The deadly MERS virus is spreading at a terrifying rate

On Thursday, the Saudi Arabian health ministry confirmed 13 more cases of patients contracting MERS-CoV, the acronym for Middle East Respiratory Syndrome Coronavirus, as well as two more deaths. MERS-CoV is an infectious disease with no known cure and is considered more deadly than SARS--which killed some 800 people during a 2002-2003 outbreak that first started in China. Since 2012, 83 people have died and 285 people have contracted the virus in the Kingdom alone. It has spread to the neighboring United Arab Emirates. Reports also suggest pilgrims from as far afield as Malaysia and the Philippines contracted the virus while on hajj in Mecca. What's been truly alarming has been the recent surge in numbers of those infected, with more confirmed reports so far this year than in all of 2013. Ian Mackay, an epidemiologist at the Australian Infectious Diseases Research Centre at the University of Queensland, has been monitoring the spread of the disease. In the chart he tweeted below, note the dramatic spike in cases in the past month (KSA is the acronym for the Kingdom). How does the view look from up there #MERS? More at VDU blog... http://t.co/d041Bqykk6 http://t.co/3AKpWY7eHQ The Saudi health ministry has been criticized for inadequately dealing with the situation. A lack of data shared by the Saudis has made it difficult for experts like Mackay as well as monitors at the WHO to study whether the virus has mutated and become more easily transmissible between humans--a development that could pave the way for a pandemic. Public health experts and epidemiologists are still struggling to understand where the virus originated and how it spreads--with most suggesting it emerged through contact with camels, and others pointing to bats as prime carriers of the virus. On Monday, the Saudi government removed health minister Abdullah al-Rabiah from his post, without offering an official explanation. His replacement, Adel Fakieh, promised "transparency and to promptly provide the media and society with the information needed." But that may not soothe local fears. In Jeddah, where the majority of cases have been reported, four doctors resigned earlier this month after refusing to treat MERS-CoV patients. That's hardly a vote of confidence as international health officials and Saudi Arabia's panicked neighbors look to the Kingdom to stave off a potential global outbreak.


What is the Middle East Respiratory Syndrome (MERS)?

China recently discovered a new coronavirus strain that is similar to MERS.  Tell me about the symptoms of MERS, the incubation period for infection, and the lethality rate.  Information on vaccines and treatments is relevant.  Official sources of information on MERS also is relevant.  Information on the origins of MERS is not relevant nor are the specific locations of previous outbreaks.  Editorials are not relevant. If the document discusses a potential animal origin, please ignore the document.

Find authoritative sources to answer this health-related question.

First MERS victim has fully recovered

As we wait for details on the second case of Middle East Respiratory Syndrome in the United States, here's some good news about the first one: The patient was released from a hospital Friday and is considered fully recovered, according to the Indiana Department of Health. The Centers for Disease Control and Prevention has scheduled a 2 p.m. news conference on the new case, a patient in Florida. But health officials reported Saturday that the first case, an unnamed U.S. health-care worker who had been living and working in Saudi Arabia, is fine. “The patient has tested negative for MERS, is no longer symptomatic and poses no threat to the community,” said Alan Kumar, chief medical information officer at the Community Hospital in Munster, Ind. The hospital talked to the CDC before releasing the patient, the hospital said. MERS comes from the same family, coronavirus, The virus's incubation period — the time between exposure and development of symptoms — is about five days, similar to SARS. While experts do not know how the MERS virus is spread, the CDC advises Americans to protect themselves by washing their hands often, avoiding close contact with people who are sick, avoiding touches to their eyes, nose and/or mouth with unwashed hands, and disinfecting frequently touched surfaces. People who develop fever and cough or shortness of breath within 14 days after traveling from countries in or near the Arabian Peninsula should see a doctor. The Indiana patient traveled from Riyadh, Saudi Arabia, to London on April 24, and then to Chicago by air. He took a bus to the Highland, Ind. area and went to Community Hospital in Munster, Ind. after falling ill. He was kept in isolation until he recovered. Authorities contacted most of the passengers on the flights and the bus, and none are symptomatic, according to the Indiana health department. So far there has been no clear evidence that the virus can be transmitted by casual contact. Hospital staff who had direct contact with the patient are still off duty and remain in temporary isolation in their homes until lab results confirm they are not infected. Related: CDC confirms first case of deadly MERS virus in Indiana

First MERS victim has fully recovered


How is the coronavirus outbreak going to end? Here’s how similar epidemics played out.

As stock markets plunge, travel is disrupted and new coronavirus infections are diagnosed across the United States, one question on everyone’s mind is how the outbreak is going to end.
No one knows for sure, but virologists say there are clues from similar outbreaks. Here are three scenarios:
When severe acute respiratory syndrome (SARS) hit Asia in 2002, it was pretty scary — with a fatality rate of about 10 percent and no drugs shown to be effective against it. (The current coronavirus by comparison has a fatality rate that has been estimated ranging from less than 1 to 3.4 percent.) But within months, SARS was brought under control, and for the most part stamped out, by international cooperation and strict, old-school public health measures such as isolation, quarantine and contact tracing.
This would be an ideal outcome. But the difference is that SARS had more severe symptoms than the current coronavirus, so people went to the hospital shortly after being infected.
Cases of coronavirus will be harder to catch and isolate, said Stuart Weston, a postdoctoral virologist at University of Maryland. Weston is one of a small group of researchers who have received samples of the coronavirus and are studying it. Weston and other experts warn the outbreak in the United States and other countries is more widespread than tracked because many people with mild symptoms don’t know they have been infected.
One of the grim lessons from the 2014-2016 Ebola outbreak in West Africa is how an epidemic can grow when it hits countries with weak health infrastructures. This is why the World Health Organization and others have been preparing countries in sub-Saharan Africa for the coronavirus, even though few cases so far have been reported there.
Compared to the coronavirus, Ebola was less contagious and transmitted mainly by bodily fluids. The coronavirus can be transmitted in coughed and sneezed respiratory droplets that linger on surfaces. And yet Ebola infected more than 28,000 people and caused more than 11,000 deaths. Ebola is more lethal, and shortages of staff and supplies, poverty, delays by leaders and distrust of government exacerbated the outbreak.
WHO leaders have been urging countries to prepare. On Friday, the organization raised its assessment of coronavirus to the highest level. “This is a reality check for every government on the planet: Wake up. Get ready. This virus may be on its way, and you need to be ready,” said Michael Ryan, WHO’s director of health emergencies. “To wait, to be complacent, to be caught unawares at this point, it’s really not much of an excuse.”
This is in essence what happened with the 2009 H1N1 outbreak, also called swine flu. It spread quickly, eventually to an estimated 11 to 21 percent of the global population. The WHO declared it a pandemic, and there was widespread fear.
H1N1 turned out to be milder than initially feared, causing little more than runny noses and coughs in most people. And H1N1 is now so commonplace, it’s simply seen as a part of the seasonal flus that come and go every year around the globe.
Early estimates on the fatality rate for H1N1 were much higher than the roughly 0.01 to 0.03 percent it turned out to be. Still, the Centers for Disease Control and Prevention estimates that H1N1 killed 12,469 people in the United States during that first-year period from 2009 to 2010, infected 60.8 million cases and caused 274,304 hospitalizations. The true number is hard to ascertain because many who die of flu-related causes aren’t tested to see whether it was H1N1 or another flu strain. As context, the seasonal flu has killed at least 18,000 people in the United States so far this season, according to the CDC.
H1N1 is a particularly good parallel, epidemiologists say, because while it had a lower fatality rate than SARS or MERS, it was deadlier because of how infectious and widespread it became.
Not to be alarmist, but another possible parallel might be the 1918 Spanish flu, which had a 2.5 percent fatality rate, eerily close to what’s estimated for the coronavirus.
CDC calls Spanish flu “the deadliest pandemic flu virus in human history,” because it infected roughly one third of the world’s population and killed an estimated 50 million people worldwide. Spanish flu was deadly to young and old, while coronavirus has proven to be most lethal to the elderly and left young people relatively unscathed.
Florian Krammer, a virologist specializing in influenzas, noted that the world was vastly different in 1918.
“We didn’t have the tools to diagnose diseases or antibiotics to fight secondary infections. Hospitals back then were places where you went to die, not to get treatment. And in 1918, the world was at war. And a lot of the people infected were soldiers stuck in trenches,” said Krammer, of the Icahn School of Medicine at Mount Sinai. “That’s hopefully not how this is going to play out.”
Ultimately, how many people die of coronavirus depends on how widely it spreads, how prepared we are and what the virus’s true fatality rate turns out to be.
If the coronavirus does indeed become ubiquitous like H1N1, it will be crucial to develop a vaccine. After the 2009 outbreak, experts developed an H1N1 vaccine that was included in flu shots people received in subsequent years. This helped protect especially vulnerable populations during following waves of infection.
In the immediate future, anti-viral drugs may help, and labs around the world are testing their effectiveness against the coronavirus.
No one knows if the coronavirus will be affected by seasons like the flu, despite President Trump’s claims that it could “go away” in April with warmer temperatures.
“We’re still learning a lot about the virus,” said WHO epidemiologist Maria Van Kerkhove. “Right now there’s no reason to think this virus would act differently in different climate settings. We’ll have to see what happens as this progresses.”
Coronaviruses are zoonotic, meaning they spread from animals to humans. Experts believe SARS spread from bats to civet cats to humans. The deadly Middle East respiratory syndrome (MERS) in 2012 was probably transmitted from bats to camels to humans. With the coronavirus, no one knows what animals caused the current outbreak. And it’s a mystery scientists will need to solve to prevent it from repeating in the future.
One prime suspect is an endangered creature called the pangolin that looks like a cross between an anteater and an armadillo and whose scales are trafficked illegally.
“With SARS, once they figured out the animals responsible in China, they were able to start culling them from the live markets,” said Vineet Menachery, a virologist at University of Texas Medical Branch. “It’s like a burst water pipe. You have to find the source in order to shut it off.”


