Coronavirus Outbreak: Health System Crashed in Wuhan outbreaks

Başlatan Karabasan, Şub 03, 2020, 05:07 ÖS

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Coronavirus tally in epicentre Wuhan may be 'just the tip of the iceberg'

  • Medical experts say official number might not reflect true scale of the outbreak as many patients may be undiagnosed
  • Testing kits are in short supply, meaning only the 'fortunate' who test positive are admitted to hospital for treatment

The official number of coronavirus cases in Wuhan might not reflect the true scale of the crisis as there may be many patients who are undiagnosed and not reported, medical experts said.
Wuhan - the city of 11 million people where the deadly virus outbreak began in December - has so far reported more than 5,000 confirmed cases of the pneumonia-like illness, or about one-third of the total number across mainland China.
But some medical experts have expressed concern that the real number could be much higher because cases are only classified as confirmed once a patient has twice tested positive for the new strain of coronavirus. Given that there is also a shortage of coronavirus testing kits, the figure could be much lower than it should be.
Professor David Hui Shu-cheong, a respiratory medicine expert from Chinese University of Hong Kong, said the official tally in Wuhan could be "just the tip of the iceberg" because it only reflected the acute cases where patients were admitted to hospital.
"There are many community cases that remain undiagnosed - unlike in Hong Kong, where cases are more carefully handled, including the mild ones. Of the 15 confirmed cases [in Hong Kong], 10 of [the patients] didn't even need to be put on oxygen," Hui said.
"So we're talking about different denominators here. For an actual picture, one usually has to wait until after the outbreak settles for a general population, zero-prevalence study to be carried out - where blood tests would reflect the number of positive cases containing the antibody without presenting the symptoms," Hui said.

In addition, Li Lanjuan, a member of the National Health Commission's expert panel on the coronavirus, told state broadcaster CCTV on Monday that since there were not enough testing kits in Wuhan, "not everyone can get tested".

"Early detection, early diagnosis, early isolation and early treatment cannot be done in Wuhan at the moment. I hope that the country can support Wuhan [more]," said Li, who was in the Hubei province city to help oversee the handling of the outbreak.

Frontline doctors in Wuhan confirmed that there was a limited number of testing kits available, and only a small number of "fortunate" patients who tested positive would be admitted to hospitals and receive treatment.

A doctor at the Union Hospital in Wuhan, who declined to be identified, said staff could only test about 100 patients a day, and they had to wait 48 hours for the results.
"When the National Health Commission announces the numbers, they're already two days old," the doctor said. "We also have to turn away patients with mild symptoms, knowing that many of them will return later [when their condition worsens]. But we don't have the space in the testing centre, or the hospital beds."

Dr Joseph Tsang Kay-yan, a Hong Kong-based infectious disease specialist, said the shortage of testing kits in Wuhan meant doctors were limited in their ability to determine the real number of cases.
"There have also been many patients who died of undifferentiated respiratory and undiagnosed pneumonia symptoms in Wuhan since December - before the virus testing kits were made available," Tsang said.
"These cases should have been investigated and counted [in the tally] if confirmed. These are factors pointing to inaccurate reporting of the official figures," he said.

The Chinese government on Monday said production of the testing kits had been disrupted by the Lunar New Year holiday break and there should be more available soon.
"By February 1, our daily output was 773,000 [testing kit] units - equivalent to 40 times the number of suspected patients at the moment," said Tian Yulong, chief engineer with the Ministry of Industry and Information Technology.
"We have only reached 60 to 70 per cent of our production capacity, and our work in the next stage is mainly about [fully] restoring production capacity," he said.
But a doctor at the Tongji Hospital in Wuhan, speaking on condition of anonymity, said the kits were still in short supply.
"I don't know what's gone wrong - we only have a very limited number of testing kits every day, there's been no increase yet," the doctor said.

Wuhan Coronavirus Looks Increasingly Like a Pandemic, Experts Say  Published Feb. 2, 2020 Updated Feb. 3, 2020, 6:49 a.m. ET

The Wuhan coronavirus spreading from China is now likely to become a pandemic that circles the globe, according to many of the world's leading infectious disease experts.

The prospect is daunting. A pandemic -- an ongoing epidemic on two or more continents -- may well have global consequences, despite the extraordinary travel restrictions and quarantines now imposed by China and other countries, including the United States.

Scientists do not yet know how lethal the new coronavirus is, however, so there is uncertainty about how much damage a pandemic might cause. But there is growing consensus that the pathogen is readily transmitted between humans.

The Wuhan coronavirus is spreading more like influenza, which is highly transmissible, than like its slow-moving viral cousins, SARS and MERS, scientists have found.

"It's very, very transmissible, and it almost certainly is going to be a pandemic," said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Disease.

"But will it be catastrophic? I don't know."

In the last three weeks, the number of lab-confirmed cases has soared from about 50 in China to more than 17,000 in at least 23 countries; there have been more than 360 deaths.

But various epidemiological models estimate that the real number of cases is 100,000 or even more. While that expansion is not as rapid as that of flu or measles, it is an enormous leap beyond what virologists saw when SARS and MERS emerged.

When SARS was vanquished in July 2003 after spreading for nine months, only 8,098 cases had been confirmed. MERS has been circulating since 2012, but there have been only about 2,500 known cases.

The biggest uncertainty now, experts said, is how many people around the world will die. SARS killed about 10 percent of those who got it, and MERS now kills about one of three.

The 1918 "Spanish flu" killed only about 2.5 percent of its victims -- but because it infected so many people and medical care was much cruder then, 20 million to 50 million died.

By contrast, the highly transmissible H1N1 "swine flu" pandemic of 2009 killed about 285,000, fewer than seasonal flu normally does, and had a relatively low fatality rate, estimated at .02 percent.

The mortality rate for known cases of the Wuhan coronavirus has been running about 2 percent, although that is likely to drop as more tests are done and more mild cases are found.

It is "increasingly unlikely that the virus can be contained," said Dr. Thomas R. Frieden, a former director of the Centers for Disease Control and Prevention who now runs Resolve to Save Lives, a nonprofit devoted to fighting epidemics.

"It is therefore likely that it will spread, as flu and other organisms do, but we still don't know how far, wide or deadly it will be."

In the early days of the 2009 flu pandemic, "they were talking about Armageddon in Mexico," Dr. Fauci said. (That virus first emerged in pig-farming areas in Mexico's Veracruz State.) "But it turned out to not be that severe."

An accurate estimate of the virus's lethality will not be possible until certain kinds of studies can be done: blood tests to see how many people have antibodies, household studies to learn how often it infects family members, and genetic sequencing to determine whether some strains are more dangerous than others.

