New Coronavirus News from 31 Jan 2020

Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study [The Lancet, 31 Jan 2020]

Authored by Joseph T Wu, Kathy Leung & Gabriel M Leung

Summary

Background

Since Dec 31, 2019, the Chinese city of Wuhan has reported an outbreak of atypical pneumonia caused by the 2019 novel coronavirus (2019-nCoV). Cases have been exported to other Chinese cities, as well as internationally, threatening to trigger a global outbreak. Here, we provide an estimate of the size of the epidemic in Wuhan on the basis of the number of cases exported from Wuhan to cities outside mainland China and forecast the extent of the domestic and global public health risks of epidemics, accounting for social and non-pharmaceutical prevention interventions.

Methods

We used data from Dec 31, 2019, to Jan 28, 2020, on the number of cases exported from Wuhan internationally (known days of symptom onset from Dec 25, 2019, to Jan 19, 2020) to infer the number of infections in Wuhan from Dec 1, 2019, to Jan 25, 2020. Cases exported domestically were then estimated. We forecasted the national and global spread of 2019-nCoV, accounting for the effect of the metropolitan-wide quarantine of Wuhan and surrounding cities, which began Jan 23–24, 2020. We used data on monthly flight bookings from the Official Aviation Guide and data on human mobility across more than 300 prefecture-level cities in mainland China from the Tencent database. Data on confirmed cases were obtained from the reports published by the Chinese Center for Disease Control and
Prevention. Serial interval estimates were based on previous studies of severe acute respiratory syndrome coronavirus (SARS-CoV). A susceptible-exposed-infectious-recovered metapopulation model was used to simulate the epidemics across all major cities in China. The basic reproductive number was estimated using Markov Chain Monte Carlo methods and presented using the resulting posterior mean and 95% credibile interval (CrI).

Findings

In our baseline scenario, we estimated that the basic reproductive number for 2019-nCoV was 2·68 (95% CrI 2·47–2·86) and that 75 815 individuals (95% CrI 37 304–130 330) have been infected in Wuhan as of Jan 25, 2020. The epidemic doubling time was 6·4 days (95% CrI 5·8–7·1). We estimated that in the baseline scenario, Chongqing, Beijing, Shanghai, Guangzhou, and Shenzhen had imported 461 (95% CrI 227–805), 113 (57–193), 98 (49–168), 111 (56–191), and 80 (40–139) infections from Wuhan, respectively. If the transmissibility of 2019-nCoV were similar everywhere domestically and over time, we inferred that epidemics are already growing exponentially in multiple major cities of China with a lag time behind the Wuhan outbreak of about 1–2 weeks.

Interpretation

Given that 2019-nCoV is no longer contained within Wuhan, other major Chinese cities are probably sustaining localised outbreaks. Large cities overseas with close transport links to China could also become outbreak epicentres, unless substantial public health interventions at both the population and personal levels are implemented immediately. Independent self-sustaining outbreaks in major cities globally could become inevitable because of substantial exportation of presymptomatic cases and in the absence of large-scale public health interventions. Preparedness plans and mitigation interventions should be readied for quick deployment globally.

☞
https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930260-9

U.S. to Quarantine Americans Returning From Hubei: Virus Update [Bloomberg, 31 Jan 2020]

The U.S. declared a public health emergency in response to the coronavirus outbreak in China, ordering as much as a 14-day quarantine of citizens returning from the province at the center of the outbreak and denying entry to some foreigners.

In addition, flights to the U.S. from China will be restricted to seven airports. U.S. carriers have already significantly cut travel to and from the country. Foreign nationals who have been in China recently will be denied entry to the U.S.

The actions, announced Friday by President Donald Trump’s newly formed virus task force, will begin Feb. 2.

Under the temporary emergency measure, U.S. citizens who have been in Hubei province during the past two weeks will be subject to the quarantine, said Health and Human Services Secretary Alex Azar. Citizens returning from elsewhere in China will be subject to screening, and have to self-quarantine for two weeks while being monitored.

Bloomberg is tracking the outbreak here. Click here to view on terminal.

More From the U.S. Virus Task Force Briefing (4:25 p.m. NY)
• The travelers who will be denied entry are foreign nationals -- other than immediate family of U.S. citizens and permanent residents -- who have been in China within the past 14 days.
• Only 1 in 6 U.S. cases of the coronavirus have been detected through airport screening, officials said.
• Chinese flights will be funneled through Los Angeles, San Francisco, New York’s JFK International, Honolulu, Chicago, Atlanta and Seattle.
• The new entry measures are being taken after instances of asymptomatic spread became clearer and China cases exploded.
• Robert Redfield, director of the Centers for Disease Control and Prevention: “This is a serious health situation in China, but I want to emphasize the risk to the American public is low. Our goal is to do all we can to keep it that way.”
• Azar: “The prudent, targeted and temporary actions will decrease the pressure on public health officials screening incoming travelers, expedite the processing of U.S. citizens and permanent residents returning from China, and ensure resources are focused on the health and safety of the American people.”

Key Developments:
• China confirmed cases rise to 9,809 from 7,700; death toll at 213
• At least two-thirds of China’s economy to stay shut next week
• Virus Impact: Travel warnings, car output and more
• See first images of how Coronavirus replicates in cells here

A New Wave of Flu Risks Patient Confusion (2:39 p.m. NY)

A new wave of influenza is picking up in the U.S., raising the risk that patients who get the seasonal illness may think they have coronavirus, which has nearly identical symptoms early on in a patient’s illness.

The Centers for Disease Control and Prevention estimates that more than 19 million Americans have fallen ill with the flu so far this season, including 180,000 people who ended up in the hospital. About 10,000 Americans have died, including more than 60 children.

This season of flu began early in the U.S. After, stalling, it’s picked back up with a new strain of H1N1 influenza, according to a government survey of the illness.

“If coronavirus becomes a larger issue in the U.S., this will be a difficult thing,” said Gregory Poland, director of the Vaccine Research Group at the Mayo Clinic in Rochester, Minnesota.
“As clinicians, we are bombarded with people right now who have flu-like symptoms.”

CDC Puts Americans Returned From Wuhan in Quarantine (1:14 p.m. NY)

The U.S. Centers for Disease Control and Prevention said that aggressive steps will be needed to stop the coronavirus from taking hold in the U.S.

“If we take strong measures now, we may be able to blunt the impact on the United States,” Nancy Messonnier, director of the Center for the National Center for Immunization and Respiratory Diseases at the CDC, said on a call with reporters Friday. “The virus is continuing to spread rapidly throughout China.”

The government has put about 200 U.S. citizens repatriated from Wuhan under legal quarantine at March Air Reserve Base in Southern California. The group includes State Department personnel, family members, children and other Americans. It’s the first time such a policy has been used in the U.S. since the 1960s, when a quarantine order was issued to stop the spread of smallpox.

The quarantine was implemented after one person wanted to leave, Messonnier said.

“We are facing an unprecedented public health threat. This is one of the tools in our toolbox,” Messonnier said.

She declined to comment on how other Americans returning from China would be monitored.

U.S. Works to Get Americans Out of Wuhan (12:15 p.m. NY)

The U.S. State Department is working to arrange additional flights for U.S. citizens still in Wuhan, where the Chinese outbreak of coronavirus is centered, according to an official with knowledge of the plans. The U.S. government effort follows the cancellation of flights by major U.S. carriers from much of China.

Seats would be offered as they become available, the official said.. The State Department is encouraging all American citizens in China to register with the Smart Traveler Enrollment (STEP) program at step.state.gov to receive updates on evacuation flights.

Delta, American Suspend Flights to China (11:20 a.m. NY)

Delta Air Lines Inc. and American Airlines Group Inc. will suspend all flights to China due to health concerns related to the coronavirus outbreak, becoming the first U.S. carriers to take such action.

People wear medical mask in the terminal that serves planes bound for China, at John F. Kennedy Airport (JFK) on Jan. 31.

Delta flights will cease from Feb. 6 through April 30, while American will halt flights starting today and running through March 27.

The decisions came the day after the U.S. government warned Americans not to travel to China. European carriers including British Airways, Air France and Deutsche Lufthansa AG had already halted flights.

Chinese Official Criticizes U.S. Reaction (9:53 a.m. NY)

Chinese officials took issue with U.S. comments about the country’s response to the coronavirus outbreak, and promised they would bring the infection under control.

“U.S. comments are inconsistent with the facts and inappropriate.” Chinese Ministry of Foreign Affairs Spokeswoman Hua Chunying said in statement posted online Friday. The World Health Organization “called on countries to avoid adopting travel bans. Yet shortly afterward, the U.S. went in the opposite direction, and started a very bad turn. It is so unkind.”

