Covid 19 china makes the virus expert said

 

EPI UPDATES : There are currently at least 549 cases and 17 deaths in China. A number of Asian countries are reporting imported cases, as is the United States. To date, bo secondary transmission has been found in cases detected outside China. A press conference with National Health Commission experts contained a number of new epidemiological insights. Direct quotes are included here for clarity. 1) When coronavirus is in SARS, the incubation period is up to 14 days. This time, according to the current patient statistics, it is estimated to be within 10 days. However, this new type of coronavirus infection has great differences among different people after infection. Some patients have a relatively long incubation period after infection, and they develop onset in two or three days. The longest is 10 days. We estimate the incubation period to be slightly longer and set it to 14 days. 2) The incubation period may now also be contagious, so this point needs to be taken very seriously, because now I also understand the situation of some patients, the patients themselves do not have fever, and those who have contacted him in the early stage have fever. People may also have infections and fevers later. Hong Kong announced their first two cases today. The first case is a 56M Hong Kong resident in good health, returned from Wuhan by say of Shenzhen in mid-January. His condition is stable. The second case is a 39M from wuhan with URI symptoms. He traveled from Wuhan by way of Shenzhebei. He is in stable condition. Macau announced their first confirmed case, a 52 year old woman. The case has a travel history to Wuhan, returned on 19 Jan. She is in stable condition. PHEIC RECOMMENDATION DELAYED: The WHO Emergency Committee met today to discuss whether to recommend a PHEIC declaration. WHO Director General Dr. Tedros announced that a decision had not been reached due to a lack of information on which to base their assessment. The EC will convene again tomorrow. They are requesting additional information from China in order to support their decsion-making process. WUHAN QUARANTINED: Chinese officials report : " From 10:00 on January 23, 2020, the city's urban bus, subway, ferry, and long-distance passenger transportation will be suspended; for no special reason, citizens should not leave Wuhan, and the airport and train station from the Han corridor will be temporarily closed.  Recovery time will be announced separately." I t was also announced that the responsibility for outbreak control in the most-affected region will be shifted to the Hubei Province level. Wuhan Municipal Health Commission will no longer be posting updates. CCDC WEEKLY PAPER ON nCOV : The report describes early features and findings of the outbreak. Briefly, four patients who worked at the Huanan Seafood Wholesale Market were admitted for pneumonia to the same hospital in Wuhan. The original case definition was: an illness of unknown etiology with 1) fever with or without a recorded temperature; 2) radiographic evidence of pneumonia; 3) low or normal leukocyte count or low lymphocyte count during the early stage of disease; and 4) no improvement or worsening symptoms after 3 to 5 days of antimicrobial treatment per standard clinical guidelines. “Most patients had severe and nonproductive cough following illness onset, some had dyspnea, and almost all had normal or decreased leukocyte counts and radiographic evidence of pneumonia.” The age range of patients is 26-89, median age is 57. No cases have been identified in contacts under follow-up. Sixteen healthcare workers have been infected. Two other clusters have also been identified. Among 198 confirmed patients, 22% report contact with the Huanan market, 32% report contact with symptomatic people, and 51% report no relevant history. NEW ECDC RISK ASSESSMENT : The European Centre for Disease Prevention and Control has published a new risk assessment . They find that: “the potential impact of 2019-nCoV outbreaks is high; further global spread is likely; there is currently a moderate likelihood of infection for EU/EEA travellers visiting Wuhan; there is a high likelihood of case importation into countries with the greatest volume of people travelling to and from Wuhan (i.e. countries in Asia); there is a moderate likelihood of detecting cases imported into EU/EEA countries; adherence to appropriate infection prevention and control practices, particularly in healthcare settings in EU/EEA countries with direct links to Wuhan, means that the likelihood of a case reported in the EU resulting in secondary cases within the EU/EEA is low.” This is divergent from the Jan 17 version which assessed the overall risk to be low. INTERNATIONAL SCREENING MEASURES Australia - Australia will begin screening passengers arriving from Wuhan, although authorities warned that an outbreak would be hard to prevent. UK - Passengers on the direct Heathrow - Wuhan (3x weekly) will be screened upon arrival. PHE has also increased its risk assessment from “very low” to “low”. US - CDC officials said Tuesday that screening for nCoV would be expanded to include Chicago and Atlanta.  