Closing borders to highly infectious pathogens never succeeds completely, experts said, because all frontiers are somewhat porous. Nonetheless, closings and rigorous screening may slow the spread, which will buy time for the development of drug treatments and vaccines.

Other important unknowns include who is most at risk, whether coughing or contaminated surfaces are more likely to transmit the virus, how fast the virus can mutate and whether it will fade out when the weather warms.

The effects of a pandemic would probably be harsher in some countries than in others. While the United States and other wealthy countries may be able to detect and quarantine the first carriers, countries with fragile health care systems will not. The virus has already reached Cambodia, India, Malaysia, Nepal, the Philippines and rural Russia.

"This looks far more like H1N1's spread than SARS, and I am increasingly alarmed," said Dr. Peter Piot, director of the London School of Hygiene and Tropical Medicine. "Even 1 percent mortality would mean 10,000 deaths in each million people."

Other experts were more cautious.

Dr. Michael Ryan, head of emergency responses for the World Health Organization, said in an interview with STAT News on Saturday that there was "evidence to suggest this virus can still be contained" and that the world needed to "keep trying."

Dr. W. Ian Lipkin, a virus-hunter at the Columbia University Mailman School of Public Health who is in China advising its Center for Disease Control and Prevention, said that although the virus is clearly being transmitted through casual contact, labs are still behind in processing samples.

But life in China has radically changed in the last two weeks. Streets are deserted, public events are canceled, and citizens are wearing masks and washing their hands, Dr. Lipkin said. All of that may have slowed down what lab testing indicated was exponential growth in the infection.

It's unclear exactly how accurate tests done in overwhelmed Chinese laboratories are. On the one hand, Chinese state media have reported test kit shortages and processing bottlenecks, which could produce an undercount.

But Dr. Lipkin said he knew of one lab running 5,000 samples a day, which might produce some false-positive results, inflating the count. "You can't possibly do quality control at that rate," he said.

Anecdotal reports from China, and one published study from Germany, indicate that some people infected with the Wuhan coronavirus can pass it on before they show symptoms. That may make border-screening much harder, scientists said.

Epidemiological modeling released Friday by the European Center for Disease Prevention and Control estimated that 75 percent of infected people reaching Europe from China would still be in the incubation periods upon arrival, and therefore not detected by airport screening, which looks for fevers, coughs and breathing difficulties.

But if thermal cameras miss victims who are beyond incubation and actively infecting others, the real number of missed carriers may be higher than 75 percent.

Still, asymptomatic carriers "are not normally major drivers of epidemics," Dr. Fauci said. Most people get ill from someone they know to be sick -- a family member, a co-worker or a patient, for example.

The virus's most vulnerable target is Africa, many experts said. More than 1 million expatriate Chinese work there, mostly on mining, drilling or engineering projects. Also, many Africans work and study in China and other countries where the virus has been found.

If anyone on the continent has the virus now, "I'm not sure the diagnostic systems are in place to detect it," said Dr. Daniel Bausch, head of scientific programs for the American Society of Tropical Medicine and Hygiene, who is consulting with the W.H.O. on the outbreak.

South Africa and Senegal could probably diagnose it, he said. Nigeria and some other countries have asked the W.H.O. for the genetic materials and training they need to perform diagnostic tests, but that will take time.

At least four African countries have suspect cases quarantined, according to an article published Friday in The South China Morning Post. They have sent samples to France, Germany, India and South Africa for testing.
At the moment, it seems unlikely that the virus will spread widely in countries with vigorous, alert public health systems, said Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University Medical Center.

"Every doctor in the U.S. has this top of mind," he said. "Any patient with fever or respiratory problems will get two questions. 'Have you been to China? Have you had contact with anyone who has?' If the answer is yes, they'll be put in isolation right away."

Assuming the virus spreads globally, tourism to and trade with countries besides China may be affected -- and the urgency to find ways to halt the virus and prevent deaths will grow.
It is possible that the Wuhan coronavirus will fade out as weather warms. Many viruses, like flu, measles and norovirus, thrive in cold, dry air. The SARS outbreak began in winter, and MERS transmission also peaks then, though that may be related to transmission in newborn camels.

Four mild coronaviruses cause about a quarter of the nation's common colds, which also peak in winter.

But even if an outbreak fades in June, there could be a second wave in the fall, as has occurred in every major flu pandemic, including those that began in 1918 and 2009.

By that time, some remedies might be on hand, although they will need rigorous testing and perhaps political pressure to make them available and affordable.

In China, several antiviral drugs are being prescribed. A common combination is pills containing lopinavir and ritonavir with infusions of interferon, a signaling protein that wakes up the immune system.

In the United States, the combination is sold as Kaletra by AbbVie for H.I.V. therapy, and it is relatively expensive. In India, a dozen generic makers produce the drugs at rock-bottom prices for use against H.I.V. in Africa, and their products are W.H.O.-approved.

Another option may be an experimental drug, remdesivir, on which the patent is held by Gilead. The drug has not yet been approved for use against any disease. Nonetheless, there is some evidence that it works against coronaviruses, and Gilead has donated doses to China.

Several American companies are working on a vaccine, using various combinations of their own funds, taxpayer money and foundation grants.

Although modern gene-chemistry techniques have made it possible to build vaccine candidates within just days, medical ethics require that they then be carefully tested on animals and small numbers of healthy humans for safety and effectiveness.

That aspect of the process cannot be sped up, because dangerous side effects may take time to appear and because human immune systems need time to produce the antibodies that show whether a vaccine is working.

Whether or not what is being tried in China will be acceptable elsewhere will depend on how rigorously Chinese doctors run their clinical trials.

"In God we trust," Dr. Schaffner said. "All others must provide data." Mesajı Paylaş
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Transmission ways of nCoV spark concern

New ways of transmitting the coronavirus have been reported, and virus nucleic acid has been detected outside human bodies, sparking public concerns that the virus could be transmitted in unknown and undetected ways.

Scientists have found coronavirus nucleic acid on the doorknob of a confirmed Guangzhou-based patient's house, the first case of novel coronavirus detected outside the human body, Guangzhou Daily reported Monday.

Mobile phone screens, computer keyboards, faucets and other household objects may indirectly transmit the virus, experts said.

A man from Northeast China's Jilin Province, who was confirmed with coronavirus infection on Monday, shared his experience, saying he had used the same microphone with another confirmed patient during a meeting in January.

Aside from respiratory droplets and contact transmissions, a 40-year-old man from North China's Inner Mongolia Autonomous Region, who lives upstairs of a confirmed patient, was also diagnosed with coronavirus infection on Saturday.

The person has no clear contact histories with people from other cities, patients, or wild animals and has never been to a market, according to the local health authority on Sunday.

Netizens were concerned the patient from Inner Mongolia might have been infected through toilet plumbing or ventilation devices.

