Health security analysis of covid 19

 

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.” Additional resources are now available on our website . January 24, 2020 - Afternoon Update EPI UPDATES Official updates from China’s National Health Commission are not expected until tomorrow morning. The Johns Hopkins University Center for Systems Science and Engineering is maintaining a dashboard to monitor the outbreak in near-real-time, and its latest estimate is 939 confirmed cases and 26 deaths (as of 3:28pm EST/UTC -5). This estimate is based on a compilation of data across a variety of official and unofficial sources . We will provide updated official figures in our next update. The US CDC confirmed the second travel-related case of 2019-nCoV in the US. The patient is a woman in Chicago who recently returned from Wuhan. The case investigation is underway, but preliminary findings indicate that she had limited contacts outside her home. There are multiple media reports that France has confirmed the country’s first 2 cases of 2019-nCoV, one in Bordeaux and one near Paris. We have not yet identified an official source, but the statement has been attributed to France’s Minister of Solidarity and Health, Dr. Agnès Buzyn. These 2 cases come on the heels of a report of a woman who managed to evade fever screening entering France and then posted about it on social media, prompting involvement by the Chinese embassy in France. WUHAN UPDATES The Hubei Provincial Health Commission announced that 40 military clinicians from the military hospital in Wuhan are being deployed to the Wuhan Pulmonary Hospital to support the civilian outbreak response. In addition to the existing travel and transportation restrictions, the Wuhan New Pneumonia Prevention and Control Command announced that the “river crossing tunnel” is closed as of midnight on January 24, and that fever screening would be implemented at bridge crossings and the “third ring road.” Additionally, normal operations for the city’s taxi service have been suspended , and 6,000 taxis have been allocated to provide limited but free transportation services, including food and medicine delivery, in the central area of the city. Several charity organizations , including the local Red Cross Society, are coordinating the collection and distribution of donations . LABORATORY TESTING BARRIERS The Beijing News is reporting that there are some delays and limitations for diagnostic testing for 2019-nCoV infection due to the availability of testing kits and requirements for their use. According to the article, a number of companies have developed nucleic acid testing kits for the virus, but some are not yet approved for use. ECONOMIC IMPLICATIONS The value of the Chinese yuan fell slightly against the dollar Friday, as the ongoing epidemic threatens consumer spending and travel ahead of the Lunar New Year. The relative value of the Chinese Yuan fell approximately 1% over the course of the week. SCIENTIFIC PUBLICATIONS Several studies were recently published in The Lancet . The first study , conducted by faculty at the University of Hong Kong and the University of Hong Kong-Shenzhen Hospital, describes the "epidemiological, clinical, laboratory, radiological, and microbiological findings of five patients in a family cluster who presented with unexplained pneumonia after returning to Shenzhen, Guangdong province, China, after a visit to Wuhan, and an additional family member who did not travel to Wuhan.” The article outlines exposure history and, crucially, identifies characteristics of the isolates that are consistent with human-to-human transmission of 2019-nCoV. The second article described the clinical features of the disease associated with 2019-nCoV. The study evaluated an early cohort of 41 confirmed cases admitted to Jin Yin-tan Hospital, including clinical charts and notes, laboratory test results, and chest x-rays for each patient. The patients had symptoms onset between December 1, 2019 and January 1, 2020. Among these patients, 66% had direct exposure to the Huanan seafood market, with similar rates of exposure between ICU and non-ICU patients. The most common symptoms were fever (98%), cough (76%), and “myalgia or fatigue” (44%). At the time of the study (January 22, 2020), 28 of the patients had been discharged, 7 remained in the hospital, and 6 had died (including 1 patient not admitted to the ICU). The requirement for discharge was an afebrile period of 10 days with associated improvements of chest x-rays and viral clearance from upper respiratory tract specimens. January 25, 2020 - Update EPI UPDATES China's National Health Commission reports 1,287 confirmed cases and 41 deaths as of 24 January. Beijing News (state media) is reporting 1,372 cases as of 25 January. There are also reports show that one of the newly reported deaths was a 62 year-old, physician who had been working in the response efforts for the ongoing outbreak. Details of the circumstances of his death are not immediately available. These numbers are a show a sharp increase from the latest WHO situation report published yesterday. The report had listed the risk of 2019-nCov as “very high” in China, “high” for neighboring areas, and “moderate” at the global level. Globally, at least 26 cases have been reported outside of China. On 24 January the WHO reported the first case of human to human transmission observed outside of China. WUHAN UPDATES Several reports indicate that Wuhan City expanding the number of treatment facilities dedicated to nCoV patients. China News reported that Wuhan has transitioned 14 general hospitals into hospitals to treat suspected and confirmed cases of nCoV. There are plans to expand this effort to include 24 hospitals with a goal for 10,000 beds for nCoV patients. This news comes amidst reports of continuous efforts to rapidly construct a facility with up to 1,000 beds for nCoV patients.  NPR reports that Wuhan hospitals are facing a growing demand on medical supplies and have made official requests for public donations to bolster their reserves. Some reports suggest that there may only be enough supplies to last 3-5 days. Several news outlets are reporting that Chinese State officials have expanded the group of military medical professionals to over 100. Eighty-five hotels throughout Wuhan city are voluntarily hosting front-line medical workers. BEIJING UPDATE Beijing News reported 10 new cases of nCoV within the capital city. These new cases brought the total number of confirmed nCoV patients in Beijing to 51 across several districts. Reports share that state officials plan to close all inter-provincial roads to Beijing tomorrow in hopes of mitigating additional spread to the cit y. CHINESE GOVERNMENT RESPONSE Chinese General Secretary Xi Jinping issued a statement citing “grave concerns” around the increased spread of nCoV throughout the country. Several of China’s largest cities, including Beijing and Shanghai, have enacted the highest level designation for a public health emergency. This designation allows the State Council to take over the public health and medical response, shifting responsibilities from local governments to a central government approach. This news follows movement restrictions in multiple cities, along with halting celebrations for the Lunar New Year and the extended closure of schools in some regions. Beginning January 27, additional restrictions will been placed on travel within the country and to all destinations overseas. Outside of mainland China, Hong Kong has announced the closure of schools. UNITED STATES RESPONSE Following confirmation of a second imported 2019-nCoV case in Chicago, the United States Department of State issued a level four travel advisory for Hubei province, China, recommending no travel to that part of the country. The remainder of China remains at a ‘Level 2’, suggesting increased caution. There are also reports that the United States is planning on sending a plane to Wuhan, China to remove over 200 US officials from the city .  SCIENTIFIC PUBLICATIONS AND REPORTS Yesterday afternoon, the New England Journal of Medicine released a new paper outlining a study that uses unbiased sequencing from early pneumonia patients in Wuhan City to identify nCoV as the causative pathogen of the ongoing outbreak.  The MRC Centre for Global Infectious Disease Analysis, a center within Imperial College London and a WHO Collaborating Centre, had published two reports estimating the potential case numbers of nCoV in Wuhan City. Today, the group released their third report estimating the transmissibility of the 2019-nCoV virus. The report concludes that there must be some level of self-sustaining human-to-human transmission, with an estimated reproduction number of 2.6 (range 1.5 - 3.5). The paper also includes a robust discussion of the implications of early modeling results on epidemic control.