South Korea shuts down primary schools as spread of MERS alarms public

The Middle East respiratory syndrome (MERS) coronavirus is seen in an undated transmission electron micrograph from the National Institute for Allergy and Infectious Diseases (NIAID). (Reuters) South Korea shut down 200 primary schools, canceled some public events and put more than 1,300 people in various levels of quarantine, acknowledging on Wednesday that the continuing spread of Middle East Respiratory Syndrome within its borders had become a crisis. Health officials announced Wednesday that five more people had been diagnosed, bringing the total infected with the virus to 30. Two patients have died. That makes the outbreak the largest outside the Arabian Peninsula, where the disease emerged in 2012. The virus, which primarily causes flu-like symptoms such as fever and cough, kills an estimated three to four out of every 10 patients infected. The situation in South Korea has alarmed the global health community because the virus has spread so fast and wide from a single individual. Other countries have imported cases in the same manner but the virus infected only a few others. How did MERS get to South Korea and why is it spreading so fast? The first known case, called an “index” case, was reported on May 20. It involved a 68-year-old man who was returning from a 16-day business trip to four Middle Eastern countries. The man was asymptomatic during his return flight but was subsequently treated at two different out-patient clinics and two hospitals which created a lot of opportunities for the virus to spread. Health care workers did not suspect the man of having MERS so he was not put in isolation. Seoul’s mayor says the 35th identified case of MERS in the country is a doctor who had contact with another MERS patient. The country has at least 41 infections, the highest of anywhere outside the Middle East. Most of the primary schools that were shut down are in Gyeonggi province which surrounds the capital of Seoul and where many of the cases have been. The South Korean government has come under criticism for their handling of the situation, including its refusal to disclose the names of the health care facilities where the first patient was treated.

The Middle East respiratory syndrome (MERS) coronavirus is seen in an undated transmission electron micrograph from the National Institute for Allergy and Infectious Diseases (NIAID). (Reuters)
South Korea shut down 200 primary schools, canceled some public events and put more than 1,300 people in various levels of quarantine, acknowledging on Wednesday that the continuing spread of Middle East Respiratory Syndrome within its borders had become a crisis.
Health officials announced Wednesday that five more people had been diagnosed, bringing the total infected with the virus to 30. Two patients have died. That makes the outbreak the largest outside the Arabian Peninsula, where the disease emerged in 2012. The virus, which primarily causes flu-like symptoms such as fever and cough, kills an estimated three to four out of every 10 patients infected.
The situation in South Korea has alarmed the global health community because the virus has spread so fast and wide from a single individual. Other countries have imported cases in the same manner but the virus infected only a few others.
How did MERS get to South Korea and why is it spreading so fast?
The first known case, called an “index” case, was reported on May 20. It involved a 68-year-old man who was returning from a 16-day business trip to four Middle Eastern countries. The man was asymptomatic during his return flight but was subsequently treated at two different out-patient clinics and two hospitals which created a lot of opportunities for the virus to spread. Health care workers did not suspect the man of having MERS so he was not put in isolation.
Others who have been infected include health care workers, other patients, family members and visitors. The World Health Organization reported that some of the cases were patients in the same room or ward as the man, and that their exposure may have been from 5 minutes to a few hours.
Seoul’s mayor says the 35th identified case of MERS in the country is a doctor who had contact with another MERS patient. The country has at least 41 infections, the highest of anywhere outside the Middle East.
Two recent cases represent an alarming development —a third generation of transmission. That is, a patient who did not have contact with the index patient but came into contact with an intermediary who had been exposed to the virus. "That raised fears that infections could now spread exponentially from all people who test positive," Korea's JoongAng Daily reported.
Most of the primary schools that were shut down are in Gyeonggi province which surrounds the capital of Seoul and where many of the cases have been.
Peter Ben Embarek, a World Health Organization working on MERS, told Science magazine that the simplest explanation for the "superspreading" event of the virus in South Korea may be a lapse in infection control measures at the hospital. It's also possible the strain that was imported may be different from others or that Koreans are more susceptible to the disease.
The South Korean government has come under criticism for their handling of the situation, including its refusal to disclose the names of the health care facilities where the first patient was treated.


South Korea’s Park is criticized for postponing U.S. visit

South Korea announced two more deaths from Middle East Respiratory Syndrome, bringing the total to nine.
TOKYO —
But Park decided she had to stay home as new cases of the disease, Middle East respiratory syndrome, continue to emerge despite government predictions that the worst is over.
The move is “designed to take care of public safety, including putting a quick end to MERS,” Kim Sung-woo, Park’s spokesman, told reporters, according to the Yonhap News Agency. Park has delayed the trip as “the people’s safety is the top priority,” and she will try to ease public concern at home, Kim said.
Park was due to leave Sunday for the United States, where she was to hold meetings with President Obama on Tuesday and visit Houston.
In Washington, State Department spokesman Jeff Rathke said that “President Obama looks forward to welcoming President Park to the White House at a mutually convenient time.”
The country has taken emergency measures to stop the spread of Middle East Respiratory Syndrome.
Two more people have died from the virus in South Korea, making a total of nine dead, health officials reported. They said 14 more cases were confirmed Thursday, pushing the number of infections to 122. Medical experts are cautioning that this outbreak is far from a pandemic, but South Koreans are alarmed.
Park’s decision comes amid vociferous criticism of her government’s handling of the outbreak. The government also faced fire for its response to the Sewol ferry disaster. Park was further chastised for embarking on a trip to South America on the first anniversary of the disaster.
But some critics questioned the message she was sending by staying home. She had previously told people not to “overreact” and said that everyone should “cooperate to ensure that economic activities will not be weakened.”
A Realmeter poll published shortly before the announcement found that 53 percent thought Park should delay the trip, while 39 percent said she should continue with it.
Fearful of contagion, South Koreans have been avoiding enclosed public places such as subway cars, shopping centers and movie theaters in droves, sparking concerns about the impact on the country's economy, which is already struggling.
“If this atmosphere continues for more than a month, the domestic economy is expected to enter a slump as it did after the ferry disaster last year,” the Chosun Ilbo, South Korea’s largest newspaper, said in an editorial.
Almost 2,500 schools have closed to try to minimize chances of infection.
A World Health Organization team that arrived in Seoul on Monday released its first recommendations, together with South Korea’s Health Ministry, on Wednesday,  proposing that schools be reopened because they have not been linked to transmission of MERS in South Korea or in the Middle Eastern countries where it originated.
All of the transmissions have happened at hospitals, leading Choi Kyung-hwan, acting prime minister, to ask people not to visit family or friends in hospitals.
But he also warned people against unnecessary panic. “The government asks that people do not hold exaggerated fears or concerns over MERS, and that they do not act based on such groundless fears, such as reducing their spending or avoiding visits to areas that have reported confirmed cases of MERS,” he said.
Read more:
South Korean President Park Geun-hye answers questions
South Korea, at behest of conservative Christians, bans LGBT march
In South Korea, journalists fear a government clampdown on the press


South Korean begins experimental MERS plasma trial, considers economic stimulus

South Korean elementary school students wear masks as a precaution against the Middle East Respiratory Syndrome (MERS) virus. (Ahn Young-joon/Associated Press) Weeks into a crisis that has killed 16 people, infected more than 150 and left thousands more under strict quarantine, South Korean officials have begun testing an experimental plasma treatment on two patients who have the Middle East Respiratory Syndrome (MERS) virus. The Korea Times reported that a 35-year-old police officer and a 38-year-old worker at the Samsung Medical Center in southern Seoul received blood plasma from a man who had fully recovered from the virus. Both men are in critical condition. The treatment is similar to one that has been used, successfully in some cases, on a limited number of those infected by the Ebola virus. "Blood plasma injection is not a medically proven treatment, but is often carried out in the absence of other treatments available," an official at Hallym University Medical Center told the news organization. "The treatment was carried out in an attempt to improve the dire condition the two are in. Implementing the treatment is an option so long as it is done with the consent of the donor and the receiver." Plasma therapy was used more widely 50 years ago, but it lost popularity because of modern developments in vaccines and more effective treatments. Its advantage is that it's fast and inexpensive, and doesn't require the years and millions of dollars it usually takes to find other ways to fight contagious diseases. The South Korean government went on the offensive on the economic front this week as stocks closed close to an 11-week low on Tuesday. Officials pledged 400 billion won ($360 million) to help businesses and hospitals and an additional 50.5 billion ($45 million) to fund health measures. Korean Finance Minister Choi Kyung-hwan said a supplementary budget is being considered to mitigate downside risks to the economy as a whole. "The government is doing all it can to quickly contain the outbreak," he told lawmakers, according to the Yonhap news agency. "There is a need to guard against excessive anxiety and to limit the economic fallout."