U.S. officials said this week that they had difficulty getting specialists from the Centers for Disease Control and Prevention to the front lines of the outbreak in China, and late Thursday the State Department advised Americans traveling in China to come home. Commerce Secretary Wilbur Ross on Thursday also said the outbreak may help bring jobs back to the U.S.

A person wears a medical mask in New York on Jan. 30.

China’s ambassador to the United Nations, Chen Xu, said during a press conference in Geneva that the country had been transparent about the disease.

“We have conducted our business in an open and transparent manner with the outside world,” he said.

Xu said that China would work with the World Health Organization to bring the disease under control, following a declaration by the WHO that the outbreak was an international emergency.

The declaration will “not only coordinate global prevention control measures but enables us to mobilize international resources to respond to the epidemic,” he said.

Stocks Slide, Treasuries Rally on Virus Jitters (9:33 a.m. NY)

Stocks dropped and bonds rallied on heightened concern that the spread of the coronavirus will slam global growth. The S&P 500 Index pared its monthly advance as investors remained on edge over the impact from the coronavirus. Treasury 10-year yields tumbled toward the lowest since October.

Delta, United Airlines Let Pilots Say No to China Trips (8:44 a.m. NY)

The Air Line Pilots Association secured agreements with United Airlines Holdings Inc. and Delta Air Lines Inc. to allow pilots to decline to fly to China if they have concerns about traveling there, according to union representatives at both carriers. Late Thursday, the pilots union at American Airlines sued the carrier in an effort to halt its China flights and called on members to refuse to fly to the Asian country.

Germany Reports Sixth Case in Munich Outbreak (8:10 a.m. NY)

Germany reported a sixth infection from an outbreak that began at an auto-parts supplier near Munich. The new case involves a child who caught the virus from his or her father, who worked at the company, Bavarian health authorities said. The German cluster is significant because it’s one of the biggest examples of human-to-human spread outside China.

Russia Reports Two Confirmed Cases (7:55 a.m. NY)

Two Chinese nationals are being kept in isolation, Deputy Prime Minister Tatyana Golikova said.

The Kremlin will weigh temporary curbs on work visas, and the country has closed the Mongolia-Russia border to Chinese nationals. Russia also said it’s halting many flights with China.

Li Supports Holiday Extension for Virus-Hit Areas, CCTV Says (7 a.m. NY)

Regions with a rapid spread of new confirmed cases can lengthen holidays, Chinese Premier Li Keqiang said. He also called for staggered travel for people returning from holiday.

Italy Unlocks Emergency Funding (6:45 a.m. NY)

The Italian cabinet declared a state of emergency, freeing up state resources to combat the virus. Two Chinese nationals are being treated in isolation in Rome, after 18 tourists from the country were taken to a hospital, health authorities reported.

Singapore, Vietnam and Pakistan Issue Travel Restrictions (6:30 a.m. NY)

Singapore has suspended visas of Chinese citizens with immediate effect. This includes those already issued, according to government officials at a briefing Friday. Vietnam has also ordered a suspension of visas for Chinese tourists.

Pakistan has stopped all direct flights to and from China until Feb. 2 and plans to delay opening its northern border with China.

U.K. Confirms Two Cases of Coronavirus (6 a.m. NY)

Two patients in England, who are members of the same family, tested positive for coronavirus, the government said. The patients are receiving specialist care in Newcastle.

“We are already working rapidly to identify any contacts the patients had, to prevent further spread,” Chief Medical Officer Chris Whitty said. The government put the mortality rate from the new coronavirus at 2%.

Meanwhile, all passengers who boarded a flight from Wuhan are well, the U.K. government said. Travelers from China with symptoms are being asked to self-isolate for 14 days.

Hong Kong Schools to Stay Closed Until March 2: (5 p.m. HK)

Hong Kong is extending school holidays till March 2, depending on the coronavirus situation, Chief Executive Carrie Lam said in a briefing. The government will step up scrutiny of tourists from Hubei province, including sending them into quarantine.

Lam again dismissed calls to close Hong Kong’s borders with China, and asked the city’s medical staff to reconsider any plans to strike.

Roads remain empty in Wuhan due to the travel restrictions, Jan. 30.

Goldman Sees Hit to U.S. Growth (4:05 p.m. HK)

The coronavirus outbreak will cut U.S. economic growth by 0.4 percentage point in the first quarter as the number of tourists from China declines and exports to the Asian nation slow, Goldman Sachs Group Inc. said.

Trapped Italian Cruise Ship Passengers Allowed to Disembark (3:44 p.m. HK)

About 7,000 passengers who’ve been kept on a cruise ship near Rome over fears of a virus outbreak on board were allowed to disembark on Friday morning.

Passengers on the ship owned by Carnival Corp., had been held in the port of Civitavecchia since Thursday morning, after one of them came down with fever and respiratory symptoms.

Subsequent examinations showed the illness was not the new coronavirus.

Japan Raises Travel Warning After Criticism Over Virus Gaps (1:11 p.m. HK)

Japan moved to strengthen its travel warning for China and to bar patients infected with the new coronavirus from entering the country, after criticism that its initial response to the deadly outbreak was too lax.

The government is set to advise that non-urgent trips to China should be canceled. It also plans to bring forward an order allowing compulsory hospitalization to Feb. 1, earlier than Feb.
7 as originally planned, Prime Minister Shinzo Abe told parliament. Patients will be barred from entering the country from the same date, he added.

Countries Worry About Evacuee Contagion, Economic Impact (11:53 a.m. HK)

Tensions are rising across the region as governments bring their citizens home from the outbreak epicenter in China, risking greater exposure among domestic populations.

Australia plans to isolate its evacuees from Wuhan on Christmas Island, better known for its grim history as a detention center for would-be asylum seekers, while the U.S. flew its citizens from the virus-stricken Chinese city to an isolated military base in California.

Workers disinfect the waiting room of Beijing railway station in the fight against SARS, May 2003.

Economist Sees Far Bigger Impact Than During SARS (7:35 a.m. HK)

The global cost of the coronavirus could be three or four times that of the 2003 SARS outbreak that sapped the world’s economy by $40 billion, according to the economist who calculated that figure.

The sheer growth in the Chinese economy over the last 17 years means the global health emergency triggered by the coronavirus outbreak has far greater potential to gouge global growth, according to Warwick McKibbin, professor of economics at the Australian National University in Canberra.

U.S. Tells Americans to Leave China (9:59 a.m. HK)

The U.S. State Department on Thursday night warned Americans not to travel to China because of the spreading coronavirus outbreak. “Those currently in China should consider departing using commercial means,” the department said in the advisory, which was Level 4, the most severe travel warning category.

The advisory puts China among several nations that the U.S. warns its citizens to avoid, including North Korea, Venezuela, Iran, Iraq and Somalia.

Study Sees Early Signs of Human Transmission (8:38 a.m. HK)

The coronavirus was spreading from person to person earlier than reported, according to a study by Chinese scientists.

Among 47 cases that occurred during 2019, 14 had been in contact with another person with respiratory symptoms, indicating likely human-to-human transmission, researchers from the Chinese Center for Disease Control and Prevention said in a study published Jan. 29 in the New England Journal of Medicine. Their analysis of the first 425 cases in Wuhan found that in its early stages, the epidemic doubled in size every 7.4 days.

“There is evidence that human-to-human transmission has occurred among close contacts since the middle of December,” Qun Li and colleagues said. Official confirmation of such transmissions wasn’t reported until weeks later.

An almost-empty MTR train in Hong Kong, Jan. 30.

Global Virus Cases Now Top Official SARS Count (7:58 a.m. HK)

The total number of coronavirus cases around the world has reached more than 9,950. That tops the count from the SARS epidemic, which in 2003 saw 8,096 officially reported cases, according to the WHO.

The latest tally shows the speed with which the new virus has spread in a short period of time, from the first case in December. It’s reached the same level that SARS did during its span of about eight months.

An overwhelming number of the cases, as with SARS, are in China. The country has 9,692 confirmed cases, while there are about 100 cases outside Greater China across 18 nations.

The numbers come with a footnote, however. SARS cases were widely considered to be under-reported, as possibly thousands went undocumented in the first few months. At the same time, the official count for the current virus is likely to be below the actual number of cases, as health officialsscramble to widen testing.

WHO Calls Coronavirus International Emergency (3:06 p.m. NY)

The World Health Organization declared the coronavirus outbreak centered in China a public health emergency of international concern, a step that will let public health authorities aid countries with less-robust health systems to stop the spread of the virus.