Experts had warned that the novel coronavirus could be transmitted through the digestive system as they found 2019-nCoV nucleic acids in patients' stool and rectal swabs, and health authorities had suggested the central air conditioning system be discontinued if coronavirus patients are found. Mesajı Paylaş
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Şub 04, 2020, 10:18 ÖÖ Last Edit: Şub 04, 2020, 10:24 ÖÖ by Karabasan
Chinese officials announced an outbreak of a highly pathogenic strain of H5N1 bird flu at a farm in Hunan. The virus was discovered on a farm with nearly 8,000 chickens. More than half of them have already died - February 2, 2020 -

The #coronavirus can survive for five days maximum on smooth surfaces under suitable circumstances: experts from China's Health Commission - February 3, 2020 -

China confirms 425 deaths from new coronavirus

The death toll in China from the novel coronavirus outbreak climbed to 425, the country's National Health Commission (NHC) said Tuesday.

In a statement, the commission said it has so far received a total of 20,438 confirmed cases, adding a total of 64 people died over the last 24 hours.

More than 171,000 people are under medical observation, while the number of people discharged reached 632.

A 44-year-old man died of the coronavirus in the Philippines, the first death confirmed outside China, according to the World Health Organization's local office on Sunday.

The patient was a Chinese national from Wuhan city, where the virus was first detected.

The NHC also announced the bodies of those who died due to the outbreak will be burned in crematorium areas near hospitals.

The number of people with the virus detected outside of China's mainland reached 15 in Hong Kong and reached eight in Macau, both are special administrative regions.

Besides China, the virus has spread to more than 20 countries, including Japan, South Korea, Thailand, the U.S., Singapore, France, Russia, Spain, Vietnam, Malaysia, Cambodia, Sri Lanka, the Philippines, India, and Canada.

The virus, which originated in Wuhan, is said to have been transmitted to humans from animals, particularly bats.

It raised alarm globally with cases reported across Asia, Europe, the U.S. and Canada.

The World Health Organization declared the outbreak an international emergency.

The U.S. declared a public health emergency due to the new type of coronavirus.

Russia on Saturday suspended the visa-free travel for tourists to and from China.

Travelers from China are being screened for the virus at airports worldwide and several airlines suspended flights to Wuhan.

Japan, South Korea, U.S., Australia, Pakistan, India, France, Germany, Indonesia, Malaysia, and Turkey evacuated their citizens from Wuhan, the epicenter of the deadly virus. Mesajı Paylaş
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Chinese Consul General in Istanbul announced that the number of people who died due to the virus reached 521. Citizens who watched the statement said that the diplomat made a phone call and then mentioned the 521 dead figure. Mesajı Paylaş
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Professor Neil Ferguson announced that 50 thousand people can become infected in China, and that one outbreak will double every 5 days. He says Wuhan has 1 month to reach the top.

For the continuation of the interview

Chinese Netizens and Expert Suspect Wuhan Bioresearch Lab Is the Source of the Coronavirus

When virologists and medical experts around the globe discussed the suspicious nature of the novel coronavirus and pointed to Wuhan's P4 lab as a likely source, netizens inside China were watching. A Chinese scholar recently challenged Wuhan's P4 lab to explain how the proteins of the novel coronavirus seem to have been precisely engineered to enable the virus to bind onto human cells. He also disclosed unethical and unprofessional practices he previously observed in China's bioresearch labs.

According to Wuhan-based Yangtze Daily, Shi Zhengli, Deputy Director of Wuhan's P4 Lab, publicized a statement on Feb. 2 saying: "I pledge with my life that the 2019 novel coronavirus has nothing to do with our lab. This virus is a punishment imposed on mankind from nature, to condemn mankind's uncivilized way of living. Those of you who believe rumors or so-called scientific analysis by unqualified researchers, I advise you to shut your damn mouths!"

Shi's statement irritated many Chinese netizens. "For such a huge calamity that may take countless lives, give us facts and evidence, not pretentious statements such as pledging with your life," one netizen commented.

A social media user named Wu Xiaohua, with a Ph.D. in biological related fields according to his WeChat profile, challenged Shi to answer key questions about the suspicious gene mutations found in the new virus.

Wu pointed out there is no way that these mutations are the outcome of natural recombination.

"Now, many scientists, including Shi herself, believe that this virus must have originated from bats, and would involve one or two virus hosts to explain the gene mutations. Based on current scientific publications, the virus must jump from rats to primates before it can infect humans. Then how is this step--from rats to primates--usually achieved? It can only be done in a research lab by scientists inserting a certain protein from primates into rats," Wu wrote.

"I have personally performed the same type of genetic engineering experiments. You cannot get away by being cavalier. Do you dare to accept the challenge and give us an explanation?" he asked.

Wu also disclosed that some biolabs in China are very poorly regulated.

"For instance, some researchers in these labs kept the laboratory dogs as pets; some disposed of animal carcasses casually because following the biosafety rules and cremating them costs a lot of money. Some cut up the laboratory pigs and took the meat home to eat. I know this happened at Beijing 301 Hospital's spine surgery lab. Worst of all, some laboratory animals were sold to wet markets as wild-caught animals for profit," he wrote.

Xu Bo, a well-known IT magnate and billionaire in China, cited reports and articles to support Wu's statements.

In his blog, Xu cited a news report about a lawsuit against biologist Li Ning.

Li is an academician of China Engineering Academy, and a former professor at China Agricultural University. The judgment in Li's case, which came out on Jan. 2 this year, stated that between 2008 and 2012, Li's lab sold experimental pigs, cows, and milk to local markets. These animal and animal products were bought using research funds; but Li and his fellow colleagues pocketed the money, a total of 10,179,201 yuan ($1,460,304), from the sale of these animals and animal products.

Li was sentenced to 12 years in prison for embezzlement.

According to a 2016 report from the China Experimental Animal Information Network, Chinese researchers use tens of millions of laboratory animals every year. The Experimental Animal Research Center of Hubei Province alone handles about 300,000 animals a year, either for bioresearch experiments inside the center, or to be sold and distributed to other labs in Hubei Province.

Xu and many other Chinese netizens say they suspect that the novel coronavirus is a genetically engineered virus that somehow escaped from Wuhan P4 Biosafety lab.

A P4 lab handles level 4 biosafety pathogens, the highest level and most dangerous, which have high fatality rates and no known treatments, such as, the ebola and SARS viruses. Such a lab must follow the highest microbiological safety standards to ensure the safety of researchers and the public.

The P4 lab in Wuhan is not only the first of its kind in China, but also the first in Asia. When it opened in 2017, U.S. scientists expressed concerns that, considering China's opaque administrative structure, if one of those killer viruses "escaped" from the lab, it could cause a doomsday disaster.

