An outbreak of a never-before-seen coronavirus continued to dramatically escalate in China this week, with case counts reaching into the 800s and 26 deaths reported by Chinese health officials.
To try to curb the spread of disease, China has issued travel restrictions in the central city of Wuhan, where the outbreak erupted late last month, as well as many nearby cities, including Huanggang, Ezhou, Zhijiang, and Chibi. Hundreds of flights have been cancelled, and train, bus, and subway services have been suspended. Collectively, the travel restrictions and frozen public transportation have now locked down an estimated 35 million residents in the region.
So far, all of the outbreak-related deaths and nearly all of the cases have been in China, but the viral illness has appeared in travelers in several other countries. That includes Japan, South Korea, Thailand, and the US.
This morning (January 24), the US Centers for Disease Control and Prevention confirmed that a second US case has been identified in Chicago. The case is a woman in her 60s who had recently traveled to Wuhan. She is said to be doing well and is in stable condition in a local hospital. She is mainly being kept in the hospital for quarantine purposes, officials said.
The first US case was identified January 21 in Washington state. The CDC reported this morning that officials have closely monitored people who have had contact with that Washington patient and, so far, none have shown signs of infection. Public health officials in Chicago are now identifying and monitoring people who had contact with the second patient.
The US—and countries around the globe—have stepped up monitoring of travelers from Wuhan. Airline passengers arriving in the US from Wuhan are being funneled to five US airports (San Francisco (SFO), New York (JFK), Los Angeles (LAX), Atlanta (ATL), and Chicago (ORD)), where they are undergoing entry screening, looking for fever and other symptoms.
In both of the confirmed US cases, the travelers arrived in the US prior to screening and did not have symptoms while traveling. The current rough estimate for the incubation time for the virus—that is, from the time of exposure to the development of symptoms—is two weeks.
Low risk, so far
The rapid rise in severity and scope of the outbreak has stoked fears of a devastating pandemic and revived memories of the deadly outbreak of SARS (Severe Acute Respiratory Syndrome) in 2003, which was also caused by a coronavirus. But health officials closely monitoring the epidemiological data have determined that—so far—the outlook is far less dire.
On Thursday, an emergency committee convened by the World Health Organization determined that the outbreak does not yet constitute a “Public Health Emergency of International Concern.”
“Make no mistake. This is an emergency in China,” WHO Director-General Dr Tedros Adhanom Ghebreyesus said during a press conference. “But it has not yet become a global health emergency.”
The committee will reconvene in the coming days to reassess, though. And Dr. Tedros (who goes by his first name) added that “it may yet become” a global emergency.
Likewise, the CDC said this morning that while the situation is evolving rapidly, the risk to the US population is currently low.
There are some key features of this outbreak that have led to those determinations and given public health experts a little comfort. For one thing, the majority of illnesses have been mild so far. And the reported deaths linked to the outbreak have mainly been in older individuals who had underlying health conditions, such as diabetes and cardiovascular disease.
Also, while person-to-person transmission of the virus has been confirmed, WHO officials say that the virus appears to mainly be hopping between people who have had close contact—that is, to family members and medical staff, not, say, people passing by in public settings, such as an airport.
The mild cases and limited transmission so far are hopeful signs that the outbreak can be controlled and the death toll will remain low.
That said, with novel viruses such as this—which likely jumped from an animal to humans in a live animal market in Wuhan—the virus can continue to evolve, and the situation can change quickly.
For that reason, WHO and the CDC are “erring on the side of caution” and taking the situation very seriously.
There are also many things we don’t yet know about the coronavirus, including where it came from, how easily it can spread from person to person, and the full scope of the clinical features of those infected.
Coronaviruses are a large family of viruses that can cause everything from mild to deadly infections in people and a variety of animals. Several coronaviruses already regularly circulate in humans and cause common respiratory illnesses that are mild to moderate. There are also the notorious members of the family that cause deadly infections, including a strain the causes SARS and one that causes MERS (Middle East Respiratory Syndrome.)
Because the new virus can cause relatively mild respiratory infections, it’s possible—if not likely—that cases have gone undetected, particularly as the outbreak has arisen amid cold and flu season. The new virus can cause nondescript respiratory symptoms, including fever, cough, chest tightness, and difficulty breathing. Mild cases could easily be mistaken for influenza or a common cold, including ones caused by established coronaviruses.
Flu activity is currently high in the US, according to the CDC. So far this season, the agency estimates that flu has caused 15 million to 21 million illnesses, resulting in up to 250,000 hospitalizations and 20,000 deaths—and that’s in the US alone.
While the WHO and others have come up with preliminary estimates of the transmission rate of the new coronavirus virus, those early estimates may be wildly off given the uncertainty of the case counts and clinical features of the illnesses.
For now, officials at WHO expect that the case count will continue to climb. The CDC said it fully expects that several more cases will be detected in the US and that the infection may spread to travelers’ close contacts on US soil.
The CDC recommends that people avoid unnecessary travel to Wuhan and adhere to standard hygiene practices, such as washing your hands frequently and covering your mouth and nose when you cough or sneeze.
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