FINANCIAL IMPACT OF EPIDEMICS Japan’s Nikkei 225 Index declined on yesterday’s coronavirus outbreak news, only to rebound in today’s trading. More broadly, markets have proved resilient during past infectious disease outbreaks. A 2006 study by Fidelity International concluded : “We cannot draw any fixed conclusions about the effects of pandemics upon stock-market performance. Equity markets react unpredictably to the unknown; nevertheless, such events should not be examined in isolation, but viewed in common with other prevailing market conditions. In investment terms, it is hard to mitigate the effects of events such as pandemics or war.” Daily updates on the emerging novel coronavirus from the Johns Hopkins Center for Health Security. EPI UPDATE S China’s National Health Commission is reporting a total of 830 confirmed cases across 29 provinces, including 177 severe cases and 25 deaths (24 in Hubei Province, where Wuhan is located, and 1 in Hebei Province). Another 1072 suspect cases have also been reported. 5 confirmed cases have been reported in Hong Kong (2), Macao (2), and Taiwan (1). Among the 53 cases reported in Guangdong Province , health officials identified 10 “cluster outbreaks,” all among families, which could provide additional insight into the degree to which the 2019-nCoV infection is transmissible among humans. The Thailand Ministry of Public Health reported Thailand’s 5th case, a 33-year-old woman traveling from China with her daughter (not known to be infected). The patient reportedly has mild symptoms and has been placed in isolation. The Korea Centers for Disease Control and Prevention (South Korea) confirmed its second case, a man who had been working in Wuhan. The Japan Ministry of Health, Labour, and Welfare confirmed the country’s second case as well, a man who arrived from Wuhan. In the United States, the Brazos County (Texas) Health Department announced that they are investigating a suspect case in an individual who recently traveled to Wuhan. Testing is in progress, and the individual has been isolated at home. WUHAN UPDATES China’s Ministry of Finance has allocated 1B yuan (approximately US$145M) to support response activities in Hubei Province. Numerous media reports (many based on an original report in the Changjiang Daily news) indicate that construction is underway for a new hospital in Wuhan that will have the capacity for 1,000 beds, with the intention of being operational by February 3. A similar effort was implemented during the 2003 SARS response to rapidly construct hospital facilities, including the 1,000-bed Xiaotangshan Medical Center, which was constructed in 7 days. The Wuhan Municipal Health Commission announced that the city has designated additional 2019-nCoV treatment hospitals in an attempt to manage the growing number of patients seeking care. ANTI-RETROVIRALS China’s National Health Commission reported that Dr. Wang Guangfa , Head of the Department of Pulmonary Medicine at Peking University First Hospital, was infected with 2019-nCoV. In an interview with the China News Agency , he reported being treated with the AIDS anti-retroviral drug lopinavirlitonavir. He is recovering from the disease, but it is unclear at this time to what extent, if any, the antiviral drug contributed to his treatment. R0 ESTIMATES Several preliminary modeling studies based on current incidence data and/or sequence data are estimating an R0 of 1.5-3 for the 2019-nCoV outbreak. This is comparable to SARS and pandemic influenza. The R0 is dependent on a myriad of factors, including the pathogen/disease itself and public health interventions and containment measures, and it will change over the course of the outbreak. CROWDSOURCED PATIENT DATA Three sources of patient-level data have been compiled using publicly available data by scientists not affiliated with the response. These efforts are based on a variety of publicly available information—including from official reports, news media, and social media—and they aim to provide a substitute for official “line list” data, which have not been published publicly. VIROLOGY DESCRIBED Scientists affiliated with the Chinese Academy of Sciences have posted a pre-print of genetic analysis of 11 samples of 2019-nCoV from some of the earliest identified patients in the ongoing outbreak. They found that (1) the virus in the same species as SARS-CoV, with 94.6% similarity in amino acid sequence and 80% similarity in nucleotide sequence across the genome; (2) the 2019-nCoV strain was less than 75% homologous to nearly all strains of SARS-CoV in the spike protein; and (3) a single isolate of a bat coronavirus shared 96.7% sequence homology with the 2019-nCoV strain, suggesting 2019-nCoV may have originated in bats and possibly shares a common ancestor with SARS-CoV. Findings also suggest that a PCR diagnostic test could differentiate 2019-nCoV from other coronaviruses. Serological testing of the patient samples showed strong IgG antibodies specific for 2019-nCoV in specimens collected 20 days after disease onset in 5 of 7 patients. HUBEI (WUHAN) UPDATES: In addition to Wuhan, travel has been shut down in nearby Ezhou  and Huanggang has been suspended. Western media reports that grocery stores and petrol stations are low on stock. School vacation has been extended. Hubei Province reports that there is a shortage of designated hospital beds (“There is indeed a long queue of fever clinics and tight beds.”) and that there have been additional healthcare worker infections. he Province has added an additional 3,000 beds from hospitals that were not previously designated. Contact tracing found fever symptoms in 35 people (2.5%) and 1 suspected case. The total quarantined population is now ~20 million Chinese citizens Nationally , all large Lunar New Year celebrations have been cancelled. DIAGNOSIS: Hubei Province reports that it can process 200 samples per day, and that results take two days. The Province is scaling up to a capacity of 2,000 samples per day.  