WHO Director-General Tedros Adhanom Ghebreyesus praised China‘s efforts to contain the outbreak, saying he had never seen a nation respond so aggressively to a disease, including building a new hospital in just 10 days. It’s a contrast to the criticism China faced for a lack to transparency during SARS.

Tedros said there’s no need at this time for measures that interfere with travel and trade, even though many governments, airlines and businesses have already taken such steps.

Children wear plastic bottles as makeshift homemade protection at Beijing Capital Airport on Jan. 30.

U.S. Has First Human-to-Human Transmission (12:43 p.m. NY)

A woman in Chicago who had been diagnosed last week with the coronavirus infected her husband, the Centers for Disease Control and Prevention said Thursday, the first case of human-to-human transmission to occur in the U.S.

Both patients are in their 60s and are doing well while being kept in isolation, CDC officials said on the call. The agency said the virus is not spreading widely and that the risk to the U.S. public remains low.

Disease experts are still trying to understand exactly how the virus spreads, and at what point after a person has become infected they become contagious. It’s also not clear, said CDC officials, how long a person has to be sick before testing positive. Both factors can present a challenge for health workers keeping tabs on contacts of people considered at risk
— With assistance by John Harney, Sybilla Gross, Jason Gale, Adela Lin, Natalie Lung, James Paton, Michelle Cortez, Bryce Baschuk, Angus Whitley, Isabel Reynolds, Randy Thanthong-Knight, Lily Nonomiya, Kana Nishizawa, Crystal Chui, Mark Schoifet, and Robert Langreth

8th Case Of Coronavirus Confirmed In The U.S. Amid Skyrocketing Outbreak [BBC News, 31 Jan 2020]

by ALLISON AUBREY

The Trump administration declared a public health emergency in the U.S. Friday in response to the global coronavirus outbreak.

"Today President Trump took decisive action to minimize the risk of novel coronavirus in the United States," said U.S. Health and Human Services Secretary Alex Azar at a White House press conference.

The risk of contracting the coronavirus is the U.S. is low — something that federal health administration officials emphasized repeatedly. "We are working to keep the risk low," Azar said.

The declaration of a public health emergency — which will become effective Sunday at 5 p.m. ET — enables the government to take temporary measures to contain the spread of the virus, which has been confirmed in seven people in the U.S.

The action means that U.S. citizens who have been in China's Hubei Province in the past 14 days will be subject to 14 days of mandatory quarantine if they travel back to the United States.

Earlier Friday, federal officials announced that American citizens who were evacuated from Wuhan earlier in the week would be quarantined for 14 days at March Air Reserve Base in Southern California. The action represents the first time in 50 years the U.S. has instituted a quarantine order.

In addition, the U.S. is temporarily suspending entry of most travelers arriving from China, or who have recently been in China, if they are not U.S. citizens.

"Foreign nationals other than immediate family of U.S. citizens and permanent residents who have traveled in China in the last 14 days will be denied entry into United States," Azar said.

Further, U.S. citizens who have been in other areas of mainland China in the past two weeks will be subject to screening at the airport of entry and to heightened monitoring for 14 days.

In their Friday remarks, federal health officials pointed to the fast global spread of the virus as justification for the move. The World Health Organization declared a global health emergency on Thursday.

U.S. officials also tried to explain their reasoning for an intense focus on this outbreak, which so far has not led to any deaths in the U.S., though it has led to more than 250 in China.

"I often get asked [about the] influenza outbreak," which has led to at least 8,000 deaths in the U.S. this season, said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which is part of the NIH. "People want to know why we're paying so much attention to the novel coronavirus."

In contrast to the seasonal flu toll, which is predictable, Fauci said, "there are a lot of unknowns [with the coronavirus]."

"The number of cases has steeply inclined each and every day," Fauci noted. In addition, at the beginning of the outbreak, it wasn't clear whether an infected person without symptoms could transmit the virus to another person.

"Now we know for sure that there are" asymptomatic infections, Fauci said.

Mining coronavirus genomes for clues to the outbreak's origins [Science Magazine, 31 Jan 2020]

By Jon Cohen

attaaaggtt tataccttcc caggtaacaa accaaccaac tttcgatctc ttgtagatct …

That string of apparent gibberish is anything but: It’s a snippet of a DNA sequence from the viral pathogen, dubbed 2019 novel coronavirus (2019-nCoV), that is overwhelming China and frightening the entire world. Scientists are publicly sharing an ever-growing number of full sequences of the virus from patients—53 at last count in the Global Initiative on Sharing All Influenza Data database. These viral genomes are being intensely studied to try to understand the origin of 2019-nCoV and how it fits on the family tree of related viruses found in bats and other species. They have also given glimpses into what this newly discovered virus physically looks like, how it’s changing, and how it might be stopped.

“One of the biggest takeaway messages [from the viral sequences] is that there was a single introduction into humans and then human-to-human spread,” says Trevor Bedford, a bioinformatics specialist at the University of Washington and Fred Hutchinson Cancer Research Center. The role of Huanan Seafood Wholesale Market in Wuhan, China, in spreading 2019-nCoV remains murky, though such sequencing, combined with sampling the market’s environment for the presence of the virus, is clarifying that it indeed had an important early role in amplifying the outbreak. The viral sequences, most researchers say, also knock down the idea the pathogen came from a virology institute in Wuhan.

In all, 2019-nCoV has nearly 29,000 nucleotides bases that hold the genetic instruction book to produce the virus. Although it’s one of the many viruses whose genes are in the form of RNA, scientists convert the viral genome into DNA, with bases known in shorthand as A, T, C, and G, to make it easier to study. Many analyses of 2019-nCoV’s sequences have already appeared on virological.org, nextstrain.org, preprint servers like bioRxiv, and even in peer-reviewed journals. The sharing of the sequences by Chinese researchers allowed public health labs around the world to develop their own diagnostics for the virus, which now has been found in 18 other countries. (Science's news stories on the outbreak can be found here.)

When the first 2019-nCoV sequence became available, researchers placed it on a family tree of known coronaviruses—which are abundant and infect many species—and found that it was most closely related to relatives found in bats. A team led by Shi Zheng-Li, a coronavirus specialist at the Wuhan Institute of Virology, reported on 23 January on bioRxiv that 2019-nCoV’s sequence was 96.2% similar to a bat virus and had 79.5% similarity to the coronavirus that causes severe acute respiratory syndrome (SARS), a disease whose initial outbreak was also in China more than 15 years ago. But the SARS coronavirus has a similarly close relationship to bat viruses, and sequence data make a powerful case that it jumped into people from a coronavirus in civets that differed from human SARS viruses by as few as 10 nucleotides. That’s one reason why many scientists suspect there’s an “intermediary” host species—or several—between bats and 2019-nCoV.

According to Bedford’s analysis, the bat coronavirus sequence that Shi Zheng-Li’s team highlighted, dubbed RaTG13, differs from 2019-nCoV by nearly 1100 nucleotides. On nextstrain.org, a site he co-founded, Bedford has created coronavirus family trees (example below) that include bat, civet, SARS, and 2019-nCoV sequences. (The trees are interactive—by dragging a computer mouse over them, it’s easy to see the differences and similarities between the sequences.)

Bedford’s analyses of RaTG13 and 2019-nCoV suggest that the two viruses shared a common ancestor 25 to 65 years ago, an estimate he arrived at by combining the difference in nucleotides between the viruses with the presumed rates of mutation in other coronaviruses.
So it likely took decades for RaTG13-like viruses to mutate into 2019-nCoV.

Middle East respiratory syndrome (MERS), another human disease caused by a coronavirus, similarly has a link to bat viruses. But studies have built a compelling case it jumped to humans from camels. And the phylogenetic tree from Shi’s bioRxiv paper (below) makes the camel-MERS link easy to see.

The longer a virus circulates in a human populations, the more time it has to develop mutations that differentiate strains in infected people, and given that the 2019-nCoV sequences analyzed to date differ from each other by seven nucleotides at most, this suggests it jumped into humans very recently. But it remains a mystery which animal spread the virus to humans.
“There’s a very large gray area between viruses detected in bats and the virus now isolated in humans,” says Vincent Munster, a virologist at the U.S. National Institute of Allergy and Infectious Diseases who studies coronaviruses in bats, camels, and others species.

Strong evidence suggests the marketplace played an early role in spreading 2019-nCoV, but whether it was the origin of the outbreak remains uncertain. Many of the initially confirmed 2019-nCoV cases—27 of the first 41 in one report, 26 of 47 in another—were connected to the Wuhan market, but up to 45%, including the earliest handful, were not. This raises the possibility that the initial jump into people happened elsewhere.