It was said that the army completely took over the city in Wuhan, China. It is now said that China will control the fire of 11 million people every day in Wuhan. The claim came from a journalist in Wuhan during the quarantine.
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According to the research of German scientists, the new type of coronavirus is at risk of contaminating other people for up to 9 days on the contaminated surfaces. Mesajı Paylaş
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China Sacrifices a Province to Save the World From Coronavirus

Musician Zhang Yaru's grandmother died on Monday after slipping into a coma. She was repeatedly turned away from the hospital.

John Chen, a college graduate, is desperately seeking help for his mom. She has a high fever, but isn't strong enough to stand in line for hours to be tested for the virus raging through their city.

On the front line, a 30-year-old respiratory doctor has slept only a few hours in two weeks.

Scenes of chaos and despair are emerging daily from China's Hubei province, the landlocked region of 60 million people where the new coronavirus dubbed 2019-nCoV was first identified in December, and where it has since cut a wide, deadly swathe.

While cases have spread around the globe, the virus' impact has been most keenly felt

The toll, which grows larger every day, reflects a local health system overwhelmed by the fast-moving, alien pathogen, making even the most basic care impossible. It's also an ongoing illustration of the human cost extracted by the world's largest-known quarantine, with China effectively locking down the region from Jan. 23 to contain the virus' spread to the rest of the country, and the world.

But Hubei -- known for its car factories and bustling capital Wuhan -- is paying the price, with the mortality rate for coronavirus patients there 3.1%, versus 0.16% for the rest of China.

"If the province was not sealed off, some people would have gone all around the country to try to get medical help, and would have turned the whole nation into an epidemic-stricken area," said Yang Gonghuan, former deputy director general of China's Center for Disease Control and Prevention. "The quarantine brought a lot of hardship to Hubei and Wuhan, but it was the right thing to do."

"It's like fighting a war -- some things are hard, but must be done."

Wuhan, home to 11 million people, is a "second-tier" Chinese city, meaning it's relatively developed but still a step below China's major metropolises of Shanghai, Beijing and Guangzhou. It has well-regarded hospitals, but resources lag behind those of more prominent cities.

In the early days of the virus' spread, prevarication and delay by local officials also allowed the pathogen to circulate more widely among an unsuspecting public.

While doctors first noticed the virus -- thought to have been passed from an animal to humans at a Wuhan food market -- in early December, and signs it was being transmitted among people were seen at the beginning of January, authorities still allowed large-scale public events to take place. The scale of the crisis only became fully apparent to the wider public in the days leading up to

Caught Out

It came "like a sudden downpour that caught Wuhan off guard," said Zeng Yan, a professor at the school of medicine at Wuhan University of Science and Technology.

The 110 intensive care unit beds in the city designated for virus patients had already been filled many times over when China announced on Jan. 23 that it would take the unprecedented step of sealing off Wuhan, preventing possible pathogen carriers from traveling out, but also preventing most people from coming in. The quarantine soon widened to encompass nearly the entire province.

Medical staff take samples from a person at a quarantine zone in Wuhan, Feb. 4.Photographer: AFP via Getty Images

In the chaotic, confused days that followed, which coincided with China's week-long national holiday, the quarantine restrictions coupled with an already overwhelmed city infrastructure meant that supplies of essential medical equipment including masks, protective suits and high-grade disinfectant were slow to get to Wuhan's hospitals.

"We were advised to use masks, gloves and protective clothing in a thrifty manner, and avoid drinking water so we would not have to go to the bathroom, which would require a change of protective clothing," said one frontline doctor working at the Third People's Hospital of Hubei Province, who declined to give her name for fear of reprisal.

Supplies Stymied

Ding Ze, whose family owns an eyewear company located in another part of China, said that their delivery of medical goggles to Wuhan was delayed by 10 days.

A doctor being disinfected by his colleague at a quarantine zone in Wuhan, Feb. 3.Photographer: AFP via Getty Images

"We sent the supply on Jan. 25, and they arrived at hospitals on Feb. 2.," he said. "All deliveries from outside to the province were slowed by the strict quarantine procedures."

While China's government activated eight cargo carriers on Feb. 2 to ship in 58 tons of supplies to Wuhan, and donations are starting to flow in from all over the world, the shortages in those crucial days -- combined with the virus' rapid spread as the surge in patients saw hospitals turn people away for lack of space -- had devastating consequences.

Between Jan 23. and Feb 4., the number of officially recorded deaths from the coronavirus in Hubei grew by over 25 times, to nearly 500. Scores more likely went unrecorded because they weren't admitted to hospital in time to be diagnosed.

Zhang Yaru's grandmother was turned away from hospital at the end of January because her symptoms were mild. She slipped into a coma shortly after and died without being diagnosed.

"She didn't manage to say a word to us before she died, she probably had no idea what happened," said Zhang, a native of E'Zhou, a smaller city adjacent to Wuhan that's also being quarantined. "Our family is now driven into a corner, desperate, all my family members are potentially infected and my grandfather is showing the same symptoms."

While virus cases within Hubei province are still growing by the thousands every day, infections are slowing in the rest of China -- an early sign that the aggressive containment may have worked to limit the coronavirus' spread nationally and globally.

Cleaners wash the street with a high-pressure water gun in Wuhan on Feb. 3.Photographer: Getty Images

The quarantine was the right thing to do for the good of the wider population, said the doctor at the Third People's Hospital. "Some may say Hubei was sacrificed, but it did effectively stem the spread to elsewhere."

The quarantine in Hubei dwarfs previous efforts in other parts of the world. In Liberia in 2014, an impoverished neighborhood of about 70,000 people was shut off during an Ebola outbreak, triggering violent riots. As the lockdown continues with no end in sight, it's raising ethical and legal questions.

Medical supplies at a makeshift hospital converted from an exhibition center in Wuhan, Feb. 3.Photographer: AFP via Getty Images

"The lockdown may be necessary to contain the spread of the virus, but you have to ensure there's enough medical resources to meet the demand for care in those cities," said Zhang Qianfan, a professor at Peking University Law School. "The lockdown shouldn't mean the city gets deserted and people are left to survive or die on their own."

Top Priority

Reports of potentially preventable deaths in Hubei exacerbated by the quarantine restrictions have been coursing through China, said Yanzhong Huang, director of the Center for Global Health Studies at Seton Hall University in New Jersey, and a senior fellow for global health at the Council on Foreign Relations.

Comparing the "draconian measures" in Hubei to the mass surveillance prevalent in China that would seem intolerable to many in the west, he said: "If you ask Chinese people, 8 out of 9 will say they can live with that."