Maca o announced a second case in a 66 year old male tourist from Wuhan. He was detected at an entrance screening.  Hong Kong officials announced they would turn two holiday camps, including a former military barracks, into quarantine zones for people who may have come into contact with carriers of the Wuhan virus. SUPERSPREADING DENIED: Chinese state media denies that a superspreading event has been identified. The original announcement was made in an official press conference. “Rumor? Super communicators have appeared: On January 22, Gao Fu [George Gao], an academician of the Chinese Academy of Sciences and director of the Chinese Center for Disease Control and Prevention, said at a press conference held by the State Council that there is no evidence that "super communicators" have appeared, but we will pay close attention. He further explained that MERS occurred in the Middle East and there has been no ‘super communicator. In Korea, "super communicator" has appeared [when a MERS case was imported].” FATALITY  DETAILS PUBLISHED: The Chinese National Health Commission published clinical details of 17 fatal cases. 15 were over the age of 60, and most had underlying chronic conditions. Although a detailed analysis is not yet available, preliminary time from hospitalization to death is approximately one week on average. DOMESTIC SCREENING: Nine passengers on a flight from China to Boston were medically evaluated at Logan International Airport after it was determined they came from Wuhan, … according to officials. ADDITIONAL PHYLOGENY: This phylogeny shows evolutionary relationships of viruses from the novel coronavirus (nCoV) outbreak. All samples are highly related with at most three mutations relative to a common ancestor. This suggests these samples share a highly recent common ancestor. We now observe clustering of related infections. These are a cluster of two infections in Zhuhai (Guangdong/20SF028/2020 and Guangdong/20SF040/2020) and a cluster of three infections in Shenzhen (Guangdong/20SF013/2020, Guangdong/20SF025/2020, Guangdong/20SF012/2020). These are noted in GISAID as "family cluster infection". This almost certainly represents human-to-human transmission.  Via https://nextstrain.org/ncov   Comment from Michael: The phylogenetic clustering is based upon very few informative positions, but that's unavoidable and given the very short real time between samples, not an issue with the results.  That said, it's interesting that there are two Guangdong clusters.  It is probably too early to attribute the mutations behind those clusters to adaptation.  Rather, they are likely drift and local fixation through founder-effect. The Center for Health Security will be analyzing and providing updates on the emerging novel coronavirus. If you would like to receive these daily updates, please sign up here and select “2019-nCoV.” You are receiving this email announcement because you’ve subscribed to one of our other newsletters. Additional resources are now available on our website .  EPI UPDATES There are currently at least 644 cases and 18 deaths reported. One case has been confirmed by Singapore's Ministry of Health. Two cases have been confirmed by Vietnam’s Health Ministry.  The CDC recommended that “travelers avoid all nonessential travel to Wuhan, China.” RISK TO VULNERABLE POPULATIONS   “ ...it’s not the residents of Washington state or Bangkok who are most at risk from the coronavirus. It’s China’s poor—as in many countries, a critically underserved population when it comes to health care. It’s the poor who were most likely to be in contact with the virus, it’s the poor among whom it will spread fastest, and it’s the poor who will likely be the main victims of over-repressive measures as the government, after weeks of what looked like a cover-up, snaps to action.” via Foreign Policy PHEIC NOT DECLARED On 22 January, the members of the Emergency Committee expressed divergent views on whether this event constitutes a PHEIC or not. At that time, the advice was that the event did not constitute a PHEIC, but the Committee members agreed on the urgency of the situation and suggested that the Committee should be reconvened in a matter of days to examine the situation further. The EC statement notes: Human-to-human transmission is occurring and a preliminary R0 estimate of 1.4-2.5 was presented.  Amplification has occurred in one health care facility.  Of confirmed cases, 25% are reported to be severe.  The source is still unknown (most likely an animal reservoir) and  the extent of human-to-human transmission is still not clear.  BIOSAFETY LEVEL DETERMINATION China has issued revised biosafety guidelines for handling nCoV-2019. These guidelines require all viral culture experiments to be conducted in a BSL3 following explicit approval from the National Health and Health Commission. All animal experiments using nCoV-2019 must also be performed at BSL3. Uncultured viruses, such as patient samples being tested for the virus, can be worked with at BSL2 if personnel are wearing PPE commiserate with BSL3 guidelines.  A BSL2 is allowed for inactivated virus and BSL1 is allowed for cloning activities that do not produce an infectious particle. The appropriate disinfectant should have a 0.55% chlorine content.