According to Xinhua, the state-run news agency, “environmental sampling” of the Wuhan seafood market has found evidence of 2019-nCoV. Of the 585 samples tested, 33 were positive for 2019-nCoV and all were in the huge market’s western portion, which is where wildlife were sold. “The positive tests from the wet market are hugely important,” says Edward Holmes, an evolutionary biologist at the University of Sydney who collaborated with the first group to publicly release a 2019-nCoV sequence. “Such a high rate of positive tests would strongly imply that animals in the market played a key role in the emergence of the virus.”

Yet there have been no preprints or official scientific reports on the sampling, so it’s not clear which, if any, animals tested positive. “Until you consistently isolate the virus out of a single species, it’s really, really difficult to try and determine what the natural host is,” says Kristian Andersen, an evolutionary biologist at Scripps Research.

One possible explanation for the confusion about where the virus first entered humans is if there was a batch of recently infected animals sold at different marketplaces. Or an infected animal trader could have transmitted the virus to different people at different markets. Or, Bedford suggests, those early cases could have been infected by viruses that didn’t easily transmit and sputtered out. “It would be hugely helpful to have just a sequence or two from the marketplace [environmental sampling] that could illuminate how many zoonoses occurred and when they occurred,” Bedford says.

In the absence of clear conclusions about the outbreak’s origin, theories thrive, and some have been scientifically shaky. A sequence analysis led by Wei Ji of Peking University and published online by the Journal of Medical Virology received substantial press coverage when it suggested that “snake is the most probable wildlife animal reservoir for the 2019‐nCoV.”
Sequence specialists, however, pilloried it.

Conspiracy theories also abound. A CBC News report about the Canadian government deporting Chinese scientists who worked in a Winnipeg lab that studies dangerous pathogens was distorted on social media to suggest that they were spies who had smuggled out coronaviruses. The Wuhan Institute of Virology, which is the premier lab in China that studies bat and human coronaviruses, has also come under fire. “Experts debunk fringe theory linking China’s coronavirus to weapons research,” read a headline on a story in The Washington Post that focused on the facility.

Concerns about the institute predate this outbreak. Nature ran a story in 2017 about it building a new biosafety level 4 lab and included molecular biologist Richard Ebright of Rutgers University, Piscataway, expressing concerns about accidental infections, which he noted repeatedly happened with lab workers handling SARS in Beijing. Ebright, who has a long history of raising red flags about studies with dangerous pathogens, also in 2015 criticized an experiment in which modifications were made to a SARS-like virus circulating in Chinese bats to see whether it had the potential to cause disease in humans. Earlier this week, Ebright questioned the accuracy of Bedford’s calculation that there are at least 25 years of evolutionary distance between RaTG13—the virus held in the Wuhan virology institute—and 2019-nCoV, arguing that the mutation rate may have been different as it passed through different hosts before humans. Ebright tells ScienceInsider that the 2019-nCoV data are “consistent with entry into the human population as either a natural accident or a laboratory accident.”

Shi did not reply to emails from Science, but her longtime collaborator, disease ecologist Peter Daszak of the EcoHealth Alliance, dismissed Ebright’s conjecture. “Every time there’s an emerging disease, a new virus, the same story comes out: This is a spillover or the release of an agent or a bioengineered virus,” Daszak says. “It’s just a shame. It seems humans can’t resist controversy and these myths, yet it’s staring us right in the face. There’s this incredible diversity of viruses in wildlife and we’ve just scratched the surface. Within that diversity, there will be some that can infect people and within that group will be some that cause illness.”

Daszak and Shi’s group have for 8 years been trapping bats in caves around China to sample their feces and blood for viruses. He says they have sampled more than 10,000 bats and 2000 other species. They have found some 500 novel coronaviruses, about 50 of which fall relatively close to the SARS virus on the family tree, including RaTG13—it was fished out of a bat fecal sample they collected in 2013 from a cave in Moglang in Yunnan province. “We cannot assume that just because this virus from Yunnan has high sequence identity with the new one that that’s the origin,” Daszak says, noting that only a tiny fraction of coronaviruses that infect bats have been discovered. “I expect that once we’ve sampled and sampled and sampled across southern China and central China that we’re going to find many other viruses and some of them will be closer [to 2019-nCoV].”

It’s not just a “curious interest” to figure out what sparked the current outbreak, Daszak says. “If we don't find the origin, it could still be a raging infection at a farm somewhere, and once this outbreak dies, there could be a continued spillover that’s really hard to stop. But the jury is still out on what the real origins of this are.”

Coronavirus death toll rises to 304 in China | TheHill [The Hill, 31 Jan 2020]

BY MARTY JOHNSON

The number of people who have died from the coronavirus in China has risen to 304, the Associated Press reports.

The country's National Health Commission reported Saturday that the total number of cases is now over 14,000, eclipsing the SARS (severe acute respiratory syndrome) virus that began in southern China in 2002-03.

Wuhan – the epicenter of the outbreak – and 16 other cities in China have been quarantined, affecting an estimated 50 million people. The containment net is the largest quarantine in modern history.

On Thursday, the World Health Organization (WHO) labeled the virus a global emergency and recommended that all countries try to prevent the cross-border spread of the virus, but noted that unnecessary interference with trade or travel should be avoided.

President Trump declared the coronavirus a public health emergency in the U.S. Friday and restricted travel to and from China. Aside from the immediate family of U.S. citizens, Chinese nationals who traveled to China in the past two weeks will be barred from entering the country.

The U.S. isn't the only country to enact such precautions, as Australia, Japan and Singapore have also set similar restrictions, the AP reports.

The 2019-nCoV Coronavirus Is Highly Effective at Human-to-Human Transmission [Barron's, 31 Jan 2020]

By Andrew Pekosz

The 2019-nCoV epidemic, known to the public as the novel coronavirus, represents an ever-changing and significant risk to the human population. A virus that had never been identified before began to infect humans in early to mid-December, leading to an explosion of cases primarily in areas of mainland China. This is a public-health concern because of the potential for the virus to spread globally and infect millions of people.

At this time, there is very little risk of infection in areas outside of mainland China. However, the virus has spread relatively quickly in China. This development should serve as a warning to other countries about the potential for this virus to cause large numbers of cases if not contained efficiently. While the scale of the current epidemic is large, the number of cases pales when compared with other respiratory viruses such as influenza, which has been estimated to have caused over 15,000,000 cases and 8,000 deaths in the U.S. alone this winter.

It is difficult, if not impossible, to predict how an epidemic caused by a new virus will turn out, but public-health officials have a clear goal of containing the outbreak so as to both reduce human disease and prevent the virus from becoming more adept at infecting humans.

They can do so by identifying infected people, limiting their contact with uninfected individuals, finding anyone who may have had contact with the infected person, and then monitoring those individuals for signs of disease. In this way, transmission from person to person can be reduced, thereby stopping the epidemic. This effort has been a challenge in mainland China, as the virus appears to be able to spread from human to human with an unexpectedly high efficiency, which results in tens of thousands of people needing to be investigated for potential infections—an inordinately large burden for the public-health services to tackle.

While the situation changes almost daily, the virus appears to be causing both mild, flu-like disease and more-serious respiratory infections that require hospitalization. Clinical, research, and public-health efforts are ongoing to contain the virus and provide better options for detecting and treating infections. The speed with which information on case numbers is being conveyed and the distribution of virus and virus sequences is unprecedented.

Vaccines and diagnostic tests specific to this virus have already been constructed, and the virus is being tested against panels of U.S. Food and Drug Administration–approved drugs to identify potential treatments. The ability to sequence the genes of the virus has allowed epidemiologists to piece together how the virus entered the human population and how it is spreading.

Combined with travel restrictions, these efforts will improve the ability of other countries to deal with the eventual appearance of infected individuals and allow them to more efficiently intervene to limit virus spread.

For the time being, most countries are planning, garnering resources, and monitoring the epidemic. For people outside of mainland China who want to do something, get your flu shot and donate blood—both will help with immediate, pressing medical conditions while we wait to see how the 2019-nCoV epidemic will unfold. B

Coronavirus: Two cases confirmed in UK [BBC News, 31 Jan 2020]

Two people from the same family have tested positive for coronavirus in the UK, the chief medical officer for England has announced.

The Chinese nationals were guests at the Staycity apartment-hotel in York, before being taken to the Royal Victoria Infirmary in Newcastle.

The hotel remains open for business but their apartment will be thoroughly disinfected, the company said.

Meanwhile 83 Britons evacuated from Wuhan in China are in quarantine.