South Korean elementary school students wear masks as a precaution against the Middle East Respiratory Syndrome (MERS) virus. (Ahn Young-joon/Associated Press) Weeks into a crisis that has killed 16 people, infected more than 150 and left thousands more under strict quarantine, South Korean officials have begun testing an experimental plasma treatment on two patients who have the Middle East Respiratory Syndrome (MERS) virus. The Korea Times reported that a 35-year-old police officer and a 38-year-old worker at the Samsung Medical Center in southern Seoul received blood plasma from a man who had fully recovered from the virus. Both men are in critical condition. The treatment is similar to one that has been used, successfully in some cases, on a limited number of those infected by the Ebola virus. Plasma therapy was used more widely 50 years ago, but it lost popularity because of modern developments in vaccines and more effective treatments. Its advantage is that it's fast and inexpensive, and doesn't require the years and millions of dollars it usually takes to find other ways to fight contagious diseases. The South Korean government went on the offensive on the economic front this week as stocks closed close to an 11-week low on Tuesday. Officials pledged 400 billion won ($360 million) to help businesses and hospitals and an additional 50.5 billion ($45 million) to fund health measures. Korean Finance Minister Choi Kyung-hwan said a supplementary budget is being considered to mitigate downside risks to the economy as a whole. "The government is doing all it can to quickly contain the outbreak," he told lawmakers, according to the Yonhap news agency. "There is a need to guard against excessive anxiety and to limit the economic fallout."


SARS-like virus has high mortality rate in Saudi Arabia, specialists say

Of 23 confirmed cases in April, 15 people died — an “extremely high” fatality rate of 65 percent, according to Johns Hopkins senior epidemiologist Trish Perl, a member of the team that analyzed the spread of the virus through four Saudi hospitals. Saudi officials said that as of Wednesday, 49 people have contracted the disease and 32 have died. The infectious disease experts, who published their findings online Wednesday in the New England Journal of Medicine, reported that infection occurred by way of person-to-person contact and poses an especially serious risk because it is easily transmitted in hospital settings. Worldwide, the overall death rate from the Middle East Respiratory Syndrome Coronavirus — or MERS-CoV — is at 59 percent, according to the Centers for Disease Control and Prevention. That rate is expected to bounce around as new clusters of infection develop. The vast majority of MERS-CoV infections have been in Saudi Arabia. No cases have been reported in the United States, but small clusters of infections have appeared in Britain, France, Italy and Tunisia. Since the virus first emerged in April 2012 with two fatal cases in Jordan, 64 people have been infected and 38 have died around the world. The virus comes from the same family as the severe acute respiratory syndrome (SARS) coronavirus, which killed nearly 800 people worldwide in 2003. At first, MERS does not look out of the ordinary compared with other, less serious types of respiratory infection. But Perl said doctors should start taking careful note of a patient’s travel history, since all reported cases have been linked to Saudi Arabia, Qatar, Jordan and the United Arab Emirates. The team of specialists mapped the likely trail of infection that spanned four Saudi hospitals in just over a month. Patients stationed in the same hospital room or ward as an infected person, or even taken care of by the same nurse, were likely to be exposed to the virus. Out of the 23 infected, hospital patients made up the majority of cases, but the virus also spread to visiting family members and hospital staff. The incubation period of the virus — the time between exposure and development of symptoms — was similar to SARS, about five days. During this period, the researchers warned, infection may be possible. While the high mortality rate is alarming, Perl said that outbreaks tend to have death rates that are high

A new virus responsible for an outbreak of respiratory illness in the Middle East may be more deadly than SARS, according to a team of infectious disease specialists who recently investigated a set of cases in Saudi Arabia.
Of 23 confirmed cases in April, 15 people died — an “extremely high” fatality rate of 65 percent, according to Johns Hopkins senior epidemiologist Trish Perl, a member of the team that analyzed the spread of the virus through four Saudi hospitals.
Saudi officials said that as of Wednesday, 49 people have contracted the disease and 32 have died.
The infectious disease experts, who published their findings online Wednesday in the New England Journal of Medicine, reported that infection occurred by way of person-to-person contact and poses an especially serious risk because it is easily transmitted in hospital settings.
Worldwide, the overall death rate from the Middle East Respiratory Syndrome Coronavirus — or MERS-CoV — is at 59 percent, according to the Centers for Disease Control and Prevention. That rate is expected to bounce around as new clusters of infection develop.

The vast majority of MERS-CoV infections have been in Saudi Arabia. No cases have been reported in the United States, but small clusters of infections have appeared in Britain, France, Italy and Tunisia.
Since the virus first emerged in April 2012 with two fatal cases in Jordan, 64 people have been infected and 38 have died around the world. The virus comes from the same family as the severe acute respiratory syndrome (SARS) coronavirus, which killed nearly 800 people worldwide in 2003.
Both viruses have a distincthaloed appearance when viewed under a microscope, and they typically target the respiratory tract. Like SARS, MERS starts with a fever and mild cough that eventually progress to pneumonia.
At first, MERS does not look out of the ordinary compared with other, less serious types of respiratory infection. But Perl said doctors should start taking careful note of a patient’s travel history, since all reported cases have been linked to Saudi Arabia, Qatar, Jordan and the United Arab Emirates.
The team of specialists mapped the likely trail of infection that spanned four Saudi hospitals in just over a month. Patients stationed in the same hospital room or ward as an infected person, or even taken care of by the same nurse, were likely to be exposed to the virus. Out of the 23 infected, hospital patients made up the majority of cases, but the virus also spread to visiting family members and hospital staff.
The incubation period of the virus — the time between exposure and development of symptoms — was similar to SARS, about five days. During this period, the researchers warned, infection may be possible.
While the high mortality rate is alarming, Perl said that outbreaks tend to have death rates that are high at the beginning but then decline over time as doctors identify patients with milder versions of the illness. She cited the H1N1 and SARS outbreaks as examples.
This particular outbreak was largely contained by early detection and isolation of those infected, and through tighter hospital infection-control procedures — steps such as assigning a specific nurse to watch for patients with symptoms, requiring health-care workers to put on face masks and gloves, and fitting masks on patients.


Most coronavirus cases are mild, complicating the response

The coronavirus has killed more than 1,300 people, brought a huge swath of central China to a standstill and rattled millions around the globe with hints of a pandemic seen in Hollywood fantasies.
But the virus’s destructive potential has overshadowed one encouraging aspect of this outbreak: So far, about 82 percent of the cases — including all 14 in the United States — have been mild, with symptoms that require little or no medical intervention. And that proportion may be an undercount.
Health authorities managing the outbreak are trying to understand what that critical fact portends. Are the 60,000 sick people tallied so far just a portion of a vast reservoir of uncounted victims, some of whom may be spreading the disease? And do the mild illnesses reveal characteristics of the virus itself — something that could be useful in crafting a more effective response?
“The fact that there are so many mild cases is a real hallmark of this disease and makes it so different from SARS,” said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health’s Center for Health Security. “It’s also really challenging. Most of our surveillance is oriented around finding people who require medical intervention.”
In China’s Hubei province, the epicenter of the coronavirus outbreak, the number of new infections rose by 14,840 in a count released Thursday, with 242 new deaths, as health officials there broadened the criteria they are using to confirm cases.
World Health Organization expert Michael Ryan said in a news briefing this week that, outside of Hubei province, the virus’s behavior did not seem to be as aggressive or accelerated.
For those who study viruses, the large number of mild cases is reason for optimism. “This looks to be a bad, heightened cold — I think that’s a rational way of thinking about it,” said Matthew Frieman, a virologist at the University of Maryland School of Medicine. “Not to diminish its importance — it’s in the middle between SARS and the common cold.”
Though the virus was identified just six weeks ago, some of its characteristics are becoming clear. For the elderly and those with underlying heart disease, diabetes or other conditions, the disease can be quite severe. They are the ones dominating the ranks of the dead, often after pneumonia or other respiratory problems that lead to organ failure.
Others are not suffering nearly as much. Healthy, younger adults seem to do better, and there have been few fatalities among children, for reasons that have caused much speculation among experts.
“It could be that some people have an immune response that results in severe illness and some people don’t,” Nuzzo said. “It is common . . . in coronaviruses that there is a spectrum of illness.”
At a presentation on the disease hosted Tuesday by the Aspen Institute in Washington, Nancy Messonnier, an official with the Centers for Disease Control and Prevention, noted that only a few of the 14 U.S. patients required oxygen during convalescence.
“All the patients in the U.S. haven’t required tons of excessive care and actually, right now, they’re actually all improving,” said Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases. “Based on the U.S. experience, and based on the experience of other countries outside China, a lot of these patients seem to be doing okay.”
But Messonnier and others are less confident about what that might signify. She noted that U.S. officials set a very low threshold for illness as they began their  search for people with the disease among returnees from central China.
“If we hadn’t been looking so hard,” she suggested, “we might not have found them.”
Another possibility, said William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center, is that the U.S. patients were a self-selected sample of fairly healthy people — hardy enough, at least, to travel to Wuhan and back. Twelve of the U.S. patients were such travelers, while two others were spouses who came in contact with them after they returned.
Schaffner also noted that in China, where the vast majority of deaths and illnesses from the “covid-19” disease have occurred, air pollution and a higher smoking prevalence may contribute to the severity of the disease.
Many experts have said early phases of outbreaks like this one tend to have a large number of severe cases, as the sickest people flock to hospitals and come to doctors’ attention. And in Wuhan, where the health-care system is overwhelmed, people have complained they cannot find a hospital to test them for the virus, let alone to treat their symptoms. So patients with milder versions may be at home, uncounted, waiting out the epidemic.
In its latest “situation report,” released Wednesday, the World Health Organization listed 45,171 confirmed cases in 25 countries including China, with just 441 of the cases outside China. The WHO classified 8,204 of the Chinese cases as severe, meaning virtually all the rest are mild.
The WHO does not break down the cases outside China, but some countries do. Singapore, for example, has reported that 15 of its 50 patients have fully recovered and been discharged. Most of the others still hospitalized are “stable or improving,” while eight are in critical condition in intensive care.
Currently, the death rate of the disease is hovering around 2.5 percent, a remarkably high level, about the rate of the 1918 flu pandemic that killed roughly 50 million people around the world. Normal seasonal flu kills less than one-tenth of one percent of people who contract the virus.
But experts have said the coronavirus fatality rate is likely to decline substantially as they compile a more accurate count of the people who contract the virus and survive. At the Aspen Institute presentation, Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, said he hoped the rate could decline toward 1 percent.
Either figure makes the virus much less deadly than severe acute respiratory syndrome (SARS), which killed more than 9 percent of the people who contracted it in 2003, and Middle East respiratory syndrome (MERS), which kills nearly 35 percent of its victims.
The mild nature of many illnesses, some experts said, may stem from the properties of the pathogen itself. For reasons scientists still don’t fully understand, one virus may be a nuisance and a very similar one can be deadly. While two different coronaviruses produced SARS and MERS, four others cause about 30 percent of all common colds.
The severity of the resulting illness is “inherent in the virus,” said Frieman, the University of Maryland virologist.
One coronavirus that causes cold symptoms, called NL63, uses the same doorway into cells and infects the same cells as SARS, he said.
“One gives you a runny nose and the other gives you lethal pneumonia,” Frieman said. “No one studies this.”
A major question to be answered is who is most at risk. While many are focused on the overall death rate from the virus, Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, said it is important to focus on the fatality rate in vulnerable groups.
“SARS was 10 percent overall, but it was 50 percent among older people,” Hotez said. Figuring out who is most at risk is essential for creating the right public health strategy.
“If you really want to address this epidemic, it’s especially important we protect the vulnerable groups,” Hotez said.
leonard.bernstein@washpost.com
carolyn.johnson@washpost.com