In the days after the quarantine order, China's government sent medical assistance into the province, while maintaining restrictions on people leaving.

More than 8,000 medical workers from across the country have gone into Hubei, mostly to the 27 hospitals in Wuhan designated for treating coronavirus patients. The rest have fanned out to smaller cities nearby. Two new hospitals, with 2,600 beds in total, were completed in 10 days, built by more than 2,000 migrant workers, while stadiums, offices and hotels are being converted into isolation units.

But hospitals in Hubei are still short of supplies, said a doctor working in the testing department at the Wuhan Tongji hospital. He also declined to give his name on concern he'd face backlash.

Workers set up beds at an exhibition center that was converted into a hospital in Wuhan, Feb. 4.Photographer: AFP via Getty Images

"Things are improving, but we are really over-loaded and running diagnostic tests 24-7, and still struggle to complete them," the doctor said on Tuesday. "I think we have not reached the peak of infections yet."

No Blame

For those seeking help and medical care in Hubei, resignation has set in -- there has been markedly little unrest in the province despite the circumstances. The idea of sacrificing one's self for a greater, national goal is deeply-embedded in Chinese culture, and is invoked by the country's leaders in times of hardship.

People are queuing for eight hours just to get tested for the coronavirus, said the college graduate, John Chen, who's 23. His feverish mother is yet to be tested.

"At first I was upset that the hospitals and officials I called for help weren't willing to do their job, but later I realized that it's not that they are unwilling to help, but that everywhere is way too short of resources," he said.

"I don't blame anyone, because if you grow up in China, you learn that's how the system works." Mesajı Paylaş
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Amazon pulls out of major Barcelona telecoms conference over coronavirus Inc has pulled out of this month's Mobile World Congress because of the coronavirus outbreak, in another blow to one of the telecom industry's biggest gatherings which attracts over 100,000 visitors to Barcelona.

"Due to the outbreak and continued concerns about the new coronavirus, Amazon will withdraw from exhibiting and participating in Mobile World Congress 2020," the company said in a statement on Sunday.

Amazon had planned a significant presence through its cloud computing arm AWS, which was due to host a full-day conference track on the first day of the event.

The online retailer is the fourth company to pull out of the annual gathering this week, following South Korea's LG Electronics, Swedish equipment maker Ericsson and U.S. chipmaker Nvidia.

The Feb. 24-27 event will go ahead as planned, the GSMA telecoms industry association, which runs the Congress, confirmed in a statement on Sunday before Amazon said it was pulling out, adding that they would tighten health precautions to guard against the coronavirus outbreak.

No visitors will be allowed to attend from China's Hubei province, where the coronavirus outbreak started, while visitors from China must prove they have been outside the country for two weeks prior to the event, GSMA said.

Some 5,000-6,000 visitors typically come from China to the world's premier telecoms industry gathering, where companies spend millions on stands and hospitality to fill their order books for the year ahead.

Chinese companies Huawei [HWT.UL] and ZTE have said they will attend, ordering China-based staff to self-isolate ahead of the event to ensure they are free of the illness, and drafting in European staff to cover for those stranded.

China raised the death toll from the outbreak to 811 on Sunday, passing the number killed globally by the SARS epidemic, while total confirmed cases of the illness reached 37,198.

The virus has spread to at least 27 countries and territories, according to a Reuters count based on official reports, infecting more than 330 people outside China. Two deaths have been reported outside mainland China - both of Chinese nationals.

More then two dozen large trade fairs and industry conferences in China and overseas have been postponed or hit by travel curbs and concerns about the spread of the virus, potentially disrupting billions of dollars worth of deals.

China reports 97 new coronavirus deaths on mainland on Sunday, toll rises to 908

The death toll from a coronavirus outbreak in mainland China rose to 908 as of the end of Sunday, the National Health Commission (NHC) said on Monday.

The number of new deaths on Sunday rose 97, the NHC said in a statement on its website, another daily record increase.

The central Hubei province, the epicenter of the outbreak, earlier on Monday reported 91 deaths on Sunday, while in the provincial capital, Wuhan, 73 people had died.

The number of new confirmed infections on mainland China on Sunday increased, after declining on Saturday below 3,000 cases for the first time since Feb. 2.

Across mainland China, there were 3,062 new confirmed infections on Sunday, bringing the total number so far to 40,171.

China slowly returns to work as coronavirus toll hits daily record

Workers began trickling back to offices and factories around China on Monday as the government eased some restrictions on work and travel in the wake of the coronavirus epidemic that has now killed more than 900 people, mostly on the mainland.

Sunday's death toll of 97 was the largest in a single day since the outbreak was first detected in December at a seafood market in Hubei province's capital, Wuhan.

Across mainland China, there were 3,062 new confirmed infections, bringing the total number so far to 40,171, according to the National Health Commission (NHC).

The epidemic has caused huge disruptions in China with usually teeming cities becoming virtual ghost towns during the past two weeks as Communist Party rulers ordered virtual lockdowns, canceled flights, closed factories and shut schools.

Authorities had told businesses to tack up to 10 extra days onto Lunar New Year holidays that had been due to finish at the end of January.

Even on Monday, a large number of workplaces will remain closed and many white-collar workers will continue to work from home.

On one of the usually busiest subway lines in Beijing, trains were largely empty. The few commuters sighted during peak-hour morning traffic were all wearing masks.

Across China, schools in provinces and regions such as Guangdong, Anhui, Zhejiang, Heilongjiang, Jiangsu, Shandong, Hebei, Jiangxi, and Inner Mongolia, as well as Shanghai and Chongqing will be shut through the end of February.

An advance team of international experts led by the World Health Organization (WHO) is heading for Beijing to help investigate the epidemic.

WHO director-general Tedros Adhanom Ghebreyesus, who made a trip to Beijing for talks with President Xi Jinping and Chinese ministers in late January, returned with an agreement on sending an international mission.

But it has taken nearly two weeks to get the government's green light on its composition, which was not announced, other than to say that WHO veteran Dr. Bruce Aylward, a Canadian epidemiologist and emergencies expert, was heading it.

"I've just been at the airport seeing off members of an advance team for the @WHO-led #2019nCoV international expert mission to #China, led by Dr Bruce Aylward, veteran of past public health emergencies," Tedros said in a tweet from Geneva on Sunday.

The WHO declared the outbreak a global emergency on Jan. 30, days after the Chinese central government imposed a lockdown on 60 million people in Hubei province.

The death toll from the outbreak in mainland China rose by 97, the largest in a single day so far, to 908 as of the end of Sunday.

Over the weekend, an American hospitalized in the central city of Wuhan became the first confirmed non-Chinese victim of the disease. A Japanese man who also died there was another suspected victim.

The coronavirus outbreak has now killed more people than the SARS epidemic did globally in 2002/2003.

