traveling and all they would do is to sterilise vehicles used for transportation.[189]
Local authorities of the capital Beijing and several other major cities, including Hangzhou, Guangzhou, and Shenzhen announced 26 January that these cities will not suffer from a lockdown similar to those of Hubei province's. Rumors of these lockdowns had already spread widely before the official announcements.[190] A spokesperson of Beijing's municipal transportation commission claimed that the expressways and highways, as well as subways and buses, are operating normally. To ease residents' panic, Hangzhou's government stressed the city will not be locked down from the outside world, and both cities said that they will introduce precautions against potential risks.[191]
Hubei cities under transportation ban[12]
CityDate quarantinedEstimated
population		Source
Wuhan23 January 2020[192]11,081,000[193]
Huanggang23 January 2020[192]6,630,000[194]
Ezhou23 January 2020[192]1,077,700[195][196]
Chibi24 January 2020490,900[197]
Jingzhou24 January 20205,590,200[198]
Zhijiang24 January 2020497,600[199]
Yichang24 January 20204,135,900[200]
Qianjiang24 January 2020966,000[201]
Xiantao24 January 20201,140,500[202]
Xianning24 January 20202,543,300[203]
Huangshi24 January 20202,470,700[204]
Dangyang24 January 2020469,600[205]
Enshi24 January 2020777,000[206]
Xiaogan24 January 20204,915,000[207]
Jingmen24 January 20202,896,500[208]
Total41,546,000

Specialty hospitals


Construction site of Huoshenshan Hospital as it appeared on 24 January

Jinyintan Hospital had initially been tasked with treating those with the coronavirus.
A specialty hospital named Huoshenshan Hospital has been under construction as a countermeasure against the outbreak and to better quarantine the patients. Wuhan City government had demanded that a state-owned enterprise fabricate such an accommodation "at the fastest speed" comparable to that of the SARS outbreak in 2003.[209]
On 24 January, Wuhan authorities specified its planning, saying they planned to have the hospital built within six days of the announcement and it will be ready to use on 3 February. The specialty hospital will have 1,000 beds and it will take up 25,000 square metres. The hospital is modelled after the Xiaotangshan Hospital [zh] which was fabricated for the SARS outbreak of 2003, itself built in only seven days.[210][211] State media praised the construction workers for their hard-working, said there will be 1,500 workers and nearly 300 construction machineries on the site at peak, and another backup team of 2,000 workers has already gathered.[212] The construction will go non-stop on the Chinese Lunar New Year's Eve and the New Year, which are 24 and 25 January. This means the workers will have to give up their holidays, and reports said these workers were paid twice as much as average.[213]
Authorities announced plans for a second specialty hospital on 25 January. The new one will be named Leishenshan Hospital [zh], with a capacity of 1,300 beds; completion is planned within "half a month."[214] Some people voiced their concerns through social media services, saying the authorities' decision to build yet another hospital in such little time showed the severity of the outbreak could be a lot worse than expected.[215]

Evacuation of foreign diplomats and citizens from Wuhan

The governments of Belgium, Thailand and the United States are planning evacuation flights for their citizens.[216][217][218]
Russia, France, Pakistan, India, Japan and Australia are considering similar measures.[219][220][221][222]
Sri Lanka has begun repatriation of Sri Lankan students in China.[223]
Vietnam permits four exceptional flights to carry Wuhan passengers home in the period 24-27th of January,[224] and organizes a flight to excavate citizens and diplomats.[225]

Criticism

Chinese authorities faced initial criticism on mishandling the outbreak, including insufficient medical supplies, lack of transparency to the press and censorship of social media.[226][227] On 1 January 2020 the Wuhan police interviewed eight residents for spreading false information (referring to the new infection as a reappearance of SARS) with none ultimately being detained or punished.[228][better source needed]
For over a month from 8 December 2019 to 17 January 2020, all the confirmed cases in China were from the sole city of Wuhan, yet meanwhile, there were already confirmed cases in Japan and Thailand.[229] Many on Chinese social media commented on the implausibility of the data and suggested that the authorities must be concealing the actual numbers,[230] with some sardonically calling the outbreak a "patriotic virus" due to its appearance of infecting people overseas rather than people in China.[231][232][233]
Several Hong Kong media correspondents were detained by the police for over an hour when they were interviewing in Wuhan's Jinyintan Hospital on 14 January. Reports said the police brought the correspondents to a police station, where the police checked their travel documents and belongings, then asked them to delete video footage taken in the hospital before releasing them.[234][229]
Authorities in Wuhan and Hubei provinces have been criticised for downplaying the severity of the outbreak and responding slower than they should. Caixin blamed Wuhan for not rolling out the first level of "public health emergency response mechanism" until 24 January, which came even later than several other provinces and cities outside of the centre of the outbreak.[235] On 19 January, four days before the city's lockdown, a "Wanjiayan," literally meaning "banquet of tens of thousands of families," was held in Wuhan, with over 40,000 families turning out at the banquet tables. The Beijing News said the authorities shouldn't be controlling the outbreak on the one hand, while having such a public assembly on the other hand, ridiculing this as Wuhan "seemed to be in two separate universes." It also said by the time when their journalists visited the Huanan Seafood Market where the coronavirus likely originated, most residents and merchants there weren't even donning face masks.[236] Experts said the authorities "lack basic common sense" for allowing such a banquet to be held.[237] Zhou Xianwang, the mayor of Wuhan, later spoke to China Central Television defending that this banquet was held annually, and it is a "sample of the people's self-autonomy." Then he claimed that the decision of allowing such a banquet was made based on the fact that the scientists used to falsely believe that the ability of the virus to spread human-to-human was limited.[238][239] Meanwhile on 20 January, Wuhan's municipal department for culture and tourism was giving out 200,000 tickets good for visiting all tourist attractions in Wuhan to its citizens for free, which was then criticised for disregarding the outbreak.[236]

Vaccines and antivirals

Main article: Novel coronavirus (2019-nCoV) § Treatment
Several organizations around the world are testing antivirals or developing vaccines. Some of these include the following.
US National Institutes of Health (NIH) is hoping for human trials of a vaccine by April 2020.[240][241] The Chinese Center for Disease Control and Prevention (CCDC) has started developing vaccines against the novel coronavirus and is testing existing drug effectiveness for pneumonia.[242][243] The Coalition for Epidemic Preparedness Innovations (CEPI) is funding three vaccine projects[244] and hopes to have a vaccine in trials by June 2020 and approved and ready in a year. The University of Queensland in Australia has received $10.6 million in funding from CEPI to develop a "molecular clamp"[245] vaccine platform.[246][247] Moderna is developing a mRNA vaccine with funding from CEPI.[248][249] Inovio Pharmaceuticals received a grant from CEPI and designed a vaccine in two hours after receiving the gene sequence.[250] The vaccine is being manufactured so that it can be first tested on animals.[250]

See also

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Further reading

Mainland China and Hong Kong
WHO
  • World Health Organization (2020). "Surveillance case definitions for human infection with novel coronavirus (nCoV)‎: interim guidance v1, January 2020". World Health Organization. hdl:10665/330376. WHO/2019-nCoV/Surveillance/v2020.1.
  • World Health Organization (2020). "Laboratory testing of human suspected cases of novel coronavirus (nCoV)‎ infection: interim guidance, 10 January 2020". World Health Organization. hdl:10665/330374. WHO/2019-nCoV/laboratory/2020.1.
Europe

External links

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