They were taken to Arrowe Park Hospital in Wirral, where they will remain for 14 days, after their flight landed at RAF Brize Norton in Oxfordshire on Friday.

The new coronavirus has caused the deaths of 213 people so far - all in China.

Cases of the virus have reached nearly 10,000 in China - and more than 100 cases have been reported in 22 other countries.
• Coronavirus: How worried should we be?
• Coronavirus declared global health emergency
• Coronavirus: What it does to the body

Prof Chris Whitty, chief medical officer for England, said the NHS was "extremely well-prepared for managing infections" and it was quickly trying to identify any close contacts the two patients had to prevent further spread.

But he said the confirmed cases could not be identified because of patient confidentiality.

Who qualifies as a close contact?

Anyone who is within two metres of the infected person for 15 minutes.

Would the virus survive on a tissue?

Probably for 15 minutes, but it is unlikely to survive on surfaces, like door handles, for more than 24 hours.

The two people with coronavirus were moved from their York apartment-hotel to be treated initially at Castle Hill Hospital in Hull, before being taken to the infectious diseases unit in Newcastle.

Public Health England said there was minimal risk of infection to either guests or staff at the Staycity property in York.

Those identified as close contacts would be given health advice about symptoms and an emergency number in case they became unwell - but wouldn't be quarantined, PHE said.

'High chance of getting better'

Prof Whitty said the specialist unit at the Newcastle hospital was experienced in treating people with infectious diseases and there was "a high chance people would get better", based on current information.

"A lot of people will end up with a relatively minor disease," he said.

The small number who go on to be more seriously ill tend to develop respiratory problems which "will be dealt with as anyone else with a respiratory disease", Prof Whitty added.

Some GPs have started sending text messages to patients, telling them to stay away from their local surgery and phone them instead, if they feel unwell and have been to China in the last two weeks.

Ian Jones, professor of virology at the University of Reading, said the possibility of further spread was "minimal" because the cases were caught early.

Virus experts said they were not surprised to see cases in the UK but there was no reason to panic.

The WHO declared the outbreak a global emergency on Thursday.

The number of coronavirus cases worldwide has now surpassed that of the Sars epidemic, which spread to more than two dozen countries in 2003.

The mortality rate for the new strain of coronavirus is currently low, at 2% - less than Sars at 10% and Ebola at 70%, the chief medical officer says.

But the death rate could yet go up if more of those in hospital die, or down if it's discovered there are many other people with mild symptoms.

The quarantined Britons are being isolated from the general public, but not in "solitary confinement", according to the chief medical officer.

"We intend them to be housed in a way which is pleasant," he added.
• Global coronavirus cases surpass Sars epidemic
• Can people recover? And other questions
• Coronavirus: Why are we catching more diseases from animals?

Pat Hackett, leader of Wirral Council, said: "All services in the hospital are running as usual including emergency services, outpatients and planned surgery. Staff working in the hospital will not be in contact with these UK citizens."

Detective work now needed

This is not a surprise and is a moment the country has been preparing for.

The response now will be two-fold.

The first is to treat the patients while preventing any spread of the virus.

This is something specialist centres in the NHS have plenty of experience of - including when caring for patients who caught Ebola during the outbreak in West Africa in 2014.

The second is a massive feat of detective work to find out who these patients may have passed the virus on to.

Last night, doctors in Germany confirmed cases there had spread before people even developed symptoms.

Effective "contact tracing" is how the virus can be contained.

There is still much we do not know about these cases, but the situation in the UK is completely different to China where there are nearly 10,000 cases and the authorities are still trying to get on top of the outbreak.

The coronavirus can spread without signs of symptoms [The Hill, 31 Jan 2020]

By Joseph Guzman

The top U.S. infectious disease doctor says people can spread the virus that’s tearing through China before any symptoms appear.

Story at a glance
• A new study shows four people became infected through asymptomatic transmission.
• Chinese authorities made the same claim earlier this week.
• The death toll from the coronavirus passed 200, with nearly 10,000 infected.

The country’s top infectious disease doctor says the Wuhan coronavirus can be spread even without symptoms.

In a study published in the New England Journal of Medicine Thursday night, researchers laid out the details of four German business associates who became infected through asymptomatic transmission.

“There’s no doubt after reading this paper that asymptomatic transmission is occurring,” Dr Anthony Fauci, the director of the National Institute for Allergy and Infectious Diseases, told CNN. “This study lays the question to rest.”

Researchers say a woman from Shanghai met with the German business associates at a company near Munich on Jan. 20. The woman displayed no signs of the disease during the visit, but became ill on her flight back to China and was confirmed to have the virus on Jan. 26.

Four of the German employees of the company were later diagnosed with coronavirus.
Earlier this week, Chinese authorities said the coronavirus could be passed when people were asymptomatic.

There have been at least six confirmed cases in the U.S., with one person-to-person transmission between wife and husband, but health officials said the risk to Americans remains low.

The death toll from the coronavirus outbreak passed 200 Friday in China, with nearly 10,000 infected.

Thursday, the World Health Organization declared the outbreak a global health emergency. The U.S. has issued a “Level 4” travel advisory for China, its highest level of warning, over the rapidly spreading outbreak.

Coronavirus: First case confirmed in Santa Clara County [The Mercury News, 31 Jan 2020]

By FIONA KELLIHER and JOHN WOOLFOLK

Traveler from Wuhan landed at San Jose international airport on Jan. 24

Santa Clara County health officials Friday afternoon announced the Bay Area’s first confirmed case of the novel coronavirus that has alarmed health officials around the world, saying it sickened a local man after he returned a week earlier from traveling in China where the disease originated.

County Health Officer Sara Cody said the man recently traveled to Wuhan, China, and returned Jan. 24 to Mineta San Jose International Airport and then first showed symptoms after getting home. He is the Bay Area’s first confirmed case, the third in California and the seventh in the United States, Cody said Friday.

But fortunately, Cody said, the man never became sick enough to require hospitalization, has had contact with few people and has been “self-isolating” at home since returning, leaving only to seek outpatient medical treatment on two occasions. Cody said the county is monitoring his family members and others with whom he came in contact.

“We understand that this news may be concerning,” Cody said. “But based on what we know today, the risk to residents of our community remains low.”

Friday’s announcement came a day after the International Health Regulations Emergency Committee of the World Health Organization declare the outbreak a “public health emergency of international concern,” citing nearly 20,000 confirmed and suspected cases and 200 deaths in China.

It also comes at the height of the season in North America for influenza, a disease that afflicts millions of Americans and kills tens of thousands annually. Though the novel coronavirus has not reached that level of misery, Cody said health officials are concerned because it is new.

“There’s a lot we don’t know,” Cody said.

County officials had been anticipating a case locally for more than a week, Cody said. The San Francisco Bay Area has the nation’s second largest Chinese American community behind New York, and its technology industry has deep ties to the country.

“We’re not surprised to be the first,” Cody said.

Cody declined to say where the local infected man lives, how old he is, how many family members had contact with him or where he sought treatment. He is currently in “stable condition” and being monitored by the public health department.
Cody emphasized that there is no evidence that the virus is spreading anywhere in the county, Bay Area or Northern California.

The man has had limited contact with other people, and health officials are contacting all of them and will have them stay at home for 14 days, Cody said.

The Centers for Disease Control and Prevention confirmed the man who lives somewhere in the county has the virus, according to a news release from the Santa Clara County Public Health Department.

Concerns about coronavirus — which originated in Wuhan, China — have spread through the Bay Area this week as more than 9,000 people have become ill in China. Over 200 people have died, mostly in the Hubei Province.

Two other confirmed coronavirus cases in California, one in Los Angeles and one in Orange County, are being closely monitored.

On Thursday, officials confirmed the first person-to-person spread of coronavirus in the United States in Chicago, raising the nation’s total number of cases to six. The Santa Clara County man becomes the country’s seventh case.

Earlier this week, Santa Clara County ramped up its Emergency Operations Center — activated last Wednesday — and reassigned about two dozen staff to the center. Alameda and San Francisco counties have also activated operations centers.

———
If you feel sick: If you were in China in the last 14 days, or are the close friend or family member of someone who has been in China in the last 14 days, and feel sick with fever, cough, or difficulty breathing, you 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.

• Avoid contact with others.

• Do not travel while sick.

• Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.

• Wash hands often with soap and water for at least 20 seconds to avoid spreading the virus to others. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available.