The virus has also spread to at least 27 countries and territories, according to a Reuters count based on official reports, infecting more than 330 people. Two deaths have been reported outside mainland China - both of Chinese nationals.

The latest patients outside China include a group of British nationals staying in a mountain village in Haute-Savoie in the Alps, French health officials said, raising fears of further infections across Europe.

Taiwan's Foxconn gets OK to restart plant in Zhengzhou, China: source

Taiwan's Foxconn has received approval to resume production at a plant in the northern Chinese city of Zhengzhou that had been shuttered due to a coronavirus outbreak, a person with direct knowledge of the matter told Reuters on Monday.

About 16,000 people, or under 10% of Foxconn's workforce in Zhengzhou, have returned to the plant, the person said, adding that company executives were "trying very hard" to negotiate with authorities to resume production in other parts of China.

The contract manufacturer, which makes devices for global vendors, is in talks to resume production at key plants including in Shenzhen and Kunshan, said the person, who was not authorized to speak publicly on the matter and so declined to be identified.

A delayed resumption of operations could impact the global technology supply chain and shipments to customers including Apple Inc, a person with direct knowledge of the matter previously told Reuters.

Foxconn, formally known as Hon Hai Precision Industry Co Ltd, did not immediately respond to a request for comment.

The coronavirus outbreak, which the World Health Organization has declared a global health emergency, threatens to disrupt Chinese manufacturing and force policymakers to ready measures to stabilize the economy.

Tens of thousands of Foxconn employees have returned to work following an extended Lunar New Year holiday and were waiting to start. They have been told to wear masks, undergo temperature checks and adhere to a specified dining system, showed internal memos reviewed by Reuters.

Foxconn built its own production lines in the southern province of Guangdong to make masks for its hundreds of thousands of employees, targeting two million masks a day when at full capacity by late February, the memos showed.

Shares of Foxconn fell 2.4% in Monday morning trade, lagging a 1% decline in the broader market. They have fallen more than 12% since the market reopened following the Lunar New Year break.

Briton in French Alps may have spread coronavirus to others across Europe

A British man who contracted the new coronavirus while attending a conference in Singapore may have led to seven other people catching the disease when he stopped off at a chalet in a French mountain village on his way home, health experts said on Sunday.

The man, Britain's third case of the virus, stayed for four days in the chalet in Les Contamines-Montjoie late last month, under the same roof as a group of British holidaymakers as well as a British family who lived in the village.

Five people from that group in the Alpine ski resort, including a child, contracted the coronavirus as a result, French officials said this weekend.

The trail does not end there, however. The disease carried by the same man may have spread elsewhere, underlining the challenges health authorities face in containing infections in an era of global air travel.

Spanish authorities said on Sunday that a British man had tested positive in Mallorca after coming into contact with an infected person in France. British health officials, meanwhile, said the country had recorded its fourth case of coronavirus, with the person catching the illness from a Briton in France.

Senior French health official Jerome Salomon confirmed in a televised statement that the two cases in Britain and Mallorca were linked to the group staying in the chalet in Les Contamines-Montjoie.

Paul Hunter, professor in medicine at England's University of East Anglia, said of the new virus patient in Britain: "This case is part of the same cluster which is being reported as linked to a British national returning from Singapore."

However, more broadly, while the outbreak of the new coronavirus has spread to at least 27 countries and territories, according to a Reuters count, only a tiny fraction of cases - about 330 out of over 37,000 - have been outside mainland China.

Residents of Les Contamines-Montjoie, a few wearing facemasks, lined up on Sunday to get tested for the new coronavirus as authorities sought to contain the spread.

French officials said they were tracing all the people who might have been in close contact with the group of 11 Britons exposed to the virus after sharing lodgings in the village.

Five of those tested positive, including a nine-year-old child and their father. Two other children - the infected child's siblings - were hospitalized in France for checks, officials added.

Their mother had left the country by the time the investigation began and was under observation in a UK hospital, French officials said. It was not clear if she was the latest case to be diagnosed in Britain.

Spanish authorities said the British man who had tested positive in Mallorca was one of four members of a family taken into observation on Friday after coming into contact with someone in France who was subsequently diagnosed with the virus.

The family appear to have been part of the larger group in the French ski resort, Fernando Simon, director of the Centre of Coordination of Health Emergencies at Spain's Health Ministry, told reporters.

However he said he could not confirm this 100% because of respect for the family's privacy.

The family returned to Mallorca from France on Jan. 29 and the father started to show light symptoms 24 hours later.

Simon said the man was currently "in good health" but was being kept in isolation and authorities were drawing up a list of everyone he may have come into contact with in Mallorca. Mesajı Paylaş
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Wuhan virus incubation period lasts up to 24 days: Chinese expert

The incubation period for the Wuhan coronavirus (2019-nCoV) can last up to 24 days, according to a study by renowned Chinese pulmonologist Zhong Nanshan (鍾南山).

The study finds that the average incubation period of the virus is 3 days but that it can take as little as one day and as long as 24 days for a patient to develop symptoms. Only 1.18 percent of cases so far had direct contact with wildlife, whereas 31.3 percent had been to Wuhan, the epicenter of the outbreak, and 71.8 percent had been in close contact with someone from the city.

An analysis of patients' symptoms indicates that fever and coughing are the most common, registering 87.9 percent and 67.7 percent, respectively. Nevertheless, only 43.8 percent of patients exhibited fever at an early stage, suggesting that body temperature cannot be viewed as a major factor in diagnosis.

Diarrhea and vomiting are uncommon, having been experienced by only 3.7 percent and 5 percent of the total patients. Around 25.2 percent of the confirmed cases had underlying illnesses such as hypertension.

Pneumonia is the most common complication suffered by patients at 79.1 percent. The median age of the cases involved is 47 years, and 41.9 percent have been female.

The study, which was the largest to date on the novel coronavirus, was based on 1,099 samples collected from 552 hospitals in 31 provincial-level administrative divisions of China. It was published Sunday (Feb. 9) on medRxiv, a preprint server for health reports awaiting peer review.

The new virus has infected over 40,000 as of Monday (Feb. 10), with the majority of cases in China. The outbreak has claimed over 900 lives, more than the 2002-2003 SARS epidemic, which resulted in 774 deaths.
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Xi warned officials that efforts to stop virus could hurt economy: sources

Chinese President Xi Jinping warned top officials last week that efforts to contain the new coronavirus had gone too far, threatening the country's economy, sources told Reuters, days before Beijing rolled out measures to soften the blow.

With growth at its slowest in nearly three decades, China's leaders seem eager to strike a balance between protecting an already-slowing economy and stamping out an epidemic that has killed more than 1,000 people and infected more than 40,000.