The new viral threat: What you need to know

Symptoms range from fever, muscle aches, dry cough, runny nose and shortness of breath to much more severe problems The SARS epidemic began in November 2002 andrea.sachs@washpost.com lena.sun@washpost.com miriam.berger@washpost.com yasmeen.abutaleb@washpost.com

The newly identified coronavirus that emerged last month from Wuhan, China, sickening more than 1,900 people worldwide and killing at least 56, has sparked growing anxiety and questions: How lethal is the virus? How can it be avoided? Is travel, especially to China, suddenly risky?
Here is what we know so far.
Coronaviruses are a large family of viruses that range from the common cold to much more serious diseases, according to the World Health Organization. They can infect both humans and animals. The newly emergent strain in China is related to two other coronaviruses that have caused major outbreaks in recent years: MERS, or Middle East respiratory syndrome, and SARS, or severe acute respiratory syndrome. The new virus hasn’t been named yet; it’s referred to as “a novel coronavirus.”
In rare cases, coronaviruses can spread from animals, such as camels and bats, to humans. (Household pets are not a threat.) The new virus is believed to have originated from a live animal market in Wuhan. But now it’s clear, health authorities say, that the virus is spreading from person to person — likely through coughing and sneezing or touching an infected surface and then the mouth, nose or eyes, or coming into contact with contaminated fecal matter.
Symptoms range from fever, muscle aches, dry cough, runny nose and shortness of breath to much more severe problems
So far, the virus appears more serious than the common cold but less dangerous than SARS, public health experts have said. It does not appear to be anywhere near as deadly as Ebola, which is harder to transmit because it requires direct contact with an infected person’s blood or bodily fluids.
Antibiotics don’t work on viruses. There’s no medication for the new coronavirus, though the National Institutes of Health said human vaccine trials could begin within three months. Currently, health-care professionals are focusing on providing “supportive care,” including ensuring patients get plenty of liquids and oxygen.
The situation is fluid but getting worse.
The CDC has urged travelers to avoid Wuhan. Several other Chinese cities also are essentially on lockdown. Even places that aren’t quarantined are experiencing disruptions and closures that could affect where travelers go and how they get around. For example, Beijing’s Forbidden City and Shanghai Disneyland have been shuttered, as have many theaters and temples.
Would-be travelers can stay abreast of developments by checking the CDC website and monitoring alerts issued by the State Department and U.S. embassies.
Beijing authorities are restricting the movements of their own people. Officials said all inter-province bus services to and from Beijing would be halted in an effort to contain the outbreak, according to local news reports. In addition, officials are suspending domestic and overseas Chinese group tours, state media reported.
Elsewhere in Asia, cases of infection appear isolated. Nevertheless, more vulnerable travelers, including those who have health issues or are older, should be cleared by a medical professional before departing.
Yes, if the insurance was purchased with the “cancel for any reason” benefit. This optional upgrade for the policy usually has several restrictions, but if the traveler meets the criteria, he or she can recover up to 75 percent of their trip costs. People with standard travel insurance who cancel because of fear of contracting the virus will have to absorb the losses, however. When traveling outside the United States, travelers should be sure they have travel medical insurance that will cover hospital costs if they fall ill while abroad or need to be taken back to the United States.
Some airlines are. Cathay Pacific passengers who reserved a ticket on or before Jan. 21 can rebook, reroute their flight or receive a refund without penalty for travel through March 31. Air China is also waiving change and cancellation fees for tickets issued by Jan. 31 for travel by March 29. Other airlines that are loosening their rules include United, China Eastern, China Southern and Hainan. Some carriers, however, are taking a wait-and-see approach.
Some hotels also are making it easier to rejigger plans: Hilton, Accor, InterContinental Hotels and Hyatt are easing restrictions, and not just on Wuhan hotels. The waiver covers changes and cancellations at properties throughout China, for travel through early February. To qualify, the booking must have occurred directly through the hotel; otherwise, the third-party agent should be contacted.
Policies vary among tour operators and should be checked.
A large number of airports around the world have established enhanced screening procedures for passengers arriving from Wuhan, and a few countries, including India, are testing passengers arriving from any destination in China. South Korea’s Incheon International Airport is employing ear thermometers. In Japan, arriving passengers must fill out health forms. Australia is distributing pamphlets.
In the United States, the CDC and Customs and Border Protection are overseeing the process at five international airports in New York, Los Angeles, San Francisco, Atlanta and Chicago. Screening for symptoms and elevated temperatures may add a few minutes to the arrival process. Passengers who test positive for coronavirus will be quarantined for further testing by the CDC.
The CDC recommends that everyone get a flu shot and other required vaccinations for their destinations. Any meat consumed should be fully cooked, and hands should be washed frequently and vigorously with soap and water for at least 20 seconds.
Jesus Gonzalez, a physician with MedStar Health in Washington, recommends that travelers wear medical masks in crowded areas, such as train and bus stations and airports.
The SARS epidemic began in November 2002
MERS emerged in the Middle East in 2012. Scientists say the first infection moved from a camel to a human in Saudi Arabia. The disease has been associated with the death of 790 people since 2012, according to the CDC. Authorities contained the outbreak by isolating patients and warning against contact with camels and camel meat during the scare.
andrea.sachs@washpost.com
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yasmeen.abutaleb@washpost.com


Coronavirus updates: Global death toll passes 1,000 as China records most deaths in a single day