Study Reports First Case of Coronavirus Spread by Asymptomatic Person [Scientific American, 31 Jan 2020]

By Andrew Joseph

A woman from China infected a person in Germany before she began displaying symptoms

People showing no symptoms appear to be able to spread the novel coronavirus that has caused an outbreak in China and led world health authorities to declare a global emergency, researchers reported Thursday in the New England Journal of Medicine. If confirmed, the finding will make it much harder to contain the virus.

The case described—from Germany—could help resolve one of the major unknowns about the virus, which as of Thursday night had infected nearly 9,700 people in China and killed 213.
About 100 more infections have been reported in 18 other countries, but no deaths.

Some viruses, including SARS, which is another coronavirus, can only be passed when a person is showing symptoms. Others, like the flu, can be spread a day or two before the onset of symptoms. If people are contagious before they become sick, they can be unknowingly spreading the virus as they go shopping or to work or to the movies. Trying to snuff out the virus in that case is a much more difficult task.

What’s also concerning is that the spread from an asymptomatic person appeared to lead to two generations of cases, meaning the person who contracted the virus then passed it on to others.

The infection described in the new paper involved a woman from Shanghai who traveled to Germany for a business trip from Jan. 19 to Jan. 22 and displayed no signs of the disease, which include cough and fever. She only became sick on her flight back to China, and was confirmed on Jan. 26 to have the virus, known provisionally as 2019-nCoV.

On Jan. 24, however, a 33-year-old German businessman who had had meetings with the woman on Jan. 20 and 21, developed a sore throat, chills, and muscle soreness, with a fever and cough arriving the following day. He began to feel better and returned to work Jan. 27.

After the woman was found to have the virus back in China, disease detectives went to work, getting in touch with people who had been in touch with the woman—including the German businessman, who by then had recovered and appeared healthy during an examination in
Munich. Tests, however, showed he had the virus.

On Jan. 28, three coworkers of the businessman tested positive for the virus. Only one of these patients had contact with the woman from Shanghai; the other two only had contact with the German man.

All four patients in Germany were isolated in hospitals and have not shown any signs of severe illness.

“The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” the experts wrote.

Germany is one of four countries, along with Vietnam, Japan, and, as of Thursday, the United States, to report limited local transmission of the virus outside of China. The large majority of cases outside China were identified in people who had picked up the virus in China and then traveled to other countries.

The increasing risk the virus seems to be posing to countries outside of China led the World Health Organization on Thursday to declare a public health emergency of international concern, or PHEIC.

Until now, there was some debate whether asymptomatic transmission of the coronavirus was possible. Health officials in China said last weekend that they had seen evidence of such spread, but U.S. health officials and leaders at the World Health Organization had repeatedly said that was a question they were still trying to answer.

Even if asymptomatic people can spread the virus, they may be less likely to than people who are sneezing and coughing—routes for the virus to jump from one person to another.
Helen Branswell contributed reporting.

8 questions about the coronavirus outbreak, answered [Vox.com, 31 Jan 2020]
By Julia Belluz

Is it safe to travel? Should you buy a mask? What about the people who don’t have symptoms?

The coronavirus outbreak, centered in China, is evolving at a dizzying speed. And so is the global response. In the past 24 hours alone, Russia and Singapore have sealed their borders to China and the World Health Organization declared the outbreak a global public health emergency. Meanwhile, the US government dramatically escalated its response — issuing its highest-level travel advisory, quarantining 195 citizens evacuated from China, and temporarily banning foreign nationals who have recently been to China from coming in.

With the case toll rising fast, reaching nearly 10,000 on January 31, and face masks flying off store shelves, it’s no wonder questions — and fears — are swirling about 2019-nCoV, as the virus is known.

For most people in the US, though, there’s really no reason to worry. And while making sense of risks with a new, quick-spreading pathogen is tricky, infectious disease experts are helping us sort it out. Here are answers to your most burning questions about the new coronavirus and its risks.

1) What is this new coronavirus, and what are the symptoms?

Coronaviruses are a large family of viruses that typically attack the respiratory system. The name comes from the Latin word corona, meaning crown, because of the spiky fringe that encircles these viruses. Most infect animals, such as bats, cats, and birds. Only seven, including 2019-nCoV, SARS, and MERS, are known to infect humans.

SARS is thought to have evolved from bats to civet cats to humans in China; MERS evolved from bats to camels to humans in the Middle East. No one knows where 2019-nCoV came from. For now, it is believed to have made the leap from animals in Wuhan, China, a city of 11 million, late last year. But researchers are still trying to suss out its precise origins.

As for symptoms: Two of the seven coronaviruses that infect humans, SARS and MERS, can cause severe pneumonia and even death in 10 and more than 30 percent of cases, respectively. But the others lead to milder symptoms, like a common cold. At the moment, we know 2019-nCoV can kill — but it’s not clear how often or how its fatality rate compares to SARS and MERS.

Did China downplay the coronavirus outbreak early on?

According to the Centers for Disease Control and Prevention, most patients right now start with a fever, cough, and shortness of breath. An early report, published in The Lancet, provided even more detailed information. It looked at a subset of the first 41 patients with confirmed 2019-nCoV in Wuhan. The most common symptoms were fever, cough, muscle pain, and fatigue; less common were headache, diarrhea, and coughing up mucus or blood. All had pneumonia and lung abnormalities on CT scans. As for the disease severity: 13 patients were admitted to an ICU, and six died. By January 22, most (68 percent) of the patients had been discharged from the hospital.

More recently, there have also been reports of people with very mild symptoms, like the four cases in southern Germany. There’s also evidence of asymptomatic cases. It’s possible that as we learn more, 2019-nCoV will look more like the flu than like SARS. That’s because infectious diseases typically look more severe when they’re first discovered, since the people showing up in hospitals tend to be the sickest. And already, the new virus appears to be less deadly than both SARS and MERS.

2) How do coronaviruses spread?

We don’t yet know how exactly 2019-nCoV spreads, but we do have a lot of data on how MERS, SARS, and other respiratory viruses move from person to person. And that’s mainly through exposure to droplets from coughing or sneezing.

So when an infected person coughs or sneezes, they let out a spray, and if these droplets reach the nose, eyes, or mouth of another person, they can pass on the virus, said Jennifer Nuzzo, an infectious disease expert and senior scholar at the Johns Hopkins Center for Health Security. In rarer cases, a person might catch a respiratory disease indirectly, “via touching droplets on surfaces — and then touching mucosal membranes” in the mouth, eyes, and nose, she added. That’s why hand-washing is an important public health measure — all the time, and especially in an outbreak.

3) Should I travel while this outbreak is going on?

A tourist wearing a respiratory mask at the Trevi Fountain in downtown Rome on January 31, 2020. The Italian government declared a state of emergency to prevent the spread of the new coronavirus after two cases were confirmed in Rome. Filippo Monteforte/AFP via Getty Images

Both the CDC and the State Department have issued their highest-level travel alerts for China, advising Americans to avoid going to China for the moment. (These advisories are likely to change as the outbreak evolves, so keep checking them.)

And that’s not only because there’s a risk of catching this new virus. Right now, numerous airlines are canceling or scaling back flights to China, in part because of decreased demand.

“I’m more concerned about the unpredictability of the [outbreak] response at this point,” said Nuzzo. “It would not be fun to go to China and get stuck there somehow. And coming back, you’ll be subject to additional screening.”

Is it safe to travel during the coronavirus outbreak? An infectious disease specialist explains.

But people worried about travel should remember that these advisories focus on China, where the epidemic is currently playing out.

Of the 9,776 confirmed cases right now, 9,658 have been found in mainland China. That’s 99 percent. And more than half of those are in Hubei. “The risk of acquiring this infection outside of Hubei and, truly, outside of China is remarkably low,” said Isaac Bogoch, a professor at the University of Toronto who studies how air travel influences the dynamics outbreaks — including the new coronavirus infection.

Source: Johns Hopkins University Center for Systems Science and Engineering

People with the virus have been detected in other countries, which is the reason the WHO declared the outbreak a public health emergency. But to date, those have mainly been travelers from China. “We can count the number of people who never had exposure to Hubei or China who were infected by this virus on one or two hands,” Bogoch said. “So if people are traveling [anywhere outside of China,] your risk is close to zero percent.”

What if you have to travel and you’re seated near someone who is sick? Bogoch said that’s not even time to panic. “There has been some work looking into the risk of acquiring infectious diseases through air travel. The risk of acquiring a respiratory infection through air travel is still extraordinarily low.”

The risk does go up if you happen to be seated within two meters of a person with a respiratory infection. But even there, simple proximity doesn’t necessarily mean you’ll catch anything. Instead, the more infectious the person is, and the longer you sit near them, the higher your risk. If you’re not near the person for very long, or they’re not very infectious, the lower the risk.