After reviewing reports on the outbreak from the National Development and Reform Commission (NDRC) and other economic departments, Xi told local officials during a Feb 3 meeting of the Politburo's Standing Committee that some of the actions taken to contain the virus are harming the economy, said two people familiar with the meeting, who declined to be named because of the sensitivity of the matter.

He urged them to refrain from "more restrictive measures", the two people said.

Local authorities outside Wuhan - where the virus is thought to have first taken hold - have shut down schools and factories, sealed off roads and railways, banned public events and even locked down residential compounds. Xi said some of those steps have not been practical and have sown fear among the public, they said.

China's state council information office did not immediately respond to requests for comment.

The official Xinhua News Agency, reporting on the Politburo meeting last Monday, called the coronavirus outbreak "a major test of China's system and capacity for governance." It added, without details, that "party committees and governments of all levels were urged to achieve the targets of economic and social development this year."

Since the meeting, China's central bank has vowed to step up support for the economy and prepared policy tools to offset the damage. The NDRC said at a weekend briefing that it was urging companies and factories to resume work, especially in "key industries" such as food and pharmaceuticals.

"In the context of the epidemic and the downward pressure on the economy, it is more important to maintain economic growth," Pan Gongsheng, vice-governor of China's central bank, said on Friday.

On Monday, Zhejiang province, an economic powerhouse in eastern China, ordered local authorities not to overreact by restricting everyday movement or shutting down "shops of chain stores and convenience stores that sell daily necessities such as vegetables, cooking oil as well as meat, eggs and dairy products," according to a government release.

China has unveiled new tax policies as it tries to reduce the burden on industries hit heavily by the epidemic.

Reuters reported this month that policymakers in China are preparing measures, including more fiscal spending and interest rate cuts, amid expectations the outbreak will devastate first-quarter growth.

Many in China returned to work on Monday after the Lunar New Year holiday was effectively extended for about 10 days, but morning commutes were far less crowded than usual and numerous factories remained shut.

The ruling Communist Party's propaganda department last week ordered state media to focus on "economic recovery", according to a person with direct knowledge of the order, who declined to be named because of the sensitivity of the situation.

China's official media has been trying to project calm. In a Monday editorial, the official People's Daily urged the public to deal with the epidemic with a "positive mood". Mesajı Paylaş
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Latest situation in virus outbreak in China

Coronavirus update:
- 60,016 cases worldwide
- New criteria includes clinically diagnosed cases
- 16,067 suspected cases
- 1,355 fatalities
- 8,070 in serious/critical condition
- 5,611 recovered
- Most cases in China
- 25 countries reporting cases Mesajı Paylaş
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Chinese military sends in fresh medical crews to coronavirus-hit Wuhan

The Chinese military is sending a fourth detachment of medical personnel to the coronavirus-hit city of Wuhan in central China, adding 2,600 specialists to take the total to 6,600, according to state media. In all, 1,400 fresh medical workers arrived in Wuhan on Thursday morning, along with 11 military transport aircraft loaded with medical supplies, The PLA Daily reported.

The mobilisation of People's Liberation Army (PLA) personnel is several times bigger than the 1,200 medical troops the PLA sent to deal with the severe acute respiratory syndrome (Sars) outbreak in 2003. Military observers said even more medical crews would be sent to help deal with a virus that has so far infected more than 60,000 people and killed over 1,300.

The decision to send fresh medical staff came after Chinese President Xi Jinping chaired a meeting of the Politburo Standing Committee, the country's most powerful political body, on the crisis on Wednesday night, according to a military insider. The insider, who declined to be named because of the sensitivity of the issue, said the president ordered the military to mobilise an extra 2,600 troops. "All the military branches immediately submitted lists of volunteers to the Central Military Commission [headed by Xi]," the insider said.

"The operation is exactly like a military response to a call-up to battle. The PLA is treating the coronavirus crisis as a non-traditional military battle. "The frontline medical crews need more comrades to share the shifts. They are just like reinforcements during a war."

The latest group was drawn from all branches of the military and theatre commands, according to the PLA Daily report.
They would be set to help treat 1,600 confirmed coronavirus patients at Hubei Maternity and Child Health Care Hospital and Wuhan Tongji Hospital, it said. Beijing-based military expert Zhou Chenming said sending PLA troops was the simplest and most effective way to tackle an epidemic because military personnel were easier to manage and better able to handle a crisis.

"The PLA has been well-trained and well-prepared to deal with any emergencies, including epidemics. It is part of their biological warfare training," Zhou said. The arrival of the fresh troops coincided with a dramatic increase in coronavirus cases due to a change in diagnostic criteria.

"The new data indicated the situation in Hubei province, especially the epicentre Wuhan, has become more serious than the central government's previous assessment, and it's a must to control and stop it immediately," Zhou said.

Chen Wei, a PLA major general and the military's top virologist in biological warfare, has been leading a working team to Wuhan since late last month, according to Communist Party mouthpiece People's Daily. Chen's top mission is to study new drugs to reduce the infection rate of medical staff working on the front line. Macau-based military observer Antony Wong Dong said the crisis could be a good test of the PLA's ability to handle unconventional warfare, similar to the role "live-fire drills" played in conventional warfare.

"[The military] has to be able to make deployments quickly in an emergency, as is the case with a large-scale war or battle," Wong said. "Governments in other countries have done the same in other epidemics." Mesajı Paylaş
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Coronavirus update:
- 66,887 cases worldwide
- 10,109 suspected cases
- 1,523 fatalities
- 10,757 in serious/critical condition
- 7,720 recovered
- Most cases in China
- Today: First case in Egypt
- 26 countries reporting cases Mesajı Paylaş
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Coronavirus: World must prepare for pandemic, says WHO

The WHO said it was too early to call the outbreak a pandemic but countries should be "in a phase of preparedness". A pandemic is when an infectious disease spreads easily from person to person in many parts of the world.

More cases of the virus, which causes respiratory disease Covid-19, continue to emerge, with outbreaks in South Korea, Italy and Iran causing concern. However, most infections are in China, the original source of the virus, where more than 77,000 people have the disease and over 2,600 have died.

More than 1,200 cases have been confirmed in about 30 other countries and there have been more than 20 deaths. Italy reported four more deaths on Monday, raising the total there to seven. Worldwide stock markets saw sharp falls because of concerns about the economic impact of the virus.

China said it would postpone the annual meeting of the National People's Congress next month, to "continue the efforts" against the coronavirus. The body, which approves decisions made by the Communist Party, has met every year since 1978.

The proportion of infected people who die from Covid-19 appears to be between 1% and 2%, although the WHO cautions that the mortality rate is not known yet.