China tentatively returned to work Monday after an extended Lunar New Year shutdown precipitated by the coronavirus outbreak, but with deaths from the epidemic continuing to rise, much of the country remained at a standstill, and many were working from home. Meanwhile, an additional 65 people on board a quarantined cruise ship have tested positive for the virus.
Here’s what we know:
● An additional 65 people on board the Diamond Princess have tested positive for the new coronavirus, Japan’s Health Ministry says, bringing to 135 the number of people who are known to have been infected. Pressure is mounting to test everyone on the cruise ship.
● China reports 1,016 dead and about 42,600 cases of coronavirus. On Monday alone, officials recorded 108 deaths in mainland China, the most in a single day. More than 7,000 of the affected patients were in critical condition, authorities said Monday. There were 42 confirmed cases in Hong Kong, 10 in Macao and 18 in Taiwan.
● Britain announced new measures allowing the mandatory quarantine of those infected after the coronavirus outbreak was designated a “serious and imminent” threat to British health. Four more cases were confirmed in Britain, doubling its total number to eight.
● New Chinese research says the virus can be transmitted by saliva, urine and stool, as well as the usual viral route of respiratory droplets. It generally takes three days from the time of infection for symptoms to manifest, and 15 percent of the infected contract severe pneumonia.
10:31 PM: CDC confirms 13th coronavirus infection in the U.S.
A person under federal quarantine in California has tested positive for coronavirus, marking the 13th confirmed case of the disease in the United States, the Centers for Disease Control and Prevention said Monday.
The person was among several hundred Americans who were evacuated last week from Wuhan, China, the epicenter of the outbreak.
“CDC is conducting a thorough contact investigation of the person who has tested positive to determine contacts and to assess if those contacts had high risk exposures,” the CDC said in an emailed statement.
The person was being treated at the University of California San Diego Medical Center. A spokesperson for the hospital did not immediately respond to a request for comment.
By: Derek Hawkins
10:00 PM: Trump said coronavirus could ‘miraculously’ go away this spring. Diseases don’t work like that, experts say.
More than once now, President Trump has suggested that the coronavirus will weaken or go away once the winter months have passed and the weather warms up.
But experts said that’s impossible to predict at this stage.
Trump first raised the idea in a tweet last week, saying the Chinese government’s efforts to control the virus would succeed “as the weather starts to warm and the virus hopefully becomes weaker, and then gone.”
He made a similar prediction in a rally Monday, suggesting that the outbreak could subside “by April.”
“You know, in theory when it gets a little warmer, it miraculously goes away, that’s true,” he told an audience in New Hampshire.
Experts said that’s wishful thinking at best: While it’s true that respiratory viruses tend to follow seasonal patterns, there’s no telling what course the novel coronavirus will take.
“This virus can do anything it wants,” Allison McGeer, an infectious-disease epidemiologist at the University of Toronto, told The Washington Post last week. “That pattern of how it’s going to spread is completely unknown, but it is critical to what the burden is going to be to all of us.”
A variety of outcomes are possible, McGeer said. The virus could peak and then recede before returning later in the year. It could also take hold in the Southern Hemisphere.
“It could be just like another coronavirus, a bunch of colds,” she said. “It could be like a regular flu season. It’s possible it could be different and worse.”
Peter Hotez, dean of the National School of Tropical Medicine at Baylor College in Texas, told CNN that nobody yet knows enough about the coronavirus to say how it will behave.
“It would be reckless to assume that things will quiet down in spring and summer,” Hotez said. “We don’t really understand the basis of seasonality, and of course we know absolutely nothing about this particular virus.”
By: Derek Hawkins
7:34 PM: Coronavirus death toll passes 1,000, and more than 7,000 patients remain in critical condition
WASHINGTON — Chinese health officials announced Monday that 108 more people died from coronavirus, the most recorded in a single day, bringing the global death toll to 1,018.
Nearly all of the new deaths were recorded in Hubei province, the epicenter of the public health crisis. The outbreak has now claimed 1,016 lives in mainland China; one person died of the disease in Hong Kong and another in the Phillippines.
The number of new infections in China grew by nearly 2,500, officials said, with 2,097 more people falling ill in Hubei.
China has confrmed more than 42,600 cases since the epidemic started. More than 7,000 people remained in critical condition in the hospital, officials said, and nearly 188,ooo were under medical supervision.
There were 42 confirmed cases in Hong Kong, 10 in Macao and 18 in Taiwan. Chinese officials also reported nearly 4,000 recoveries in the mainland.
By: Derek Hawkins
6:29 PM: The coronavirus is spreading rapidly. So is misinformation about it.
Meghan May, a university professor who researches emerging diseases, seemed an unlikely person to contribute to misinformation about the novel coronavirus. Yet last week, May shared a mea culpa on Twitter, owning up to unwittingly retweeting information that had origins in a Russian misinformation campaign.
The story that managed to evade her typically discerning sensors: a claim that a Chinese Internet company had accidentally released death toll and infection totals — ones that exceeded official estimates — before quickly scrubbing evidence of them online. If true, May said at the time, the numbers indicated that the outbreak in the Chinese city of Wuhan was far more severe than the public was warned about.
Since the first cases of a then-unidentified pneumonia were reported in late December, hoaxes, half-truths and flat-out lies have proliferated, mostly through social media. BuzzFeed News for several days kept a running list of misinformation, including wildly inaccurate reports that the death toll in China was 112,000 as of late January (reality: around 80 at the time); claims that Chinese people eating bats were the source of the outbreak (a viral photo of a woman biting a bat was not taken in China); and false suggestions that the virus was lab-engineered as a kind of bioweapon.
“I gave it some degree of credence because the artificial numbers would make the scale of the lockdown in Wuhan and the additional cities much more rational,” May told The Washington Post on Monday. “And I saw it shared by a person who is typically very credible.”
Parts of the false story seemed rooted in fact: There are signs that Beijing has silenced whistleblowers and underreported cases of infections. But the situation the story described never happened.
“It’s really insidious when you have this cloud of confusion around details,” May said.
Read more here.
By: Kim Bellware
3:00 PM: Second government-chartered flight evacuating Canadians leaves Wuhan
TORONTO — A second government-chartered flight evacuating Canadians from the epicenter of the coronavirus outbreak in China has departed, Canadian foreign affairs minister Francois-Philippe Champagne said Monday.
The flight will stop in Vancouver to refuel before making its way to a Canadian military base in Trenton, Ontario, where its 185 passengers will join the 215 evacuees who arrived last week. All of them will spend 14 days in quarantine there.
Passengers completed health and immigration screenings at the airport in Wuhan. Anyone exhibiting symptoms of the virus would not have been allowed to board the aircraft, but it was not immediately clear if anyone was turned away.
Officials conduct regular health checks of those quarantined in Trenton. None of the travelers has been diagnosed with the virus.
Myriam Larouche, a Canadian graduate student, told the Canadian Broadcasting Corp. that she passes the time in quarantine by doing her homework and watching movies. The evacuees are also allowed outdoors to exercise, but must stay within a restricted area and avoid physical contact with each other.
By: Amanda Coletta
2:08 PM: A traveling British businessman appears to have spread the coronavirus in at least three countries
The story of a traveling British business executive who appears to have passed the coronavirus to Britons in at least three countries has prompted concerns over “superspreaders,” who could play an outsize role in transmitting the infection.
A British national, who has not been named, may have unwittingly spread the virus to at least 11 people in the course of his travels from Singapore to France to Switzerland to England, according to public health authorities and accounts in the British media. Infected Britons in England, France and Spain probably caught the virus from him.
The businessman, one of the first British nationals to test positive for the virus, works for the gas analysis company Servomex, according to the Guardian. He traveled to Singapore for work Jan. 20 and departed Jan. 22, the paper reported. He is thought to have contracted the virus while he was there.
Read more: “British coronavirus ‘superspreader’ may have infected at least 11 people in three countries”
By: Karla Adam
1:51 PM: China turns to disinfectant spray in attempt to fight the coronavirus
Emergency service workers in China are soaking cars, buildings and even airplanes with disinfecting spray in an attempt to eliminate the virus from the city of Wuhan, where the epidemic began.
In recent days, media outlets linked to the ruling Communist Party have released videos showing the sprayers at work.
In one video posted Monday to the Twitter account of the People’s Daily, workers in face masks wielding spray guns walk down Wuhan’s narrow, empty streets as they trigger the devices, unleashing white clouds behind them. They appear to be spraying the substance indiscriminately, soaking cars and buildings as they go.
The footage also shows trucks flashing their headlights as huge amounts of the disinfectant spew out of tubes attached to the vehicles.
It’s unclear how effective the method is, especially considering that the entire region is under a travel lockdown and many people are not venturing outside.
Caitlin Rivers, an assistant professor in the health security program at the Johns Hopkins Center for Health Security, said it’s unusual to use any type of spray campaign to try to prevent the spread of a viral respiratory infection.
“I have never seen that be used except for mosquito control, in which case that is warranted,” she said.
Thus far, experts think the coronavirus is largely transmitted by close person-to-person contact and respiratory droplets. “Some coronaviruses can persist on surfaces, but I usually don’t think of a street as a surface I worry about,” Rivers said.
By: Siobhán O’Grady
1:00 PM: President Trump says Xi told him heat kills viruses
President Trump said Monday that Chinese President Xi Jinping reassured him that the cases of coronavirus are likely to dwindle during warmer months.
“He feels very confident, he feels very confident,” Trump said. “And he feels that, again as I mentioned, by April, or during the month of April, the heat generally speaking kills this kind of virus. So that would be a good thing.”
Trump made the remarks during a meeting with governors at the White House. He had spoken with China’s leader on the phone Friday.
By: Adam Taylor
12:54 PM: Coronavirus will ‘undoubtedly’ affect Canadian economy, minister says