4) I’m still worried about the new coronavirus. What should I do to protect myself? Buy a mask?

In the US, the risk to the public is currently deemed low. And just about every health expert Vox has spoken to has said there’s no good evidence to support the use of face masks for preventing disease in the general population.

Masks are only useful if you have a respiratory infection already and want to minimize the risk of spread to others, or if you’re working in a hospital and are in direct contact with people who have respiratory illnesses. (Plus, there are reports of runs on masks and other supplies health workers need to stay safe.)

How tech companies are scrambling to deal with coronavirus hoaxes

That’s why the CDC advises against the use of masks for regular Americans. “The virus is not spreading in the general community,” Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, reasoned in a press briefing on January 30. But people are hoarding them anyway, and for the wrong reasons.

The best thing you can do to prevent all sorts of illness, said Messonnier, is “wash your hands, cover your cough, take care of yourself, and keep alert to the information that we’re providing.”

5) What about the cases of people spreading the virus before they show symptoms? Isn’t that worrisome?

The best evidence we have that the virus can spread before a person has symptoms comes from Germany. There, four people are known to have the virus.

The outbreak was identified in Bavaria on January 27, when a German businessman was diagnosed. He had been in meetings with a female colleague who was visiting from Shanghai and had the virus but didn’t know it. The woman only began to feel symptoms — such as fever and a cough — after she left Germany, and days after meeting with the German businessman.

This suggests she may have transmitted the virus to the man before knowing she was sick.

By January 28, three co-workers of the businessman were diagnosed with the virus, according to a New England Journal of Medicine case report. One had contact with the woman from Shanghai; the two others appear to have gotten the virus from the German businessman. “The fact that asymptomatic persons are potential sources of 2019-nCoV infection may warrant a reassessment of transmission dynamics of the current outbreak,” the study authors wrote.

But they also emphasized how mild the disease appeared to be among the German patients.

And there’s the question of how much of a risk asymptomatic spread truly poses to public health. “Even if there have been cases of asymptomatic transmission of this infection, those will be typically rare cases, and with just about every other respiratory tract infection known to humankind, those are not the people who are driving an epidemic,” said Bogoch.

6) Does the WHO declaration that the coronavirus is a global health emergency mean this is going to become a deadly pandemic?

The WHO’s declaration of a “public health emergency of international concern,” or PHEIC, does not mean we are facing a deadly pandemic.

Instead, a PHEIC is a political tool the agency can use to draw attention to a serious disease threat. It’s meant to engage the global community in a coordinated outbreak response, galvanize resources, give countries guidance on how to react, and stop the disease from spreading further across borders.

The agency’s director general, Tedros Adhanom Ghebreyesus, was very clear that they sounded the alarm as a precautionary measure: The agency is concerned about the potential damage the virus could do in countries with weaker health systems, and called on the international community to help. He emphasized that the vast majority of cases are still in China, and that China has moved swiftly to get the outbreak under control.

The 2 key questions that will determine if the coronavirus outbreak becomes a pandemic

If the disease continues to spread, however, it could turn into a pandemic: or a disease that spreads globally, with epidemics in multiple countries around the world. And that’s something health officials in the US and around the world are working to prevent. “We are preparing as if this is the next pandemic,” the CDC’s Messonnier said on January 31.

For now, the CDC and WHO are still calling this an outbreak. Very soon, health experts may determine that there are enough cases in China to call the outbreak an epidemic.

As for the question of deadliness, we don’t yet know how lethal this disease is or how easily it spreads. If you take the current number of deaths and divide it by the number of known cases, “the case fatality is 2 percent — and it’s gone down from 3 percent in the early days,” said
University of Michigan’s Howard Markel, who studies outbreaks. “And if it goes really, really low, we’ll probably say — like we did in Mexico in 2009 with swine flu — that it’s something very similar, if not less deadly, than regular seasonal flu.”

So once more of these mild or asymptomatic cases are discovered, this virus could look a lot less scary.

“We live [with] and tolerate a whole lot of respiratory viruses,” said Nuzzo, “some of which are even more transmissible than the estimates people have come out with for this one — but they don’t make the headlines.” If the new coronavirus winds up looking less severe, she added, “we may be moving away from containing the virus as a goal to one of minimizing its spread.”

7) Is my city at risk of an outbreak?

Some of the best research on that question comes from Bogoch and his colleagues. They’ve done great studies in the past couple of weeks on the cities most vulnerable to novel coronavirus infections. What’s the big takeaway?

It’s really East Asia and Southeast Asia that are most at risk. The researchers — from the University of Oxford, University of Toronto, and London School of Medicine and Tropical Hygiene — used 2019 data from the International Air Transport Association to find all the cities in China that received at least 100,000 airline passengers from Wuhan during February through April.

They then modeled how the disease could spread from those cities if they experienced local outbreaks. Here are 15 of the top 50 destinations that might see outbreaks (also pay attention to the IDVI — the Infectious Disease Vulnerability Index — number. It’s a measure of a country’s ability to manage an infectious disease. Scores closer to zero mean they’re less prepared.)

Oxford Journal of Travel Medicine

“By no means would anybody be surprised if there are more cases exported to Europe and the US,” said Bogoch. “But the places that are going to have the greatest volume and number of infections exported would be to East Asian and Southeast Asian centers.”

8) When will this end?

There are a few ways this outbreak could end, as my colleague Brian Resnick explained. Perhaps public health measures — identifying cases fast, putting infected people in isolation — will stop the spread of this coronavirus. (That’s what stopped the spread of SARS in 2003.)

Because this is a zoonotic disease, which came from an animal, finding and eliminating that source would also help. Or maybe a vaccine or antiviral will be invented quickly to help curb a broader epidemic (but that’d likely take years).

Finally, there’s the possibility the virus will simply die out. “Disease outbreaks are a bit like fires,” Resnick wrote. “The virus is the flame. Susceptible people are the fuel. Eventually a fire burns itself out if it runs out of kindling. A virus outbreak will end when it stops finding susceptible people to infect.” There’s also the possibility the outbreak doesn’t end, as Nuzzo told Vox, and this simply becomes one of the diseases in circulation that commonly infects humans. How worrying that is again depends on how severe 2019nCoV turns out to be.

Coronavirus Live Updates: U.S. and Australia Tighten Controls as Toll Passes 250 [The New York Times, 31 Jan 2020]

RIGHT NOW

Qantas joined the list of airlines suspending flights to mainland China. U.S. and Australia bar foreigners who’ve recently been to China.

The United States and Australia are temporarily denying entry to noncitizens who have recently traveled to China, hoping to limit the spread of the new coronavirus to their countries.

The American restrictions, announced on Friday, exempt immediate family members of American citizens and permanent residents. Prime Minister Scott Morrison announced Australia’s temporary ban on Saturday, saying that “Australian citizens, Australian residents, dependents, legal guardians or spouses” would still be allowed into the country.

American officials also said that any United States citizen returning home who has been in the Hubei province of China within the past 14 days — believed to be the virus’s incubation period — will be quarantined for up to 14 days. Wuhan, the epicenter of the outbreak, is in Hubei.

Those who have been to other parts of China within the past 14 days will be subject to “proactive entry screening” and up to 14 days of monitoring and self-quarantine.

The United States will also funnel all flights from China to just a few airports, including Kennedy in New York, O’Hare in Chicago and San Francisco International Airport.

Dr. Anthony S. Fauci, the director of the National Institute of Allergy and Infectious Diseases, said the American actions were being taken because there were “a lot of unknowns” surrounding the virus and its transmission path.

“The number of cases have steeply inclined with every day,” Dr. Fauci said.

The announcement came as major air carriers suspended flights between the United States and mainland China. American Airlines, Delta Air Lines and United Airlines said direct air service would be halted for months, news that rattled the stock market and industries that depend on the flow of goods and people. Qantas followed suit on Saturday, announcing its own suspension of flights to China.

The United States on Friday also joined the World Health Organization in declaring the coronavirus, which has sickened nearly 12,000 people and has spread to the United States and 21 other countries, a public heath emergency.

More than 250 people have died, with nearly 12,000 infections confirmed.

Chinese officials on Saturday reported the highest death toll so far in a 24-hour period.

◆ The 46 new deaths in China raised the toll to 259.

◆ About 2,100 new cases were also recorded in the country in the past 24 hours, raising the worldwide total to nearly 12,000, according to Chinese and World Health Organization data.
The vast majority of the cases are inside China; about 100 cases have been confirmed in 21 other countries.

◆ All of China’s provinces and territories have now been touched by the outbreak.