On Monday Iraq, Afghanistan, Kuwait, Oman and Bahrain reported their first cases, all involving people who had come from Iran. Officials in Bahrain said the patient infected there was a school bus driver, and several schools had been closed as a result.

Among other developments:

Some upcoming football matches in Italy's Serie A and the Europa League will be played behind closed doors to prevent the spread of the virus, Italy's sports minister says
Gold surged to its highest price in seven years as coronavirus fears led investors to seek a safe haven
South Korean pop group BTS asks fans to stay away from upcoming TV shows, which will be taped without a studio audience
North Korea has quarantined 380 foreigners in a bid to stop the coronavirus from breaking out.

What does the WHO say?

WHO chief Tedros Adhanom Ghebreyesus told reporters on Monday that the number of new cases in recent days in Iran, Italy and South Korea was "deeply concerning".

However he added: "For the moment we are not witnessing the uncontained global spread of this virus and we are not witnessing large scale severe disease or deaths.

"Does this virus have pandemic potential? Absolutely, it has. Are we there yet? From our assessment, not yet."

Slovak Prime Minister Peter Pellegrini was taken under suspicion of coronavirus.

Iranian Deputy Minister of Health, İreç Herirçi announced that a new type of coronavirus (Kovid-19) was detected. Mesajı Paylaş
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A third of coronavirus cases may be 'silent carriers', classified Chinese data suggests

The number of "silent carriers" - people who are infected by the new coronavirus but show delayed or no symptoms - could be as high as one-third of those who test positive, according to classified Chinese government data seen by the South China Morning Post.

That could further complicate the strategies being used by countries to contain the virus, which has infected more than 280,000 people and killed nearly 13,000 globally.

More than 43,000 people in China had tested positive for Covid-19 by the end of February but had no immediate symptoms, a condition typically known as asymptomatic, according to the data. They were placed in quarantine and monitored but were not included in the official tally of confirmed cases, which stood at about 80,000 at the time.

Scientists have been unable to agree on what role asymptomatic transmission plays in spreading the disease. A patient usually develops symptoms in five days, though the incubation period can be as long as three weeks in some rare cases.

One obstacle is that countries tally their confirmed cases differently. The World Health Organisation classifies all people who test positive as confirmed cases regardless of whether they experience any symptoms. South Korea also does this. But the Chinese government changed its classification guidelines on February 7, counting only those patients with symptoms as confirmed cases. The United States, Britain and Italy simply do not test people without symptoms, apart from medical workers who have prolonged exposure to the virus.

The approach taken by China and South Korea of testing anyone who has had close contact with a patient - regardless of whether the person has symptoms - may explain why the two Asian countries seem to have checked the spread of the virus. Hong Kong is extending testing to airport arrivals in the city, even if travellers have no symptoms. Meanwhile in most European countries and the US, where only those with symptoms are tested, the number of infections continues to rapidly rise.

A growing number of studies are now questioning the WHO's earlier statement that asymptomatic transmission was "extremely rare". A report by the WHO's international mission after a trip to China estimated that asymptomatic infections accounted for 1 to 3 per cent of cases, according to a European Union paper.

"The number of novel coronavirus (Covid-19) cases worldwide continues to grow, and the gap between reports from China and statistical estimates of incidence based on cases diagnosed outside China indicates that a substantial number of cases are underdiagnosed," a group of Japanese experts led by Hiroshi Nishiura, an epidemiologist at Hokkaido University, wrote in a letter to the International Journal of Infectious Diseases in February.

Based on their research, Nishiura put the proportion of asymptomatic Japanese patients evacuated from Wuhan, ground zero of the outbreak in China, at 30.8 per cent - similar to the classified Chinese government data.

But official figures from South Korea - which had carried out nearly 300,000 tests on all close contacts of its confirmed cases as of Wednesday - are the most comparable to China's. More than 20 per cent of the asymptomatic cases reported to the Korea Centres for Disease Control and Prevention remained without symptoms until they were discharged from hospital.
"Korea currently has a significantly higher rate of asymptomatic cases than other countries, perhaps due to our extensive testing," Jeong Eun-kyeong, director of South Korea's CDC, told a press briefing on March 16.

Another useful point of reference is the data collected from the Diamond Princess cruise ship, which was quarantined for weeks in Yokohama, Japan. All of its passengers and crew were tested, with 712 people testing positive - 334 of whom were asymptomatic, according to official Japanese figures.

An EU report has put the proportion of asymptomatic cases in Italy at 44 per cent, but in most parts of the country people without symptoms are not tested.

In Hong Kong, 16 of the 138 confirmed cases as of March 14 were asymptomatic or presymptomatic, according to Ho Pak-leung, a professor with the microbiology department of the University of Hong Kong.

All of these numbers point to a significantly higher ratio of asymptomatic cases than indicated by data publicly released by China so far. There were 889 asymptomatic patients among the 44,672 confirmed cases as of February 11, epidemiologists from the Chinese Centre for Disease Control and Prevention wrote in a paper published online in JAMA Network Open on February 24.

The WHO has said the role of asymptomatic transmissions in the spread of the disease was not clear, but carriers without symptoms were unlikely to be a key factor overall.

However, some scientists are asking whether asymptomatic and presymptomatic transmissions have been underestimated.
A joint study by experts in China, the US, Britain and Hong Kong estimated that undocumented cases of the pneumonia, mostly with mild or even no symptoms, were the source of infection for 79 per cent of documented ones before Wuhan was locked down on January 23.

"These undocumented infections often experience mild, limited, or no symptoms and hence go unrecognised, and, depending on their contagiousness and numbers, can expose a far greater portion of the population to the virus than would otherwise occur," the specialists from Columbia University, the University of Hong Kong, Imperial College London, Tsinghua University, and the University of California, Davis wrote in the report.

A separate study by scientists from the University of Texas at Austin estimated that people who had not yet developed symptoms transmitted around 10 per cent of the 450 cases they studied in 93 Chinese cities. Their findings are awaiting publication in the journal Emerging Infectious Diseases.

Ho from the University of Hong Kong said some asymptomatic patients had a viral load similar to those with symptoms.
"Of course it is hard to say if they may be less infectious if they don't cough. But there are also droplets when you speak," he said, referring to how the respiratory virus is transmitted.

Benjamin Cowling, an epidemiology and biostatistics professor at the University of Hong Kong, said there was "clear evidence that infected persons could transmit infection before symptoms appear". "There are many reports of transmission around one to two days before symptom onset," he said.

A better understanding of asymptomatic cases could lead to adjustments in public health policy, experts said.
"The asymptomatic ratio … could be higher among children than in older adults," Nishiura wrote in the International Journal of Infectious Diseases. "That would considerably change our scope of the outbreak, and even the optimal interventions can change." Mesajı Paylaş
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