TORONTO — The coronavirus will “undoubtedly” have a “real” impact on the Canadian economy, the country’s finance minister said Monday.
Delivering a keynote address at a meeting of the Economic Club of Canada in Alberta, Bill Morneau said that the virus is likely to disrupt supply chains and hit Canada’s tourism sector. He also noted that oil prices have fallen 15 percent since the outbreak began because of a decrease in demand and fewer flights traveling to and from China.
“The virus is undoubtedly going to have an economic impact” across the country, Morneau said, adding that he expects it to be a topic of conversation when central bankers and finance ministers from the Group of 20 countries meet in Saudi Arabia later this month.
Last week, Carolyn Wilkins, the senior deputy governor for the Bank of Canada, said the central bank was trying to better understand the potential economic risks posed by the coronavirus. She said much would depend on how long the epidemic lasts.
“It’s never a good time to have an outbreak like this,” she said. “But when the global economy is feeling a little fragile [and] we’ve got mixed data in Canada, it’s certainly not great timing.”
There have been seven confirmed cases of the coronavirus in Canada.
By: Amanda Coletta
12:36 PM: Hong Kong evacuates apartment building after two cases in units 10 stories apart
Hong Kong’s Center for Health Protection announced early Tuesday that it would be evacuating some residents of an apartment building after two people were diagnosed with coronavirus, despite living in apartments 10 stories apart.
The evacuation will take place in the Hong Mei House in the Cheung Hong Estate in Tsing Yi, public broadcaster RTHK reported, and only those who live in apartments with the number 7 on each floor will be evacuated.
Officials said that engineers from Hong Kong’s housing department would investigate the sewage system in the building to see whether it could have been the source of the virus’s spread.
During the 2003 SARS outbreak, more than 300 people were infected in the Amoy Gardens apartment complex in Kowloon, Hong Kong, eventually leading to a quarantine of the apartment complex. Officials later said that the outbreak had spread through bathroom drainpipes.
By: Adam Taylor
12:16 PM: Coronavirus could delay delivery of Russian S-400 air defense missile system to China
MOSCOW — Russia’s arms export agency Rosoboronexport warned Monday that its exports of the S-400 long-range air defense missile system to China could be delayed by the coronavirus.
Government officials earlier indicated that a delivery of the S-400 system to China would take place in July.
“We’re working out these scenarios just in case. I don’t rule out that certain delays in implementing all of our contracts may arise,” Rosoboronexport chief Alexander Mikheyev said, according to Interfax.
He said the agency had contracts with China for delivery and for training its personnel.
Russian health authorities are monitoring more than 20,000 people in Russia for signs of the virus, including 6,000 Chinese citizens. Two cases of the virus have been found so far.
Russia’s Federal Anti-Monopoly Service warned Monday of “economic looting” by retailers seeking to take advantage of the crisis, with a sharp increase in the cost of medical masks across Russia.
“The vast increase in retail prices for medical masks in 68 regions of the Russian Federation has all the indications of ‘economic looting’ during a period of increased demand,” the FAS said in a statement.
Russian President Vladimir Putin said last week that pharmacies that price-gouged on medicines and medical masks should have their licenses canceled.
By: Robyn Dixon
11:53 AM: Scientists hope an antiviral drug being tested in China could help patients
U.S. officials confirmed last week that physicians in Wuhan, China, have begun testing an experimental drug called remdesivir on coronavirus patients.
The drug, made by Gilead Sciences, was successfully used on the first U.S. patient, a 35-year-old man in Snohomish County, Wash. He recovered, but a single case can’t determine the extent to which the drug may have contributed.
Scientists are hopeful that the drug will work. Although remdesivir failed an ebola clinical trial, it has shown promise in laboratory tests against other coronaviruses, including severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS).
Timothy Sheahan, an assistant professor of epidemiology at the Gillings School of Global Public Health at the University of North Carolina at Chapel Hill, said that instead of developing a new drug for each emerging virus, the hope is that remdesivir could be broadly useful and work against multiple coronaviruses — one drug that could work against multiple bugs.
“I think starting a clinical trial is essential for determining if this drug will work” against the coronavirus, Sheahan said.
One of the clinical studies will test remdesivir on infected patients who are in the hospital but do not have severe symptoms. The other will test it on people with severe infections, who are on supplemental oxygen or have other complications.
Gilead is providing the drug to Chinese researchers at no charge, according to spokeswoman Sonia Choi.
By: Carolyn Y. Johnson
11:41 AM: Manufacturing in China remains slow
China’s manufacturing industry, which leads the world in terms of output, continues to be hobbled by the coronavirus epidemic. The full impact cannot be measured.
Smartphone sales in China may dip by 50 percent in the first quarter, in part because manufacturing has not fully resumed, Reuters reported.
The slowdown is having ripple effects. Automaker Nissan said Monday it would temporarily halt production at a plant in Japan over shortages of parts in the supply chain from China.
A Tesla factory in Shanghai is set to resume production, Reuters reported, but many key manufacturing facilities remain closed.
China has blocked the reopening of Foxconn plants, which supply Apple and other international technology giants, over coronavirus concerns, the Nikkei Asian Review reported. Some production may soon resume with a skeleton workforce, a source told Reuters.
By: Benjamin Soloway
10:49 AM: Advance team of WHO experts arrives in China
An advance team of World Health Organization experts has arrived in China to help lay the groundwork for a larger team, officials from the body said Monday.
The team is led by Bruce Aylward, a Canadian physician and epidemiologist, who previously worked on the WHO’s response to the 2014 ebola outbreak in West Africa.
“Bruce and his colleagues will be working with their Chinese counterparts to make sure we have the right expertise on the team to answer the right questions,” Tedros Adhanom Ghebreyesus, the WHO director general, told reporters at a daily news conference.
Officials from the WHO declined to be drawn into specifics about what Aylward’s team would be doing in China, describing the members as medical professionals who would be given a large degree of autonomy to coordinate with local counterparts.
“The team is there first and foremost to learn,” said Michael Ryan, executive director of the WHO health emergencies program.
Tedros had made a trip to Beijing for preliminary talks with President Xi Jinping and Chinese officials in late January, during which it was agreed that an international mission would be sent, but subsequent deliberations over its format lasted weeks.
Some public health experts have criticized the Chinese government for initially misleading the world about the threat posed by the outbreak.
“We were deceived,” Lawrence Gostin, a professor of global health law at Georgetown University who also provides technical assistance to the WHO, told The Washington Post.
By: Adam Taylor
10:31 AM: Hong Kong billionaire pledges $12.9 million to help Wuhan
Li Ka-Shing, the richest person in Hong Kong with an estimated net worth of $29.4 billion, has pledged a donation of $12.9 million to help Wuhan, the city at the center of the coronavirus outbreak.
The donation was made through the Li Ka Shing Foundation, which announced the news Monday that it would be making the donation “in support of the frontline healthcare professionals battling the Novel Coronavirus outbreak in Wuhan.”
Li is one of Asia’s best-known philanthropists and his charitable organization is the second largest private and individual-led foundation in the world, after the Bill & Melinda Gates Foundation.
On Feb. 6, the Gates Foundation announced that it would commit $100 million toward the global response to the coronavirus epidemic. A number of other wealthy figures have pledged money to help in the fight against the outbreak.
The Jack Ma Foundation, established by and named after the Chinese billionaire and co-founder of Alibaba Group, pledged $14.4 million toward fighting the outbreak in late January. The funding will primarily go toward vaccine research underway at Chinese institutions. Other big names donating millions in funds include the online food delivery company Meituan Dianping, logistics subsidiary Cainiao Global and Tencent Charity Foundation. Alibaba’s payment and health subsidiaries are also offering loans and free services to affected people.
By: Adam Taylor and Miriam Berger
9:58 AM: Quarantines and travel bans pose test to personal relationships
There’s nothing like a quarantine or an international travel ban to test a relationship.
As the coronavirus continues to spread around the world, mixed-nationality couples and families looking to leave China have found themselves divided by citizenship status. Frustration and anxiety is running high as people struggle to navigate emergency measures meant to contain the virus, but which critics say have stoked xenophobia and public panic.
Getting out of China, no matter one’s nationality, is becoming harder and harder. Airlines are canceling flights. Countries are imposing bans on people traveling from China. Within the country, movement between and within cities is highly restricted. Chinese regulations and diplomatic relations have further complicated some efforts by governments to evacuate their citizens.
Countless couples and families have faced a maddening array of international barriers.
Read more here: “Love in the time of coronavirus, quarantines and travel bans”
By: Miriam Berger
9:40 AM: New model suggests coronavirus outbreak began in November, University of Toronto researchers say
A new disease-transmission model created by University of Toronto researchers suggests that the coronavirus epidemic started one month earlier than commonly believed.
The model uses open-access data to replicate epidemiological scenarios, allowing the researchers to test some narratives about the outbreak.
Although it is only a model, it may provide a plausible explanation for how the virus was able to spread so quickly — useful in the absence of hard evidence.
“You can’t get up to that level of cases if the epidemic started in December even if you pushed the reproduction really high,” David Fisman, a professor in the Dalla Lana School of Public Health and one of the model’s creators, said in a statement.
“If you have a reproduction number of three, the epidemic could not have stated in mid-December because, according to the graph, it is undershooting the cases that were found in December,” Fisman said.
The findings of Fisman and his colleagues were published in the Annals of Internal Medicine last week. The research suggested not only that the outbreak may have started earlier than widely thought, but also that it has not yet been controlled.
By: Adam Taylor
8:30 AM: Russia quarantines top Chinese diplomat
A top Chinese diplomat has been quarantined by Russian authorities as a safety precaution against the coronavirus outbreak, Interfax news agency reported Monday.
The diplomat, Consul General Cui Shaochun, had arrived in Yekaterinburg on Thursday to take up his new post but had not yet met with any Russian diplomats, according to Interfax.