◆ Countries and territories that have confirmed cases: Thailand, Japan, Hong Kong, Singapore, Taiwan, Australia, Malaysia, Macau, Russia, France, the United States, South Korea, Germany, the United Arab Emirates, Canada, Britain, Vietnam, Italy, India, the Philippines, Nepal, Cambodia, Sri Lanka and Finland.

◆ Cases recorded in Thailand, Taiwan, Germany, Vietnam, Japan, France and the United States involved patients who had not been to China.

◆ No deaths have been reported outside China.

A Chinese doctor who called the virus ‘controllable’ regrets his words.

A prominent respiratory expert who originally told Chinese state media that the coronavirus was under control and preventable has admitted that his choice of words was inappropriate.

Wang Guangfa, head of the department of pulmonary medicine at Peking University First Hospital in Beijing, compared himself and other medical professionals tackling the outbreak to soldiers walking onto a battlefield.

“All the bullets are flying,” said Dr. Wang, in an interview with Jiemian, a finance-focused news site founded by Shanghai United Media Group, which is controlled by the government of Shanghai.

In many ways the doctor, who has been widely criticized for his reassuring early statements, has come to symbolize how slowly China recognized the urgency of the outbreak. Dr. Wang himself contracted the coronavirus, apparently during a visit to Wuhan.

As the virus began to spread through Wuhan in early January, people who spoke out about it online were silenced by censors and, in some cases, held by the police, accused of spreading rumors. When journalists from Hong Kong visited a Wuhan hospital, police officers detained them for hours. (The Hong Kong news media were among the first to shed light on the fast-spreading virus.)

Wuhan Coronavirus
• Impact in the U.S.

Updated Jan. 31, 2020
o There have been seven confirmed cases in the U.S., but no deaths. Anxiety is intense on college campuses.
o The 195 Americans who were evacuated from Wuhan to California have been quarantined as one person tried to flee.
o If you live in California, here’s what this means for you.
o President Trump has temporarily suspended entry into the U.S. for any foreign nationals who have traveled to China.
o Delta, United and American Airlines are suspending service from the U.S. and China.

Dr. Wang initially said that the virus could not be spread by human-to-human contact. But 11 days later, he confirmed to state media that he had the virus, and that he may have contracted it during a trip to Wuhan with a group of experts.

In his interview with Jiemian, published on Friday, Dr. Wang said he had misdiagnosed himself as having the common flu, and that he had waited days before checking himself into a hospital.
He said he had since recovered and was discharged on Thursday.

Asked why he had originally called the coronavirus “preventable and controllable,” Dr. Wang blamed limited information at the time of his Wuhan visit. A clearer picture of the virus’s transmissibility would have required “epidemiological data, which is difficult to judge,” he said.

“These controversies may have been a kind of misunderstanding,” Dr. Wang said of the criticism he had received. He also defended his original phrasing, saying that many outbreaks of infectious diseases in history were ultimately controlled in the end.

His interview has been widely shared on Weibo, China’s Twitter-like social media platform.
Some of the most popular comments are from angry users.

“‘Could be prevented and controlled,’ Wang Guangfa,” said one user, who wrote under a pseudonym based on “Gorbachev” in Chinese characters. “Because of this line, the most critical half-month was squandered! And resulted in this.”

A view of the epicenter from a New York Times reporter.

Amy Qin, who covers China from Beijing, on Friday arrived in Wuhan, the city at the center of the coronavirus outbreak that has killed over 250 people so far. Follow Amy as she reports around Wuhan.

Amy arrived in a wary city that has been cut off from the rest of the world for more than a week.

Streets were mostly empty as people avoided contact with one another and stayed fearfully at home. Not everybody could bear to stay inside, however.

All around the city, authorities and businesses have worked to create an air of normalcy.

It’s clear, however, that the city has been strained to its limits by the epidemic.

Apple will close its China stores for a week.

Apple on Saturday said it would close its stores in mainland China, one of its biggest markets, until Feb. 9.

In a statement, the iPhone maker said it was closing stores, corporate offices and contact centers “out of an abundance of caution and based on the latest advice from leading health experts.” Its online store will remain open, it said.

The company operates 42 stores in mainland China, though its iPhones and other devices are widely available through other retailers.

Apple generates about one-sixth of its sales and one-quarter of its operating income in China.
While its results there fell last year, Tim Cook, Apple’s chief executive, told investors last week that the company’s new iPhone 11 was selling well in the country.

But he also cautioned that the coronavirus outbreak had kept the company from offering more specific guidance about its financial performance in the coming months.

Mr. Cook also said the company was looking for ways to minimize supply disruptions. Apple makes most of its iPhones and other gadgets in China, usually in factories owned by third-party contractors like Foxconn of Taiwan.

Apple is only one of a slew of global companies reconsidering their China operations as the outbreak has spread. A prolonged slowdown or closure in China could have a major impact on global economic growth.

China’s central bank, the People’s Bank of China, addressed such concerns on Saturday, pledging to make sure the country’s financial system had enough cash to deal with the economic blow. It also said it would lower lending rates for companies. Local regulators in
Guangdong Province, as well as in Beijing and the city of Chengdu, have also announced efforts to support companies.

Chinese truckers bring food to a locked-down city.

Early on Saturday, a group of truck drivers smoked cigarettes in the soft morning light as they waited to undertake a mission of national urgency: delivering fresh produce to the stricken city of Wuhan.

Broccoli, cauliflower, potatoes, chili peppers and more were due to head there by the truckload from Shouguang, an eastern city that is one of China’s biggest vegetable producers.

The coronavirus is testing one of the Chinese government’s proudest achievements: its ability to feed its 1.4 billion people.

As anxious shoppers around the country load up on provisions, many shops and supermarkets have been selling out of fresh food each morning, leaving slim pickings by midday. Towns and villages in many places have also closed off roads to passing traffic, which has caused some truck shipments to take longer than usual.

So far, there have been no signs of a major breakdown in China’s food supplies. The government has ordered vendors to keep prices stable and punished stores that have gouged consumers.

Shouguang is one of several places in China that have donated vegetables to Wuhan in recent days. The Wuhan government has tasked three retailers with selling the goods and delivering the proceeds to the city’s virus-fighting budget.

On Saturday, the 10 or so trucks in Shouguang that were Wuhan-bound had been festooned with red banners that read, “Pull together in times of trouble, go Wuhan!” and “The people are united, fight the epidemic together.”

The journey would take four days in total. After the trip, the truck drivers would be sequestered at home for two weeks, because of the possibility that they’d been exposed to the virus. That might mean thousands of dollars in forgone wages.

Still, several of them said they had leapt at the opportunity to take part.

“I knew about the dangers,” said Ma Chenglong, a 34-year-old driver. “But when the country is in trouble, we common people have a duty.”

California health officials cast a wary eye.

A third confirmed case of coronavirus in California was announced on Friday, raising questions about the state’s vulnerability in the outbreak on the same day the federal government imposed a 14-day quarantine for the 195 people who arrived on an evacuation flight from Wuhan, China.

The three confirmed cases were in Los Angeles, Orange and Santa Clara Counties. In all, seven cases had been reported in the United States as of Friday night.

In Los Angeles County, the infected person reported to the authorities that he was feeling unwell as he was traveling back to Wuhan, China, the center of the outbreak. The patients in Orange County and Santa Clara County had also traveled to Wuhan.

Sonia Angell, director of the California Department of Public Health, said in a recorded video message that the health risk to the general public in California was low. “But we still consider this a serious public health concern,” Dr. Angell said.

The United States government has imposed a federal quarantine on the 195 people who were evacuated on Wednesday from Wuhan, China, to a California military base, officials said on Friday.

The group will be held at March Air Reserve Base in Riverside, Calif., for 14 days, to ensure that they are not infected with the coronavirus.

Travel constraints could disrupt operations at the United Nations.

Around the world, the growing number of constraints on travelers from China because of the coronavirus outbreak has reverberated to the United Nations, a hub of international diplomacy with operations that involve travel in all 193 member states.

In an advisory issued Friday evening, the organization’s headquarters in New York told staff members and their families that “they may be subjected to travel restrictions and health screening measures implemented by local authorities for travelers entering or exiting the country.”

While United Nations diplomats and other personnel were not banned from traveling, the advisory warned that “it would be prudent to make contingency arrangements should the need arise.” A page on the United Nations website provided staff members with practical steps and advice.

Reporting was contributed by Alexandra Stevenson, Elaine Yu, Amy Qin, Raymond Zhong, Michael Corkery, Annie Karni, Russell Goldman, Thomas Fuller and Carlos Tejada. Wang Yiwei contributed research.