Russian Foreign Ministry official Alexander Kharlov told Interfax that Cui would be quarantined at home for two weeks and would not hold previously scheduled meetings.
By: Adam Taylor
7:25 AM: Japan corrects new cruise ship infected cases to 65
TOKYO — Japan’s Health Ministry says 65 additional people on board the Diamond Princess cruise ship have tested positive for the new coronavirus, correcting an earlier statement from the vessel’s parent company.
The Health Ministry said the 65 cases came from 103 samples taken from people on board. The Diamond Princess’s operator had earlier said 66 more people were infected.
The latest data means that 135 people on board the ship have tested positive out of 439 tests carried out, or nearly one person in three.
Despite growing calls to test everyone on board the ship, Japan’s chief government spokesman Yoshihide Suga said Monday that under current circumstances, that would be “difficult.”
Officials say Japan has the capacity to test 1,000 people a day but also needs to direct resources to other test centers around the country.
Some 3,600 passengers and crew were allowed to disembark from a ferry quarantined in Hong Kong Sunday after all 1,800 crew members tested negative for the virus. It was feared the crew members might have come into contact with infected passengers on a previous trip.
“Isn’t that strange?” popular commentator Toru Tamakawa said on TV Asahi, asking why Japan, a much bigger country, had not been able to undertake a similar testing program. “How many people are there in Hong Kong? Isn’t that strange? Why could we not do that?”
The passengers on board the Diamond Princess were placed under 14-days’ quarantine last Wednesday, largely confined to their cabins apart from brief chances to walk on deck. But the crew have had to continue working, without any quarantine arrangements, and several have now fallen ill. One Indian crew member issued a plea for help on Monday, arguing that he and fellow employees will all soon fall sick if they remain on board.
By: Simon Denyer and Akiko Kashiwagi
7:11 AM: After being largely absent, Chinese leader Xi inspects ‘front-line work’ against coronavirus
After being largely absent from the public in recent days, Chinese President Xi Jinping was shown donning a face mask and having his temperature taken on Monday.
According to the state-run Xinhua News Agency, Xi inspected the “front-line work” to counter the novel coronavirus in the Chaoyang district of Beijing.
Xi acknowledged Monday that the situation remains serious, but he added that the Chinese leadership would take further measures to contain the spread of the virus and prevent mass layoffs as a result of the economic fallout, according to Chinese state TV.
To some, Xi’s recent absence from the public stage — and from the coronavirus epicenter of Wuhan — appeared to be an attempt to distance himself from the mistakes of the regional Communist Party’s leadership.
But public frustration — including with the Communist Party in Beijing — mounted last week, following the death of Wuhan doctor Li Wenliang, who succumbed to the coronavirus. Li had been among the first to raise alarm over the new virus. He was subsequently detained and silenced by Wuhan police.
His death last week triggered a short-lived Chinese online campaign under the hashtag #WeWantFreedomOfSpeech, directed against what many viewed as an attempt by officials to cover up the crisis early on.
By: Rick Noack
6:12 AM: China cracks down on wildlife trade believed to be behind virus outbreak
Chinese authorities said Monday they are cracking down on the trade in illegal wildlife, as the dangers of unhygienic wildlife markets where multiple species mix finally begins to sink in.
Any form of wildlife trade will be strictly prohibited on platforms including marketplaces, supermarkets, dining establishments and e-commerce sites, and all sites raising wild animals will be quarantined, the official Xinhua News Agency reported.
Violators will be penalized, and for serious violations, suspects will be handed over to the police for criminal investigation.
Two weeks ago, China banned the trade of wild animals until the coronavirus epidemic has been eliminated across the country, after evidence emerged that the disease was transmitted to humans through a market in the city of Wuhan that traded in game meat.
The SARS epidemic in 2002-2003 was thought to have been transmitted through the trade in masked palm civets, a nocturnal mammal with a long tail that spends much of its life in trees and is considered a delicacy in parts of the country.
Police in the southwestern province of Yunnan, a hub for the illegal trade in wildlife and for transit from neighboring countries, said they have launched their biggest operation in history against the wildlife trade, with 2,351 places where wild animals are bred “closed or controlled” and 16 places for wildlife viewing closed.
Police on the island of Hainan said Monday they arrested a man for keeping a rare and endangered python on a farm. Shanghai police said they detained a man accused of illegal hunting, finding 109 dead wild animals, including wild ducks and turtledoves.
Traditional Chinese medicine — and mystical beliefs in the powers of eating and consuming products made from wild animals in many parts of China — have brought many species close to extinction, with the reclusive pangolin in particular danger.
Ironically, a suggestion that the coronavirus might have been transmitted to humans via pangolins might offer a small lifeline to that animal, considered the most trafficked mammal in the world.
But a crackdown on illegal wildlife trade after SARS soon petered out. Wildlife experts say the latest ban needs to be made permanent.
By: Simon Denyer
6:00 AM: Online company Indeed tells its people to work from home over virus fears
Online recruitment company Indeed has asked its employees in Dublin and Sydney to work remotely, amid concerns that some of its staff may have been exposed to the novel coronavirus.
In Dublin, the company employs more than 1,000 workers.
Company officials said the move was a precautionary measure, taken after one Singapore-based employee was tested for the virus. The staff member has not yet been confirmed to have the virus.
“Since some employees who visited Singapore have recently visited our Sydney and Dublin offices, we are asking all employees in the Dublin and Sydney offices to work from home until we have received confirmation,” a company statement read, according to the Irish Independent newspaper.
The suspension of office work at the company came as many Chinese were heading back to work on Monday after an extended break. Many Chinese companies — including e-commerce giant Alibaba — asked their employees to work from home after the virus’s spread accelerated, in what has been described as the “world’s largest work-from-home experiment.”
By: Rick Noack
5:45 AM: Mistrust swirls through Hong Kong as officials struggle to paper over the cracks
HONG KONG — Panic buying is gripping Hong Kong, where the collapse in trust in the city’s government over the past year is prompting residents spooked by the coronavirus threat to take dramatic measures to procure essential household supplies.
The frenzy is perhaps best exemplified by a run on toilet paper, which has become extremely difficult to find in the city’s supermarkets. Many other products are scarce, especially hand soap, sanitizer and surgical masks, and even staples such as rice.
One Hong Kong woman flew to Myanmar, which until 2016 was under U.S. sanctions, to stock up on surgical masks — a trip that until recently would have been a staggering move for a resident of a financial hub that proclaims itself to be “Asia’s world city.”
Underpinning the panic is the widespread feeling in Hong Kong, reinforced by months of political unrest last year, that the city’s government places the interests of the Communist Party ahead of those of Hong Kong residents.
Read the full report here: In Hong Kong, toilet paper is in short supply. Trust in the government is even more scarce.
By: Shibani Mahtani
5:30 AM: ‘Soon we will all be infected’: Crew aboard Diamond Princess pleads for help
NEW DELHI — As the number of confirmed coronavirus cases onboard the Diamond Princess cruise ship rises, Indian crew members are making a public appeal for help.
Binay Kumar Sarkar, 31, said he was one of about 160 Indian crew members on the ship. He said the crew was busy serving meals to passengers in their rooms three times a day and that everyone is “scared who will be [infected] next.”
Sarkar posted a video on Facebook on Monday ]in which he and several other crew members — all wearing masks and Princess Cruises uniforms — implored Indian Prime Minister Narendra Modi for assistance.
All those aboard the ship should be tested, and those who are healthy should be allowed to go to their home countries, Sarkar told The Washington Post. Keeping everyone on the boat means “very soon we will all be infected.”
The Diamond Princess, now docked off Yokohama, was placed under a 14-day quarantine that will last until Feb. 19. It has more than 3,700 passengers and crew onboard, and 136 of them have tested positive for the virus so far.
By: Tania Dutta and Joanna Slater
5:18 AM: Eleven Americans among additional 66 people on board Diamond Princess who have virus
TOKYO — Eleven Americans are among 66 additional people on board the Diamond Princess who have tested positive for the new coronavirus, the cruise ship operator said Monday.
The latest results bring to 136 the number of passengers and crew who have tested positive for the virus, not including a former passenger from Hong Kong who is thought to have brought the virus on board before disembarking.
The latest cases were made up of four Australians, one Briton, one Canadian, 45 Japanese, three Filipinos, one Ukrainian and 11 Americans, Princess Cruises said in a statement.
The ship and its 3,711 passengers and crew were placed under quarantine last Wednesday.
“Since it is early in the quarantine period of 14 days, it was not unexpected that additional cases would be reported involving individuals who were exposed prior to the start of the quarantine,” the company said. “The quarantine end date remains at February 19, unless there are any unforeseen developments.”
Given the high number of people on board who have tested positive for the virus, there have been calls for everyone to be tested. Japanese Health Minister Katsunobu Kato said Monday that the ministry was looking into the feasibility of testing everyone before they are discharged, to ensure they do not spread the virus around Japan or elsewhere.
But later, Chief Cabinet Secretary Yoshihide Suga said that, under current circumstances, testing everyone would be “difficult.” He did not give reasons.
Last week, a Japanese government official said the country has the capacity to test 1,000 people a day.
Some 3,600 passengers and crew were allowed to disembark from a ferry quarantined in Hong Kong after all 1,800 crew members tested negative for the virus. It was feared the crew members might have come into contact with infected passengers on a previous trip.
By: Simon Denyer
5:11 AM: Britain announces four new cases of coronavirus, doubling total
LONDON — Britain announced Monday that four more people tested positive for coronavirus, bringing the total number of cases in the country to eight.
Chris Whitty, chief medical officer for England, said that the “new cases are all known contacts of a previously confirmed U.K. case, and the virus was passed on in France.”
The new cases come amid concerns of a so-called coronavirus “super spreader.” According to media reports, a British man caught the virus in Singapore and is linked to seven other cases in England, France and Spain. Sky News said the British national flew from Singapore to the French Alps, where five British nationals tested positive, before flying to Britain on Jan. 28.
On Monday, the British government declared coronavirus a “serious and imminent threat to public health,” giving health authorities greater powers including forcibly sending people to isolation.
According to local media, the decision was made after one of the people in quarantine attempted to leave the hospital.
By: Karla Adam
4:30 AM: China notes rise in percentage of virus patients cured, even as death toll soars
China’s health authorities say the proportion of people being cured of the new coronavirus has risen sharply in the past two weeks, indicating an improvement in the country’s ability to provide medical treatment.
The proportion of patients who are cured has risen to 8.2 percent, up from 1.3 percent on Jan. 27, Mi Feng, a spokesman for the National Health Commission, told a news conference. In the worst-hit province of Hubei, the percentage of patients who have been cured rose to 6.1 percent from 1.7 percent on Jan. 27.
Mi said that reflected an improvement in treatment across the country as well as an increase in the supply of hospital beds in Hubei after new hospitals were built.
On Sunday, 632 patients walked out of hospital, bringing the total of people who have been discharged to 3,281.
However, the daily death toll set a record Sunday, with 97 deaths, bringing the total to 908. The number of confirmed cases since the epidemic began rose by more than 3,000 to 40,171.
After accounting for those people who are cured or who have died, China is still treating 35,982 confirmed cases, including 6,484 in serious condition, with 23,589 suspected cases.
Nearly 400,000 people have been identified as having had close contact with infected patients, with nearly 190,000 under medical observation.
Mi said an advance team from the World Health Organization would arrive in Beijing on Monday. China has come under criticism for not allowing in foreign medical experts sooner.
By: Simon Denyer
3:46 AM: China launches app to check proximity to the coronavirus
China has released a mobile app that is supposed to show people if they have come into contact with the new coronavirus, and whether they are at risk of catching it.
The “close contact detector” was released Saturday evening, with users scanning a QR code and submitting their name, phone number and ID number to make an inquiry into whether they have come into contact with an infected person, mainly through plane, train and bus journeys.
Those who have been in close contact are advised to stay home and get in touch with local health authorities, state news agency Xinhua reported.
The report did not disclose how the app would work, saying only that it received support from the National Health Commission, the Ministry of Transport, China Railway and the Civil Aviation Administration of China “to ensure accurate, reliable and authoritative data.”
China’s Communist Party operates an extensive system of surveillance over citizens, and identity cards are required to buy train and long-distance bus tickets. But the app will not currently be able to establish whether people might have caught the virus in shopping malls, for example.
The National Health Commission defines close contact as being proximity with a person who is confirmed or suspected of being infected with coronavirus, with no effective protection.
It includes people who work closely together, share the same classroom or live in the same house, as well as medical staff who have been in close contact with patients.
On a flight, Xinhua reported, all passengers in the same row as the infected person, as well as those three rows in front and three rows in back, would be defined as having come into close contact. This also applies to flight attendants who provide cabin services in the area. Other passengers would be referred to as having general contact.
In a fully enclosed air-conditioned train, all the passengers and crew members who are in the same compartment are regarded as being in close contact, Xinhua reported.
By: Simon Denyer
3:40 AM: Coronavirus is a ‘serious and imminent’ threat to Britain, says health secretary
The spread of the new coronavirus is a “serious and imminent” threat to public health requiring stricter quarantine measures, Britain’s Health Department announced Monday.
The statement in the name of Health Secretary Matt Hancock also designated Arrow Park Hospital as an isolation facility and declared that all of China’s Hubei province, the epicenter of the outbreak, was an “infected area.”
The statement added that new measures have been adopted, giving the government greater powers to quarantine and isolate people to stop the spread of the virus, which has infected more than 40,000 people worldwide, nearly all of them in China.
The announcement followed the revelation that one British man who caught the virus in Singapore went on to possibly infect seven other people around Europe before returning to Britain.
The British government advises against all travel to Hubei province and all but the most essential travel to the rest of mainland China. “If you’re in China and able to leave, you should do so,” the travel advisory warned.
On Sunday, 200 British and foreign nationals were evacuated from the city of Wuhan, where the outbreak began.
By: Paul Schemm
3:25 AM: Taiwan tightens restrictions on Hong Kong and Macao travelers
Taiwan announced new restrictions Monday on travelers from Hong Kong and Macao in an effort to stem the spread of the coronavirus outbreak.
Only those traveling for business purposes or with residency in Taiwan will be allowed on the island, said Taiwan’s Mainland Affairs Council. The new restrictions will take effect Tuesday.
Even those allowed in must submit to a 14-day quarantine, either at home or in a hotel. According to the South China Morning Post, 10,840 students from Hong Kong and Macao are studying in Taiwan, 7,900 of them having left the island ahead of the Lunar New Year holidays.
All residents of mainland China were already banned from entering Taiwan on Feb. 6.
By: Paul Schemm
2:48 AM: Median coronavirus incubation period is three days but can stretch up to 24
People infected with the new coronavirus normally come down with symptoms after about three days, but the disease can incubate in some people for up to 24 days, new research by Chinese scientists shows.
The disease spreads rapidly from among humans, and aside from conventional forms of transmission such as direct contact and respiratory droplets, it can be also be transmitted through saliva, urine and stools, but the fatality rate is “relatively low,” according to the research, co-authored by 37 doctors and researchers, which has not yet been peer-reviewed.
Fewer than half the infected patients who sought medical attention had fevers at the time, although nearly 90 percent developed a fever during hospitalization. Two-thirds of people had coughs, while diarrhea and vomiting were rare. Severe pneumonia occurred in 15.7 percent of cases.
The median incubation period, between infection and the onset of symptoms, was three days, but there was a wide range of between zero and 24 days. One of the authors told Chinese media that the 24-day incubation period occurred only in “individual cases.”
The study looked at 1,099 cases where patients were confirmed to have the virus. Of the group, just over 1 percent had direct contact with wildlife, just over 30 percent had been to Wuhan, the city where the outbreak originated, and nearly 72 percent had contact with people from Wuhan.
Of 62 stool samples tested, four tested positive to the presence of the virus, while evidence was also found of the virus in gastrointestinal tracts, saliva and urine. “Hygiene protection should take into account the transmission via gastrointestinal secretions,” it said.
By: Simon Denyer
2:03 AM: China starts animal trials on mice to develop new coronavirus vaccine
Chinese scientists have begun animal trials as they seek to develop a vaccine against the new coronavirus, Chinese media outlet Yicai reported Monday.
Samples of the new vaccine were injected into more than 100 healthy mice on Sunday, and if the trials go well, the new vaccine could enter human clinical trials as soon as April, Yicai reported, citing multiple sources including an official from the Chinese Center for Disease Control and Prevention, or China CDC.
“This is still at a very early stage, and there are still many steps to be taken before it can be used on humans,” the official was quoted as saying.
The vaccine has been designed and developed by the China CDC, Tongji University School of Medicine and the Siwei (Shanghai) Biotechnology Co.
Calls to China CDC, Tongji University and Siwei were not immediately answered.
By: Simon Denyer and Yang Liu
1:45 AM: Another 60 people on board the Diamond Princess test positive for the virus
TOKYO — Japan’s Health Ministry said on Monday another 60 people on board the Diamond Princess cruise ship have tested positive for the new coronavirus, bringing to 130 the total number known to have been infected on board the ship.
The infected passengers will be taken to local hospitals for treatment.
Calls have been growing for Japanese authorities to test all roughly 3,700 passengers and crew on board the ship, especially since a significant proportion of those tested have been found to have the virus. Those calls have intensified after Hong Kong’s authorities were able to test all 1,800 crew members on board another cruise ship, and when they all tested negative, letting everyone disembark.
Health Minister Katsunobu Kato has insisted that only people who show symptoms or are seen as being at high risk would be tested, but on Monday he said authorities were studying whether it was feasible to test everyone on board before letting them leave the ship at the end of the quarantine period, to prevent the spread of the infection in Japan.
Before Monday’s test results were announced, 70 people out of 336 people tested had been found to have the virus, including six crew members.
On Saturday, Japan’s Defense Minister Taro Kono tweeted that the U.S. government has explained to Japan that it is not thinking of disembarking any passengers on the Princess Diamond before the 14-day quarantine period ends, based on advice from U.S. health authorities.
Some passengers had been asking to be flown home, fearing they could get infected on board the ship, and Japanese media had reported that a plan to take Americans out by another ship was under consideration.
By: Simon Denyer and Akiko Kashiwagi
1:15 AM: Coronavirus death toll still accelerating, but growth in new infections stabilizes
The death toll from coronavirus has soared past 900, surpassing the toll from thee 2002-2003 severe acute respiratory syndrome (SARS) epidemic, according to data released by China’s National Health Commission on Monday, with 97 new deaths the previous day, the highest daily toll since the outbreak began.
The number of new infections also continues to grow, but the rate of increase appears to be stabilizing or even slowing, especially outside the worst affected province of Hubei.
On Sunday, China added 3,062 new confirmed infections, bringing the total of people known to have the virus to 40,171. It also added 4,008 new suspected infections.
But the number of new infections outside Hubei was only 444, compared to a peak of 890 new infections outside Hubei on Feb. 3.
Chinese health officials said Sunday that the apparent tapering off in new infections outside Hubei could be a result of the strict quarantine measures that have been out in place. The World Health Organization also noted an apparent tapering off in infections, calling it “good news,” but cautioned many people still hadn’t been tested and it was too early to make predictions about the number of new infections.
By: Simon Denyer